Journal of Obstetrics and Gynaecology

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Diagnosis of central nervous system

abnormalities: comparison of prenatal
neurosonography and foetal magnetic resonance
imaging findings

Sureyya Saridas Demir, Erkan Cagliyan, Fatma Ceren Sarioglu, Handan

Guleryuz & Sabahattin Altunyurt

To cite this article: Sureyya Saridas Demir, Erkan Cagliyan, Fatma Ceren Sarioglu, Handan
Guleryuz & Sabahattin Altunyurt (2021): Diagnosis of central nervous system abnormalities:
comparison of prenatal neurosonography and foetal magnetic resonance imaging findings, Journal
of Obstetrics and Gynaecology, DOI: 10.1080/01443615.2021.1907560

To link to this article: https://doi.org/10.1080/01443615.2021.1907560

Published online: 08 Jul 2021.

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JOURNAL OF OBSTETRICS AND GYNAECOLOGY
https://doi.org/10.1080/01443615.2021.1907560

RESEARCH ARTICLE

Diagnosis of central nervous system abnormalities: comparison of prenatal

neurosonography and foetal magnetic resonance imaging findings
Sureyya Saridas Demira , Erkan Cagliyana , Fatma Ceren Sarioglub , Handan Guleryuzb and
Sabahattin Altunyurta
a
Division of Perinatology, Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey; bDivision of
Pediatric Radiology, Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey

ABSTRACT KEYWORDS
Magnetic resonance imagining (MRI) is gradually becoming the more preferred imaging modality in Central nervous system;
the evaluation of central nervous system (CNS) abnormalities rather than foetal ultrasonography (USG). magnetic resonance
The aim of this study was to compare the findings of prenatal neurosonography and foetal MRI. The imaging; neurosonography;
foetal malformations; foetal
study was a retrospective study analysing the records of 160 pregnant women who underwent both ultrasonography; pre-
foetal MRI and USG due to suspicion of CNS abnormalities between 2008 and 2019. Indications for natal diagnosis
applying foetal MRI were neurosonography and foetal MRI findings. When the compatibility between
MRI and USG results was examined in CNS abnormalities, it was found fully compatible in 61.3% of
cases, partially compatible in 24.53% of cases, and not compatible in 14.5% of cases. When comparing
prenatal neurosonography and foetal MRI findings, additional findings were reported in 16.9% of cases,
and no additional finding was reported in 66.8% of cases. While normal anatomical findings were
reported in 8.8% of the cases in MRI, the diagnosis made by neurosonography changed in 7.5%. Foetal
MRI has more advantages than USG both in imaging the CNS abnormalities in more detail and in
determining the accompanying additional anomalies.

IMPACT STATEMENT

What is already known on this subject: USG is a safe, practical and cost-effective primary imag-
ing method that is widely used for foetal anomaly screening. However, there may sometimes be
difficulties in evaluating the foetal brain structures due to foetal position which is unsuitable for
imaging, extremely obese with a high body mass index, oligohydramnios and ossified foetal skull.
For this reason, magnetic resonance imaging (MRI) is used as the most commonly used imaging
method after USG in the evaluation of foetal anatomy, especially CNS.

What do the results of this study add?: In our study, we saw that foetal MRI has more advan-
tages than neurosonography in both seeing CNS abnormalities in more detail and recognising add-
itional anomalies that may accompany.

What are the implications of these findings for clinical practice and/or further research?: We
have seen that besides neurosonography, foetal MRI can provide important information that can
affect the clinical approach in pregnancy management by increasing the correct diagnosis in preg-
nancies with congenital CNS abnormalities. MRI: it is the best secondary imaging modality that can
aid diagnosis in addition to neurosonography in the diagnosis of CNS abnormalities and in sus-
pected cases. Therefore, foetal MRI should be used more widely in prenatal diagnosis.

