The role of fetal magnetic resonance imaging in the diagnosis and management of congenital anomalies of the fetal body

Objectives - This thesis studies fetal magnetic resonance imaging as a diagnostic tool in
addition to ultrasound in congenital anomalies of the fetal body.
The aims were to assess the overall diagnostic accuracy, examine its role in diagnosis and
prognostication of specific anomalies and assess patient experience during fetal MRI and
professional opinions on its utility.
Methods - Retrospective and prospective recruitment of patients referred for a fetal MRI due to concerns of a fetal body anomaly on ultrasound. Ultrasound and MRI findings were
correlated with pregnancy outcome and final diagnosis made by imaging, surgery or
postmortem. Expert panel reviews were conducted to assess the value of the MRI
information.
We studied the role of fetal MRI in prognostication of congenital diaphragmatic hernia and in diagnosis of tracheo-oesophageal fistula/oesophageal atresia. A case series of neck masses assessed the role of fetal MRI in diagnosis and prediction of postnatal airway compromise.
A qualitative study was undertaken with patients and healthcare professionals to gain insight
into the patient experience and the utility of the MRI information for clinical practice.
Results - The diagnostic accuracy study included 242 cases and found fetal MRI has an
improved diagnostic accuracy over ultrasound alone of 24.6%.
The qualitative study found patient themes including the misconceptions of antenatal
screening, perceptions of MRI and interaction with the MRI image. Professional themes
comprised the role of reassurance, how MRI informs clinical practice and multidisciplinary
collaboration.
Conclusions - Fetal MRI improves the accuracy of the diagnosis of congenital anomalies of
the fetal body when used in addition to ultrasound. It also provides additional information for certain anomalies which can be used for prognostication and management planning.
Fetal MRI is an acceptable investigation for parents and the findings are used by a variety of
healthcare professionals with increasing reliance.