Congenital chest malformations range from small and asymptomatic entities to large space occupying masses that require immediate neonatal respiratory support and surgical treatment.
Fetal lungs increase in volume throughout gestation and can be measured with MRI volumetry. Normal lung volumes have been documented by MRI as demonstrating growth proportionate to fetal body size.
The fetal lungs, trachea, and main bronchial tree are composed mainly of water and exhibit high signal intensity relative to adjacent structures on T2-weighted images, which allows evaluation of lung morphology and volume. MR imaging is no substitute for US in first-line screening, but it is useful in cases in which US has limitations. In a study by Levine et al. of 74 fetuses with diagnosed thoracic anomalies examined with US, MR imaging provided additional information in 38% and changed management in 8%.
Lung parenchyma is homogeneously brighter than muscle on T2w and increases in the signal after 24 weeks gestation, while T1w signal decreases with gestational age. An apparent diffusion coefficient has been used in addition to T2w signal to assess lung maturation.
The diaphragms are dome-shaped bands between the lungs and the abdomen. They have low signal on T2w, slightly lower than adjacent liver. Breathing may be noted on dynamic SSFP sequences.
The esophagus is rarely seen unless caught during a swallow. If an atresia is present, fluid may be identified proximal to the obstruction, but is not a constant finding. Thick dynamic SSFP sequences in the sagittal midline plane may best demonstrate transient dilatation of a proximal esophageal pouch. The thymus is homogeneous, intermediate signal in the anterior mediastinum. It is best seen in the third trimester and should not have any mass effect on adjacent vessels or the trachea.
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