Multimodality imaging evaluation of fetal spine anomalies with postnatal correlation

Abstract

Congenital anomalies of the spine are associated with substantial morbidity in the perinatal period and may affect the rest of the pa-tient’s life. Accurate early diagnosis of spinal abnormalities during fetal imaging allows prenatal, perinatal, and postnatal treatment planning, which can substantially affect functional outcomes. The most common and clinically relevant congenital anomalies of the spine fall into three broad categories: spinal dysraphism, segmentation and fusion anomalies of the vertebral column, and sacrococ-cygeal teratomas. Spinal dysraphism is further categorized into one of two subtypes: open spinal dysraphism and closed spinal dysra-phism. The latter category is further subdivided into those with and without subcutaneous masses. Open spinal dysraphism is an emer-gency and must be closed at birth because of the risk of infection. In utero closure is also offered at some fetal centers. Sacrococcygeal teratomas are the most common fetal pelvic masses and the prog-nosis is variable. Finally, vertebral body anomalies are categorized into formation (butterfly and hemivertebrae) and segmentation (block vertebrae) anomalies. Although appropriate evaluation of the fetal spine begins with US, which is the initial screening modality of choice, MRI is increasingly important as a problem-solving tool, es-pecially given the recent advances in fetal MRI, its availability, and the complexity of fetal interventions.