Introduction imaging method in antenatal screening programs is neuroso-

The central nervous system (CNS) is the most complex struc-
ture among the foetal and adult systems. This is where con-
genital malformations are most frequently observed, both in
fetuses with and without chromosomal abnormalities.
Structural abnormalities associated with major functional
problems are difficult to diagnose. On the contrary, major
anatomical defects may not cause significant malfunctioning
(Ceausescu et al. 2018). Therefore, accurate diagnosis of CNS
abnormalities is essential for pregnancy management and
parental counselling (Jarvis et al. 2017). The first preferred
nography. Foetal magnetic resonance imaging (MRI) is gener-
ally preferred as a second-line in cases when the diagnosis
could not be confirmed by neurosonography (Paladini
et al. 2007).
Ultrasonography (USG) is the primary imaging modality
because of being widely available, easily applicable, practical,
cost-effective and safe for the imaging of foetal anatomical
structures (Kul et al. 2012; Reda et al. 2018). However, rea-
sons such as inappropriate foetal position, maternal obesity,
oligohydramniosis and low sensitivity to detect malforma-
tions of cerebral cortical development limit the effectiveness

CONTACT Sureyya Saridas Demir drsureyyademir@hotmail.com Division of Perinatology, Department of Obstetrics and Gynecology, Dokuz Eylul University
School of Medicine, Izmir, Turkey
ß 2021 Informa UK Limited, trading as Taylor & Francis Group
2 S. S. DEMIR ET AL.
of the images (Rossi and Prefumo 2014). Moreover, there may
be some difficulties in visualising the anatomical structures of
the foetal brain due to ossification in the skull. (Sefidbakht
et al. 2016; Tanacan et al. 2020). In addition, the results of the
examination are closely related to the timing of examination
and experience of the examiner (Raafat et al. 2020). For this
reason, foetal MRI has been used as an additional imaging
method in foetal anatomy evaluations since Smith et al. (1983).
Foetal MRI became an important diagnostic tool in compli-
cated cases due to its increased soft-tissue resolution, wide
field of view, the ability to depict myelination and sulcation,
and multiplanar imaging (Reda et al. 2018). Besides, maternal
obesity is not significantly affected by foetal position, oligohy-
dramniosis and bone artefacts (Yalçın et al. 2018). On the other
hand, foetal movements observed during MRI scan may restrict
the accuracy of the diagnosis in some cases (Tanacan et al.
2020). Hence, ultrafast MRI sequences with only a few seconds
of scanning time have been developed in the last decade to
minimise the negative impact of foetal mobility on the quality
of images (Hubbard et al. 1999). Especially, in recent years,
there is an increasing number of studies in the literature com-
paring the accuracy of neurosonography and foetal MRI in con-
genital CNS abnormalities and explaining the additional
advantages of foetal MRI. However, a common consensus
could not have been reached in these studies on foetal USG
and MRI findings. Therefore, the aim of this study is to reveal
which indications are applied for foetal MRI in the CNS abnor-
malities detected by USG, to compare the findings of prenatal
neurosonography and foetal MRI and to reveal the compatibil-
ity of MRI results with USG results and additional findings on
foetal MRI.
Materials and methods
