Fetal intracranial hemorrhage: role of fetal MRI

Abstract

Objective

To date, prenatal diagnosis of intracranial hemorrhage (ICH) is mainly based on ultrasound (US) findings rather than magnetic resonance imaging (MRI). We aimed to: investigate the role of MRI in the diagnosis of fetal ICH among pregnancies referred to fetal MRI and to characterize the topography of fetal ICH using MRI.

Methods

We retrospectively identified fetal ICH cases diagnosed by MRI from 2008-2015, and reviewed their prenatal and postnatal medical records.

Results

Of the 2638 MRIs performed during the study period, 36 had ICH (median age 27 weeks). The most common US indication for MRI was a suspected cerebral anomaly (86%): 20 (55%) fetuses were referred for ventriculomegaly; 8 (22%) for ICH and the other 8 had a variety of different indications. We distinguished two broad topographic patterns, (i) those related to hemorrhage of the periventricular germinal matrix (GMH, n=24; 67%) and (ii) those not related to GMH (non-GMH, n=12; 33%). GMH fetuses were referred to MRI later (median 28 vs 22 weeks, p=0.005). Intrauterine demise was more frequent in non-GMH (58% vs 4%, p<0.001).

Conclusion

MRI is an important tool in prenatal diagnosis of ICH, especially when US describes non-specific intracranial abnormalities. GMH occurs more frequently and later in pregnancy than non-GMH.

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