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Chiari II malformation with myelomeningocele

Case Study
Kline-Fath, Beth, M.D. Cincinnati Children's Hospital Medical Center • USA
Serai, Suraj, Ph.D. Cincinnati Children's Hospital Medical Center • USA

Patient history

A 31-year-old pregnant female with fetus at 22 weeks with suspected myelomeningocele was evaluated for intrauterine repair.

MR examination

MRI was done on Ingenia 1.5T. With the mother on her side – one digital Anterior coil on her back and another one on her front are used. These two coils used together with the Posterior coil integrated in the table, cover the patient on all sides.


View ExamCard used:

Images

 T2-weighted single shot TSE<br>
Scan time 1.08 min.<br>
Voxel Size 0.9 x 1.33 x 4 mm<br>
FOV 280 x 280 x 68 mm<br> BTFE<br>
Scan time 1.07 min.<br>
Voxel Size 1.2x 1.39 x 6 mm<br>
FOV 340 x 340 x 198 mm<br>
T2-weighted single shot TSE
Scan time 1.08 min.
Voxel Size 0.9 x 1.33 x 4 mm
FOV 280 x 280 x 68 mm
BTFE
Scan time 1.07 min.
Voxel Size 1.2x 1.39 x 6 mm
FOV 340 x 340 x 198 mm

The sagittal T2-weighted SSh TSE image shows a hindbrain abnormality with cerebellar tonsils in the foramen magnum (long arrow) and lack of visualization of the fourth ventricle (short arrow). This finding is consistent with Chiari II malformation.
  
The T2-weighted BFFE sagittal spine image shows a lumbosacral spinal defect (arrow) consistent with myelomeningocele.

Diagnosis and follow-up

Based on the radiologist report, it was decided that the patient would be a candidate for prenatal intrauterine repair of myelomeningocele.

Clinical impact of using Ingenia 1.5T

A difficulty in fetal MRI is that imaging the mother requires a large field of view, but the fetus is very small and embedded deep inside the mother, so SNR is inherently low. The key is to maximize SNR. That can be done using Ingenia with its digital architecture. Because the signal is digitized directly in the coil, it helps to obtain high SNR. This coil setup used at Cinicinnati Children's offers big advantages. When the fetus moves, no repositioning of the coil is needed. The field of view can just be moved, the coil elements are already there and Ingenia’s SmartSelect automatically chooses the elements to obtain the best possible SNR. Ingenia’s wide bore is another advantage; with pregnant patients, it really makes a difference.

Ingenia’s strong gradients allow to set up fast imaging and that helps reduce fetal motion that can influence the scan. The gradients also help to reduce the TR and TE for high quality in the Balanced SSFP images. High SNR, digital coil setup and wide bore contribute to a smart approach for fetal MR imaging at Cincinnati Children’s Hospital.


Related reading:


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Nov 28, 2013

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Case Study
Ingenia 1.5T
Anterior coil, Body, dStream, Fetal, Pediatric, Posterior coil, SNR, Women's health
 

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