One hundred and sixty-two pregnant women were retro-
spectively enrolled in the study from Dokuz Eylul University
School of Medicine, Department of Obstetrics and
Gynaecology, Division of Perinatology Department between
January 2008 and January 2019. This study was conducted in
accordance with the principles of the Helsinki Declaration
and Institutional Ethical Committee which approved this
study (Approval no. 5252-GOA; 2020/07-28; the date of issue:
13.04.2020). However, a written informed consent was not
obtained from the participants due to retrospective research.
Patients who underwent both foetal MRI and USG due to
suspicion of CNS abnormalities were retrospectively selected
from the hospital information processing system. Inclusion
Table 1. Demographic features of pregnant.
Mean maternal age
18–25 years
26–35 years
36–45 years
Mean gestational week for USG
Mean gestational week for MRI
Foetal MRI according to gestational week groups
18–24 weeks
25–28 weeks
>28 weeks
Termination of pregnancy cases
MRI: magnetic resonance imaging; USG: ultrasonography.
criteria were patients who were diagnosed with isolated CNS
abnormalities by neurosonography or who had the suspicion
of CNS abnormalities and who were referred for foetal MRI
above 18 weeks of pregnancy. Exclusion criteria were history
of radiation or any teratogen exposure, monochorionic twin
pregnancies, foetal MRI requesting below 18 weeks of preg-
nancy, and fetuses having anomalies other than CNS
abnormalities.
The differences between the findings of the USG and the
foetal MRI were discussed in terms of both quality and quan-
tity. Prenatal ultrasonographic examinations were performed
in the Department of Perinatology with Voluson 730 Expert
(GE Medical Systems, Zipf, Austria). Foetal MRI scanning was
performed with a 1.5-Tesla MRI device (Gyroscan Achieva;
Philips Medical Systems, Eindhoven, The Netherlands). In
accordance with the preliminary diagnosis specified in USG,
for the MRI acquisition protocol, single-shot turbo spin echo
(SSH-TSE) with T2-weighted rapid imaging sequence in the
axial, coronal and sagittal plane were used for all fetuses. The
images were evaluated by two radiologists experienced in
foetal MRI. No contrast agent or sedation was used in the
examinations.
Statistical analysis
Statistical analyses were performed with Statistical Package
for the Social Sciences (SPSS.22, IBM Corp., Cary, NC).
Quantitative data were reported using mean, standard devi-
ation, and range, while qualitative data were reported as fre-
quency and percentage.
Results
In this study, 160 pregnant women were included and the
maternal age ranged from 18 to 44 years with the mean of
age was 28.29 ± 5.63 years. Thirty-five point six per cent of
pregnant ranged between 18 and 25 years, 53.1% of preg-
nant ranged between 26 and 35 years, and 11.3% of preg-
nant ranged between 36 and 45 years. The mean gestational
week for neurosonography and for MRI was 24.21 ± 4.37 and
24.51 ± 4.28, respectively. Foetal MRI was performed at the
18th–24th gestational week in 91 (56.8%) cases, at the
25th–28th gestational week in 33 (20.6%) cases and after
28th week in 36 (22.6%) cases. Termination of pregnancy was
performed at 31 (19.4%) cases. Demographic features of all
cases are given in Table 1.
28.29 ± 5.63 (18–44)
57 (35.6%)
85 (53.1%)
18 (11.3%)
24.21 ± 4.37 (18–37)
24.51 ± 4.28 (18–37)
91 (56.8%)
33 (20.6%)
36 (22.6%)
31 (19.4%)
 JOURNAL OF OBSTETRICS AND GYNAECOLOGY 3

