Prenatal ultrasound is considered a routine clinical procedure today but a professor of radiology at the University of Vienna asks if that is good enough. Daniela Prayer, a leading advocate of in utero magnetic resonance imaging (MRI) suggests such advanced scans should not be considered a luxury but a necessity for the unborn.

Improvements in technology have made MRI not only safer for the fetus but faster as well. "Today we have ultrafast sequencing requiring 15 to 30 seconds for rendering dynamic images," she said.

Where there were once only two contrast agents, "today we have so many more that we can characterize olfactory bulbs in the fetus," Prayer said.

In her presentation, she showed high resolution imaging that allows monitoring of the child's behavior in the womb, revealing esophageal atrosia, a swallowing problem indicating the child will aspirate into its lungs the first feeding of the mother's milk. She showed diagnoses of unborn infants at 16 to 18 weeks gestation with damaged kidneys and one with a blocked rectum, problems that can be corrected with a surgical intervention.

Prayer said the University of Vienna was the first to image brain fiber tracking proving a diagnosis of cortical spinal connectors.

The benefit of pre-natal MRI is that the whole child can be viewed and if a surgery is indicated, in utero is safer, as the child is contained in a natural life-support system. "There are no lines or tubes or needles as there would be for a child born with a life-threatening defect," she said.

"In response to the question whether prenatal MRI is a luxury or a necessity, I would pose the question, 'Do we have the right to withhold the diagnostic?'" Prayer said.

— John Brosky, European Editor

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