Monica Sestopal Epelman MD, Presenter: Nothing to Disclose

Johnson M. Ann, Abstract Co-Author: Nothing to Disclose

Beverly Gilbert Coleman MD, Abstract Co-Author: Consultant, Koninklijke Philips Electronics NV

Leonardo Gonzalez MD, Abstract Co-Author: Nothing to Disclose

Holly L. Hedrick, Abstract Co-Author: Nothing to Disclose

Diego Jaramillo MD, MPH, Abstract Co-Author: Nothing to Disclose

MRI has been increasingly used for evaluation of fetal abnormalities, as preoperative imaging for corrective fetal or postnatal surgery. The use of US in identifying amniotic bands syndrome (ABS) has been well described in the literature. However, to best of our knowledge, there are no analyses of ABS as visualized by antenatal MRI. The determination of extremity ABS is of particular importance since the natural history of this entity results in extremity deformity or limb amputation.

A search of our fetal MRI database of approximately 2500 cases resulted in 8 fetal MRI studies of 10 fetuses (including two twin pregnancies) which were referred to MRI to assess for possible extremity ABS. The initial diagnosis had been suggested by US exams performed either at our Institution or in referring centers. All patients had a dedicated sonographic evaluation at our Institution. Three reviewers retrospectively evaluated each MRI and corresponding US exams to assess the ability of MRI to visualize the structural components of ABS. During evaluation of the MRI images the reviewers were blinded to the US results. We evaluated for visualization of soft tissue edema with annular constrictions and/or amputation, and identification of the amniotic bands themselves. Outcome was made by fetal surgery or postnatal imaging.

Of the 10 fetuses studied, outcome evaluation showed that six were positive for ABS while four were negative. MRI clearly identified 4 of the 6 cases, but was not diagnostic in two of them due to excessive fetal motion. There were no false positive interpretations of ABS. The bands themselves were clearly identified on all US studies, but not on any of the MR Images.

Knowledge of the MRI appearance of extremity ABS will aid in the prenatal diagnosis and fetal intervention, if clinically indicated. In this small sample, MRI showed a sensitivity of 0.67 and a specificity of 1.0. The overall sensitivity and specificity of MRI in the diagnosis of ABS has yet to be established by means of larger prospective studies.

Knowledge of the MRI findings in extremity fetal amniotic band syndrome may prompt fetal intervention to prevent limb deformity or amputation.

Epelman, M, Ann, J, Coleman, B, Gonzalez, L, Hedrick, H, Jaramillo, D, Evaluation of Extremity Fetal Amniotic Band Syndrome by MRI with US Correlation.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5016480.html