Table 2. Comparison of prenatal neurosonography and foetal MRI findings.

Neurosonography findings n (%) MRI findings n (%)
Corpus callosum anomalies 36 (22.5) Corpus collosum anomalies 27 (16.8)
Corpus collosum anomalies þ cerebellar hypoplasia 3 (1.9)
Normal anatomic findings 6 (3.8)
Neural tube defects 21 (13.1) Neural tube defects
NTD þ Chiari malformation type II 8 (5) NTD þ Chiari malformation type II 7 (4.4)
Diastematomyelia 1 (0.6)
Encephalocele 4 (2.5) Encephalocele 2 (1.3)
Encephalocele þ Chiari malformation type III 1 (0.6)
Chiari malformation type III 1 (0.6)
Myelomeningocele 4 (2.5) Myelomeningocele 2 (1.3)
Myelomeningocele þ Hydrocephalus þ Chiari malformation type III 1 (0.6)
Chiari malformation type II 1 (0.6)
Meningocele 3 (1.9) Meningocele 2 (1.3)
Meningocele þ vermian hypoplasia 1 (0.6)
Diastematomyelia 2 (1.3) Diastematomyelia 2 (1.3)
Posterior fossa anomalies 25 (15.6) Posterior fossa anomalies
Cerebellar vermian agenesis 1 (0.6) Cerebellar vermian agenesis 1 (0.6)
Cerebellar vermian hypoplasia 5 (3.1) Inferior vermian hypoplasia 2 (1.3)
Mega cisterna magna 1 (0.6)
Dandy Walker malformation 1 (0.6)
Cerebellar hypoplasia þ Lissencephaly 1 (0.6)
Cerebellar hypoplasia 3 (1.9) Cerebellar hypoplasia 3 (1.9)
Mega cisterna magna 7 (4.4) Mega cisterna magna 5 (3.1)
Normal anatomic findings 2 (1.3)
Dandy Walker malformation 5 (3.1) Dandy Walker malformation 5 (3.1)
Chiari Malformation type II 1 (0.6) Chiari Malformation type II 1 (0.6)
Aqueductal stenosis 1 (0.6) Corpus collosum anomaly 1 (0.6)
Posterior fossa defects 2 (1.3) Chiari Malformation type II 1 (0.6)
Dandy Walker variant 1 (0.6)
Ventriculomegaly 84 (52.5) Ventriculomegaly
Primary ventriculomegaly 84 (52.5) Primary ventriculomegaly 66 (41.3)
Lissencephaly 1 (0.6)
Ventriculomegaly þ Lissencephaly 2 (1.3)
Chiari Malformation type II 1 (0.6)
Encephalomalacia 2 (1.3)
Ventriculomegaly þ Corpus collosum anomalies 3 (1.9)
Ventriculomegaly þ Megacisterna magna 3 (1.9)
Ventriculomegaly þ Cerebellar hypoplasia 1 (0.6)
Pontocerebellar atrophy 1 (0.6)
Normal anatomic findings 4 (2.5)
Intracranial lesions 18 (11.3) Intracranial lesions
Intracranial mass 1 (0.6) Glial tumour 1 (0.6)
Intracranial haemorrhage 3 (1.9) Intracranial haemorrhage 2 (1.3)
Porencephalic cyst 1 (0.6)
Intracranial AV malformation 1 (0.6) Intracranial vascular malformation 1 (0.6)
Galen vein aneurysm 1 (0.6) Galen vein aneurysm 1 (0.6)
Intracranial cystic lesions 2 (1.3) Arachnoid cyst 1 (0.6)
Normal anatomic findings 1 (0.6)
Choroid plexus haemorrhage 1 (0.6) Choroid plexus haemorrhage 1 (0.6)
Arachnoid cyst 9 (5.6) Arachnoid cyst 5 (3.1)
Pontocerebellar atrophy 1 (0.6)
Corpus collosum anomalies 1 (0.6)
Normal anatomic findings 2 (1.3)
Cephalic Disorders 25 (15.6) Cephalic Disorders
Hydrocephalus 12 (7.5) Hydrocephalus 7 (4.4)
Vermian hypoplasia þ corpus callosum anomalies 1 (0.6)
Hydrocephalus þ lissencephaly þ cerebellar hypoplasia 2 (1.3)
Haemorrhage in germinal matrix 1 (0.6)
Chiari Malformation type II 1 (0.6)
Microcephaly 4 (2.5) Microcephaly 1 (0.6)
Cerebellar hypoplasia 1 (0.6)
Normal anatomic findings 2 (1.3)
Macrocephaly 1 (0.6) Macrocephaly þ Arachnoid cyst 1 (0.6)
Holoprosencephaly 5 (3.1) Holoprosencephaly 5 (3.1)
Lissencephaly 2 (1.3) Normal anatomic findings 2 (1.3)
Trigonocephaly 1 (0.6) Ventriculomegaly 1 (0.6)
Cystic hygroma 1 (0.6) Cystic hygroma 1 (0.6)
NTD: neural tube defects; MRI: magnetic resonance imaging.

