One of the most exciting parts of my job as a pediatric radiologist at Cincinnati Children’s is the collaboration with other doctors and their healthcare teams. Working together, we help provide the best care for our patients.
This is especially true for fetal imaging diagnosis, which is one of my areas of special interest and subspecialty. We, as radiologists, provide fetal diagnoses through the analysis of images obtained with ultrasound and fetal MRI. Thanks to these techniques, there are many malformations, genetic conditions and tumors that we are able to detect. Through this collaborative work, doctors at the Fetal Center of Cincinnati, in Cincinnati Children’s, will be able to counsel parents, establish a treatment plan that sometimes starts before birth, and, in some situations, even change the mode of the delivery of the baby. In many fetal conditions, it is essential and even lifesaving to have this stablished treatment plan, ahead of time.
Anorectal malformations represent one wide group of malformations in which I am very interested. There are many types, but they usually have in common that the opening for the rectum is absent and many have associated malformations in the genitourinary system.
Even though they can be detected through physical inspection at birth, they can be very challenging to diagnose in the womb. Once the doctors notice that there is a newborn with a problem involving the anus, and sometimes the genital area, many different imaging tests and surgical procedures will be performed in order to provide the specific anatomy of the malformation so the surgeons can perform the final repair.
Image of a normal rectum on fetal MRI
Ultrasound image of a normal anal sphincter. The outer ring is the muscle complex. The bright center is the anal mucosa.
Throughout these years, I have published several papers in an effort to provide clues to guide in this prenatal diagnosis. One of the things that we noticed is that analyzing the fetal MRI appearance of the rectum, its content and the adjacent organs, we can detect some of these malformations. Other authors did the same with ultrasound and emphasized the importance of assessing the anal sphincter when there is concern for an anorectal malformation. These evaluations could be challenging, especially when the fluid that normally surrounds the baby in the womb is absent, which is unfortunately a frequent event in these malformations.
Right now, I am working on a research project in conjunction with Dr. Beth Rymeski and Dr. Rachel Hanke, from the division of Pediatric Surgery. We are trying to analyze how accurate we are in our fetal MRI anorectal malformation prenatal assessment in order to detect potential additional clues, recognize limitations of the technique or establish new approaches for improvement. It is this spirit of collaboration and our search for improvement that allows us to provide the best care for our patients.
This Fetal MRI image shows a dilated and short rectum in a fetus with an anorectal malformation
This is a fetal ultrasound image of the perineum in the context of an anorectal malformation. The anal sphincter is abnormal (barely detectable muscle complex and no central bright mucosa)
Contributed by Dr. Maria A. Calvo-Garcia and edited by Glenn Miñano, BFA.
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