|Ulrich Kramer, MD, and Heinz-Peter Schlemmer, MD, at the University Hospital Tuebingen (Tuebingen, Germany) ? Image captured via the Magnetom Avanto 1.5T MRI with Tim from Siemens Medical Solutions (Malvern, Pa)|
An MRI was requested of this 36-year-old patient to confirm the suspicion of diaphragmal hernia for planning surgery. The fetus?in its 26th week?has a history of known situs inversus and sonographic suspicion of atrial septum defect and diaphragmal hernia. The patient’s position was oblique to the left side to reduce compression of the inferior vena cava by the fetus, leading to reduced venous flow to the right atrium. To reduce movement artifacts, sedation was accomplished by oral administration of 5 mg diazepam prior to the exam. What were the findings and diagnosis?
Findings* and Diagnosis
The fetus presented with pelvic orientation; the placenta was situated ventrally. Situs inversus presenting with a left-sided liver was detected. Mesenterial structures were detected in the dorsal mediastinum, predominantly on the left side. The volume of the left lung was considerably reduced secondary to compression by intestinal structures. The urogenital structures and urinary bladder appeared normal. In a case of situs inversus, MRI demonstrated a large diaphragmal defect with left-sided dystopia of abdominal structures in the mediastinum and consecutive lung compression. This crucial information was needed for proper therapy planning, because surgery is indispensable in this case to keep the baby alive after delivery.
More Information on the Scan
Siemens Medical’s Magnetom Avanto with Tim (total imaging matrix) allows two Body Matrix coils to be used in combination with Spine Matrix coils for extended coverage. First, localizer images were acquired to find the correct angulation for coronal and sagittal slices in the fetus. Subsequently, TrueFISP sequences were used to get anatomical coverage of thoracic and abdominal structures of the fetus. Representative angulations were repeated with T2 W TSE sequences to demonstrate findings with higher resolution. This particular image is an ultrafast, T2 W TrueFISP (fetal sagittal) image with the following parameters: TR 4.3 ms / TE 2 ms / Flip Angle: 69? / BW: 490 Hz/Px / Slice Thickness: 4 mm / Matrix: 156 x 256 mm / FoV: 325 x 400 mm. This scan took only a few seconds.
*These findings are based on the entire exam, not just the image shown here.