Prenatal neurosonography and foetal MRI findings of all
160 pregnant women are presented in Table 2. Primary ven-
triculomegaly (84, 52.5%), corpus callosum anomalies (36,
22.5%), posterior fossa anomalies (25, 15.6%), neural tube
defects (21, 13.1%), intracranial lesions B (18, 11.3%) and
hydrocephalus (12, 7.5%) were the most common neurosono-
graphic findings necessitating foetal MRI screening.
Foetal MRI demonstrated corpus callosum anomalies with
cerebellar hypoplasia in 3 cases and normal anatomic find-
ings in 6 cases among 36 cases with suspicion of corpus
4 S. S. DEMIR ET AL.
Figure 1. Sagittal (a) and axial (b) SS-FSE T2-weighted images of a 29-week gestational age fetus with severe inferior vermian hypoplasia (short arrow), an elevated
torcula (long arrow), and cystic dilatation of the posterior fossa. The findings are consistent with a Dandy Walker malformation.
callosum anomalies in foetal USG. Foetal MRI changed the
diagnosis as diastematomyelia in one of the eight cases with
neural tube defect with Chiari malformation type II. Foetal
MRI reported one encephalocele with Chiari malformation
type III in one case, and Chiari malformation type III in one
case among four cases with a diagnosis of encephalocele in
neurosonography. Myelomeningocele with hydrocephalus
and Chiari malformation type III in one case, and Chiari mal-
formation type II in one case were reported in MRI among
four cases with suspicion of Myelomeningocele in foetal USG.
Foetal MRI revealed additional information as meningocele
with vermian hypoplasia in one of the three cases with a
diagnosis of meningocele in neurosonography.
All diastematomyelia cases diagnosed by neurosonography
were confirmed by foetal MRI. Dandy Walker malformation,
Chiari malformation type II, galen vein aneurysm, choroid
plexus haemorrhage, holoprosencephaly, and cystic hygroma.
Foetal MRI changed the diagnosis as inferior vermian
hypoplasia, mega cisterna magna, Dandy Walker malforma-
tion and cerebellar hypoplasia with lissencephaly in 2, 1, 1,
and 1 cases, respectively, among four cases with suspicion of
cerebellar vermian hypoplasia in foetal USG. Foetal MRI
revealed normal anatomic findings in two cases among seven
cases with suspicion of mega cisterna magna. Foetal MRI
agreed with neurosonography in five cases with Dandy
Walker malformation (Figure 1). In one case, aqueductal sten-
osis in foetal USG was reported as corpus callosum anomaly
in foetal MRI. Two cases with suspicion of posterior fossa
defects in foetal USG were reported as Chiari Malformation
type II and Dandy Walker variant in foetal MRI.
Normal anatomic findings, lissencephaly, ventriculomegaly
with lissencephaly, Chiari malformation type II, encephaloma-
lacia, ventriculomegaly with corpus callosum anomalies, ven-
triculomegaly with mega cisterna magna, ventriculomegaly
with cerebellar hypoplasia and pontocerebellar atrophy were
reported in 4, 1, 2, 1, 2, 3, 3, 1 and 1 cases, respectively,
among 83 patients with a prenatal diagnosis of primary ven-
triculomegaly in foetal USG.
Foetal MRI changed the diagnosis of a case with intracra-
nial mass to glial tumour. Porencephalic cyst in one case was
reported among three cases with suspicion of intracranial
haemorrhage. Foetal MRI revealed no abnormality in one
case and arachnoid cyst in one case among the cases with
the diagnosis of intracranial cystic lesions in neurosonogra-
phy. In one case pontocerebellar atrophy, in one case corpus
callosum anomaly and in two cases normal anatomic findings
were reported among nine cases with suspicion of arach-
noid cyst.
Foetal MRI demonstrated vermian hypoplasia with corpus
callosum anomalies, hydrocephalus with lissencephaly and
cerebellar hypoplasia, haemorrhage in germinal matrix and
Chiari malformation type II in 1, 2, 1, and 1 among 12 cases
with a suspicion of hydrocephalus in foetal USG. Foetal MRI
reported cerebellar hypoplasia and normal anatomic findings
in 1 and 2 of 4 cases with a diagnosis of microcephaly in
neurosonography. Foetal MRI reported additional finding as
macrocephaly and arachnoid cyst in a case with macroceph-
aly. No abnormality was found in foetal MRI in two cases
with lissencephaly. Foetal MRI changed the diagnosis of a
case with trigonocephaly to ventriculomegaly.
Table 3 shows the compatibility of MRI results with USG
and additional findings on MRI. If the compatibility between
MRI and USG results was examined, it was found fully com-
patible in 98 (61.3%) cases, partially compatible in 39 (24.3%)
cases and no compatible in 23 (14.5%) cases. When compar-
ing prenatal neurosonography and foetal MRI findings, add-
itional findings were reported in 27 (16.9%) cases, no
additional finding was reported in 107 (66.8%) cases, normal
anatomic findings on MRI were reported in 14 (8.8%) cases
and MRI changed the diagnosis in 12 (7.5%) cases.

