Welcome to the SPR Members’ page for Fetal Imaging!

Our intent is to provide a central resource for SPR members who seek additional information to help establish or grow their involvement with fetal imaging in their communities. Content is offered in a downloadable format for your use and modification. To offer suggestions on ways to improve the page or add other useful components, please contact the Fetal Imaging Committee members through the listserv link listed under RESOURCES.

More Information

An example of an Obstetrical Ultrasound checklist for technologists or reporting physicians

There are many superb fetal ultrasound resources developed over many decades by smart and dedicated medical professionals from multiple disciplines; it is not our intention to assemble them all here. You are encouraged to review the following documents for detailed information on suggested components of thorough ultrasound evaluation of a fetus:

Selected resources used by the Fetal Imaging Committee members follow, including

An example of a reporting template for the ultrasound examination

  • Commonly-used tables
  • Commonly-used reference materials

Educational  Resources

Websites

Recommended Texts

  • Benacerraf BR. Ultrasound of Fetal Syndromes. Second Edition. Churchill Livingstone, 2008.
  • Callen PC.  Ultrasonography in Obstetrics and Gynecology. Fifth Edition. WB Saunders and Co, 2008.
  • Sanders RC.  Structural Fetal Abnormalities: The Total Picture. Second Edition. Elsevier Health Sciences, 2002.
  • Woodward PJ.  Diagnostic Imaging: Obstetrics. Amirsys, 2005.
  • Woodward PJ. Expertddx: Obstetrics. Amirsys, 2009.

Fetal CT

by Teresa Victoria MD, Children’s Hospital of Philadelphia

Congenital skeletal abnormalities are a group of rare abnormalities of the fetus that affect bone growth and development. The prenatal diagnosis of these entities is challenging because of the relative rarity of each skeletal dysplasia, the multitude of differential diagnoses encountered when the bony abnormalities are identified, lack of precise molecular diagnosis and the fact that many of these disorders have overlapping features and marked phenotypic variability. In addition, our main imaging modality in the obstetric world, ultrasound, only has 40-60% sensitivity in the diagnosis of such malformations, and prenatal MR has not been show to shed significant light in the evaluation of these abnormalities.

Prenatal low-dose CT is an imaging modality that emerged to better evaluate these entities. This imaging study is ONLY done during the second and third trimester of gestation, in the fetus with severe skeletal abnormalities, when the diagnosis is still in question after performing an ultrasound. It is also done at low dose such that the fetal skeleton is well seen, but the fetal body is not.

The main risk to this examination is the radiation dose. We aim to keep it as low as reasonably achievable. Our mean radiation dose is <5 mSv. To put things in context, the American College of Radiologists describes the suspected in-utero deterministic radiation dose of <50 mSv as negligible. Note that this study is only done in a highly selective group of fetuses with severe skeletal abnormalities, as discussed above.

Technique

Once the patient is on the CT table, the top and bottom of the uterus are sonographically marked with radiopaque markers. The topogram, which only includes the maternal abdomen between the markers, confirms fetal position. Our protocol for this unenhanced CT is: 80-100 kVp, modulated mAs, pitch 1.2 mm, slice thickness 1.5 mm on a 1.2 mm detector, rotation time 0.5 sec. Images are then evaluated in a 3D console, where the maternal abdomen can be selectively excluded and the fetal skeleton can be reconstructed in 3D for complete evaluation.

Image Interpretation

Although this is a radiology exam, we usually do our image interpretation in conjunction with the obstetricians, geneticists, and when appropriate, orthopedic colleagues, and then reach a team-approach diagnosis.

Evaluation of bone mineralization requires a learning curve. We found the fetal atlas of Schumacher et al. [1], which shows postmorten radiographs of normal fetuses up to a gestational age of 23 weeks, valuable. The reconstructed fetal skeleton is then evaluated as expected for these group of diseases, including description of shape of skull, ribs, vertebral bodies, and pelvis, and full evaluation for the presence of fractures, bone bowing and segmentation anomalies. Referral to the always helpful Taybi and Lachmans’s “Radiology of Syndromes, Metabolic Disorders and Skeletal Dysplasias” [2] is strongly encouraged.

