Diagnostic Impact of Fetal MRI in 556 Fetuses: Where It Adds Value Beyond Ultrasound

TL;DR

This study shows that fetal MRI adds significant diagnostic value over ultrasound, especially for brain and gastrointestinal issues, in over 500 cases.

Contribution

The study quantifies MRI's added diagnostic value beyond ultrasound across multiple fetal anatomical systems using a large cohort.

Findings

MRI ruled out initial diagnoses in 20.1% of cases and revealed additional findings in 32%.

The highest diagnostic contribution was for central nervous system and gastrointestinal anomalies.

Ultrasound alone was sufficient for genitourinary, thoracic, and vertebral anomalies.

Abstract

Objectives: This study aimed to assess the diagnostic contribution of fetal MRI across different anatomical systems and evaluate its added value beyond prenatal ultrasonography. Methods: This retrospective cohort included 556 fetuses who underwent both prenatal ultrasound and fetal MRI in a single tertiary center. Cases were classified by anatomical system. The concordance between ultrasound and MRI findings, as well as additional or ruled-out findings identified by MRI, was analyzed. Statistical significance and clinical relevance were also evaluated. Results: Among the 556 cases, complete concordance between ultrasound and MRI findings was observed in 48.9%. MRI ruled out the initial diagnosis in 20.1% and revealed additional findings in 32% of cases. A total of 192 additional findings were identified, while 115 previously suspected anomalies were ruled out. The highest diagnostic contribution was observed in central nervous system (CNS) and gastrointestinal system (GIS) anomalies. Posterior fossa abnormalities and cystic or mass lesions were frequently detected as additional findings on MRI. In contrast, ultrasound alone was generally sufficient for evaluating genitourinary (GUS), thoracic, and vertebral anomalies. The overall diagnostic yield of MRI was higher in anatomically complex or sonographically ambiguous cases. Conclusions: Fetal MRI provides significant additional diagnostic value, particularly in CNS and GIS anomalies, by detecting additional findings, clarifying uncertain diagnoses, or excluding suspected anomalies. Its selective use may enhance both prenatal counseling and postnatal management.

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