Table 3. Compatibility and additional findings of MRI and USG results.
Compatibility of MRI results with USG results
Fully compatible 98 (61.3%)
Partially compatible 39 (24.3%)
No compatible 23 (14.5%)
MRI: magnetic resonance imaging; USG: ultrasonography.
Discussion
Even if the possibility of detecting CNS abnormalities has
increased with neurosonography in recent years with the
development of USG technique and knowledge, the correct
diagnosis in congenital CNS abnormalities has always been
controversial. Because of the mineralisation of the foetal skull,
the complexity and variations of foetal anatomic structures
make it difficult to make the correct diagnosis with USG.
Therefore, foetal MRI has been used to make a definitive and
second-line diagnosis of congenital CNS anomalies. In the
present study, the most frequently requested foetal MRI indi-
cations and comparison of prenatal neurosonography and
foetal MRI findings were revealed.
The most common MRI indication for CNS abnormalities is
ventriculomegaly and constitutes 40% of foetal MRI indica-
tions for CNS abnormalities (Manganaro et al. 2017; Parazzini
et al. 2012). In a study in which Yalçı n et al. examined the
foetal MRI indications, 53% of the cases were planned for fur-
ther evaluation of ventriculomegaly that was sonographically
detected (Yalçın et al. 2018). In a study by Sefidbakht et al.,
74.4% of the patients had foetal MRI due to suspicion of ven-
triculomegaly (Sefidbakht et al. 2016). In a study by Tanacan
et al., primary ventriculomegaly (32.7%), corpus callosum
anomalies (26.3%), posterior fossa anomalies (10%) and
neural tube defects (10%) were found the most common
neurosonography findings that necessitated foetal MRI
screening (Tanacan et al. 2020). According to a meta-analysis
of 710 fetuses performed by Rossi and Prefumo, 44.7% of
cases were ventriculomegaly and 33.8% of cases were mid-
line anomalies. In the present study, 52.5% of the indications
for requesting foetal MRI were ventriculomegaly, 22.5% were
corpus callosum anomalies, 15.6% were posterior fossa
anomalies and 13.1% were neural tube defects in accordance
with the literature.
Prenatal MRI may be particularly useful for abnormalities,
including cerebral structures that are not easily recognised
by USG. Biometric measurements can be made in axial/trans-
verse plans in routine prenatal USG examinations, but foetal
USG is insufficient in taking sagittal images (Salomon et al.
2011). Therefore, sagittal images obtained by foetal MRI are
required in the evaluation of corpus callosum anomalies, pos-
terior fossa, and especially vermiş (Rossi and Prefumo 2014).
Moreover, foetal MRI has advantages over foetal USG in size,
characterisation and identification of CNS lesions.
A comparison of foetal USG and MRI in the evaluation of
foetal CNS abnormality has been one of the most important
issues discussed in the literature. On the other hand, the gen-
eral opinion in the literature is that foetal MRI gives more
detailed and precise results than foetal USG as we have
reached in the present study. However, because the applic-
ability of foetal MRI to each patient is not cost-effective, it
JOURNAL OF OBSTETRICS AND GYNAECOLOGY 5
Additional findings on MRI
Additional findings 27 (16.9%)
No additional finding 107 (66.8%)
Normal anatomic findings on MRI 14 (8.8%)
MRI changed the diagnosis 12 (7.5%)
has been used by many professionals as a second-stage
screening method in cases where an anomaly is suspected
with foetal USG scanning. Rossi and Prefumo (2014) recently
published a review article including 13 articles and 710
fetuses undergoing both USG and MRI for CNS abnormalities.
According to the review, there was approximately 65% agree-
ment between USG and MRI in detecting CNS anomalies and
the highest agreement was reported for ventriculomegaly.
Another result of the review was that MRI provided add-
itional information in 22% of cases and MRI changed the
diagnosis and clinical management in 30% of cases. In a
retrospective study conducted by Paladini et al. (2007) on
773 fetuses, it was concluded that 86.5% of the cases were
compatible with USG and MRI, 7.9% of the cases had add-
itional findings in MRI and 4.8% of the cases had additional
findings in USG. According to a meta-analysis recently per-
formed by Jarvis et al. (2017), which included 34 studies and
959 fetuses, the accuracy of prenatal USG at diagnosis was
75% and the accuracy of MRI at diagnosis was 91% when
results were confirmed by postnatal imagining, surgery or
autopsy. In a review and meta-analysis by Van Doorn, which
included 27 articles and 1184 cases, it was revealed that the
diagnoses by foetal USG and foetal MRI were agreed in 65%
of cases, an additional or different pathology was reported in
MRI in 23% of cases and the diagnosis of USG was rejected
and reported normally in MRI in 8% of cases. Therewithal, in
the same meta-analysis, it was found that the diagnosis of
foetal MRI was correct in 80% of cases undergoing postnatal
imaging or autopsy, whereas foetal USG was diagnosed cor-