In summary, low-dose fetal CT affords exquisite detail of the fetal bones, allowing improved prenatal diagnosis, parental counseling and predelivery planning in a selective group of fetuses.

References

  1. Schumacher R, Spranger JW, Seaver LH. Fetal radiology: a diagnostic atlas. Berlin; New York: Springer, 2004: viii, 194 p.
  2. Lachman RS, Taybi H. Taybi and Lachman's radiology of syndromes, metabolic disorders, and skeletal dysplasias, 5th ed. Philadelphia: Mosby Elsevier, 2007: xxiii, 1365 p.

Professional Resources

Educational posters

by Ashley Robinson

Links

Reference texts and articles for further reading

Join the Fetal listserv!

  • Click here to go the SPR fetal imaging list serv rules page.

Resources

Guidelines Reporting Templates

SPR Fetal Imaging Experts

Institutions involved in prenatal imaging (in alpha order by US – Canada cities)

ATLANTA
Children's Healthcare of Atlanta- Egleston Hospital
Adina Alazraki, MD
Nilesh Desai,MD
Jonathan Loewen, MD
Sarah Milla, MD

BOSTON
Boston Children's Advanced Fetal Care Center
Dr. Carol Barnewolt
Dr. Stephen Brown
Dr. Susan Connolly
Dr. Judy Estroff
CINCINNATI
Cincinnati Children's Hospital Medical Center
Beth Kline-Fath
Maria Calvo-Garcia
Carl Merrow
Marcia Komlos Kukreja
DENVER
University of Colorado Hospital
Dr. Kimberly Dannull
Dr. Laura Fenton
Dr. Mariana Meyers
Dr. Carol Rumack
HALIFAX
Izaak Walton Killam Grace Health Centre
Dr. Marian Macken
HOUSTON
Texas Children's Hospital
Dr. Chris Cassady
Dr. Amy R Mehollin-Ray
Dr. Jennifer L Williams
INDIANAPOLIS
Riley Hospital for Children
Dr. Kimberly Applegate
IOWA CITY
Children's Hospital of Iowa
Dr. Michael D'Alessandro
Dr. Simon Kao
JACKSONVILLE
Wolfson Children’s Hospital
Dr. Chetan C. Shah
LITTLE ROCK
Arkansas Children's Hospital
Dr. Leann Linam
LOS ANGELES
Institute for Maternal Fetal Health at Hollywood Presbyterian Medical Center
Dr. Hollie A. Jackson
LEBANON, New Hampshire
Darthmouth-Hitchcock Medical Center
Dr. Steven Sargent
MEMPHIS
Le Bonheur Children's Hospital
Dr. Harris Cohen
MONTREAL
Hopital Ste-Justine
Dr. Josée Dubois
Dr. Laurent Garel
Dr. Andrée Grignon
Dr. Françoise Rypens
Montreal Children's Hospital - McGill University Health Center
Dr. Lucia Carpineta
NASHVILLE
Vanderbilt Children's Hospital
Dr. Marta Hernanz-Schulman
NEW YORK
Sarah Sarvis Milla
New York University
Dr. Benjamin Taragin
Children's Hospital at Montefiore
PHILADELPHIA
Children's Hospital of Philadelphia
Dr. Anne Hubbard
Dr. Erin Simon
PITTSBURGH
Children's Hospital of Pittsburgh
Dr. Beverley Newman
SAN DIEGO
UCSD Medical Center
Dr. Rosalind Brown Dietrich
TORONTO
Hospital for Sick Children
Dr. Susan Blazer
Dr. Suzanne Laughlin
WASHINGTON
Children's National Medical Center
Dr. Dorothy Bulas
Eva Rubio

Fetal Imaging Committee Members

Listserv

 

Unknown Cases FETAL

Unknown Case #74

Potter's Syndrome

Unknown Case #68

Walker-Warburg Syndrome

Unknown Case #64

Omphalocele

 

Unknown Case #61

 pericardial teratoma

Unknown Case #55

Posterior Urethral Valves on Fetal MRI

Unknown Case #50

Epignathus teratoma

 

Unknown Case #48

 

CHAOS

Educational Resources

Resident and Fellow Training

Meetings