In utero magnetic resonance imaging for brain and spinal abnormalities in fetuses

In the past eight years magnetic resonance imaging has been used to detect fetal abnormalities in utero at many centres around the world. An increasing number of published papers have shown improved diagnostic accuracy with in utero magnetic resonance imaging compared with obstetric ultrasonography, the current reference standard. This is particularly so in cases of brain and spine abnormalities in the fetus, and much of the published work has concentrated on those anatomical regions. When a new application for an existing technology is discovered, there is a delicate balance between assessing the method adequately in a research environment and the desire to introduce it into the clinical arena as soon as possible. Here we describe the current status of in utero magnetic resonance imaging and outline some of the ethical issues raised by working with a new application in this complicated clinical environment. The fictional case we outline is a composite story of circumstances we found ourselves in soon after we started our research programme on in utero magnetic resonance imaging in 1999. Our situation was helped by foresight and by discussing it prospectively with the local research ethics committee. We have used this scenario to introduce the topic of in utero magnetic resonance imaging, to show its potential benefits, and to outline the practical and ethical issues that are raised by using the technique. The obstetrics and radiology departments of a teaching hospital decide to carry out clinical in utero magnetic resonance imaging in some pregnant women whose fetuses have developmental brain problems diagnosed by ultrasonography. The first case attempted is technically successful, but the agenesis of the corpus callosum and Dandy-Walker malformation detected by ultrasonography cannot be confirmed by in utero magnetic resonance imaging. The brain seems to be normal. The woman had decided to terminate the fetus …