rectly in only 54% of the cases. In a similar study conducted
by Whitby et al. (2004) on 100 fetuses, it was found that foe-
tal MRI and USG had similar results in 52 cases, MRI had extra
information in 12 cases, MRI changed the diagnosis of USG in
35 cases and MRI reported the brain normally in 11 cases. In
the present study, additional findings were reported in 16.9%
of cases, no additional finding was reported in 66.8% of
cases, normal anatomic findings on MRI were reported in
8.8% of cases and MRI changed the diagnosis in 7.5% of
cases in accordance with the literature.
One of the controversial problems between the studies
examining the relationship between foetal USG and MRI is
due to differences in the classification of CNS abnormalities.
In the present study, ventriculomegaly constitutes the largest
group of anomalies. When the contribution of foetal USG
and foetal MRI to the ventriculomegaly diagnosis is com-
pared, the diagnosis was changed by foetal MRI, or an add-
itional anomaly was detected in 11.2% of cases with
ventriculomegaly diagnosed by USG in 51.5% of all cases. In
a prospective study of 147 cases of ventriculomegaly diag-
nosed by USG, additional CNS abnormalities were detected
in 17% of MRI cases and corpus callosum agenesis was the
6 S. S. DEMIR ET AL.
most common association with ventriculomegaly (Griffiths
et al. 2010). In 179 fetuses with ventriculomegaly, 19.5% of
MRI detected additional findings (Parazzini et al. 2012).
Prenatal MRI can detect the midline anomalies including cor-
pus callosum anomalies with a high sensitivity of 88.9%, as
reported by Conte et al. (2016). Corpus callosum dysgenesis
is the second most common indication for foetal MRI, with a
prevalence of 1.8 per 10,000 deliveries and associated with
additional CNS anomalies (Glass et al. 2008). Glenn et al.
detected additional anomaly in 22.5% of cases with corpus
callosum dysgenesis by foetal MRI compared to USG (Glenn
et al. 2005). In the present study, while corpus callosum
anomaly which is the second most common indication for
foetal MRI was found to be 22.5% in foetal USG, additional
anomalies and normal anatomic findings were observed in
1.9% and 3.8% of the cases with foetal MRI among the cases
with corpus callosum anomalies. MRI has a crucial role in the
identification of extension, localisation and identification of
intracranial cystic–ischaemic–haemorrhagic lesions
(Manganaro et al. 2012). In the present study, intracranial
mass, cyst and haemorrhagic lesions diagnosed by foetal
USG were more accurately and exactly defined in foetal MRI.
Due to the necessity of multiplanar imagining of posterior
fossa anomalies, foetal MRI has advantages over foetal USG,
especially in the imaging of vermiş (Manganaro et al. 2017).
The most common indications for requesting foetal MRI from
posterior fossa anomalies are suspected Dandy Walker
Malformation cerebellar hypoplasia/dysplasia/haemorrhage
and Chiari malformation as in the present study. The last
group of CNS anomalies, neural tube defects, includes a
number of malformations that affect the spinal cord from the
early stages of gestation (Egloff and Bulas 2015). In most of
our cases with neural tube defects, it was concluded that foe-
tal MRI was compatible with foetal USG.
The best approach for comparing two imaging modalities
is undoubtedly the basis for an information source that is
considered as the gold standard. In studies conducted on
this topic, it can be seen that foetal autopsy findings were
taken as a reference Standard (Rossi and Prefumo 2014;
Verburg et al. 2015). However, foetal autopsy acceptance
rates of families in our country are quite low (Kul et al. 2012).
In the evaluation limited to macroscopic examination, it is
not possible to reveal the final diagnosis of foetal anomalies
and all the accompanying findings. For these reasons, a com-
parison of USG and MRI findings remain controversial.
Therefore, the most important limitation of our study is that
the findings and diagnoses of foetal USG and MRI were not
compared with foetal autopsy findings.
In conclusion, when CNS abnormalities are detected in
foetal USG, foetal MRI will make an important contribution
both in imaging the anomalies in more detail and in deter-
mining the accompanying additional anomalies. Foetal MRI
examination can provide information that may affect the clin-
ical approach, and it makes important contributions to the
management of pregnancies with the information it provides.
Foetal MRI is an advanced imaging method that can be used
in selected cases suspected of CNS abnormalities. Limitations
of previous studies suggest that more researches are needed
to clarify the full effect of foetal MRI.
Disclosure statement
No potential conflict of interest was reported by the authors.
ORCID
Sureyya Saridas Demir http://orcid.org/0000-0002-4051-3703
Erkan Cagliyan http://orcid.org/0000-0001-6864-6551
Fatma Ceren Sarioglu http://orcid.org/0000-0002-6714-2367
Handan Guleryuz http://orcid.org/0000-0002-3205-4658
Sabahattin Altunyurt http://orcid.org/0000-0002-8887-3097
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