When an unborn baby has an abnormality, decisions about the delivery and neonatal care can often be planned in advance – with help from an MRI.

Image acquisition can be tricky, however, and quality reporting is an acquired skill. Dr Lauren Raubenheimer is an expert in the field and has recently joined SCP Radiology as a consulting radiologist.

Having honed her skills in London under world-renowned fetal and neonatal imaging specialist Prof. Mary Rutherford, she provides insight into fetal MRI, and what it can mean to expecting couples and their healthcare providers.

When would fetal MRI be recommended?

Dr Raubenheimer explains that fetal MRI can be performed either in the second or third trimester. “My special interest is in fetal brain anomalies but I also perform MRIs for body abnormalities, including congenital diaphragmatic hernia, congenital lung lesions, spina bifida, kidney anomalies and fetal tumours.”

Patients are typically referred from Fetal Medicine Specialists after an abnormality has been detected on screening ultrasound. The MRI can be done to confirm the abnormality as well as to assess for sonographically occult abnormalities (abnormalities that are not readily visible through standard imaging techniques). This can significantly affect the prognosis.

MRI can also be superior to ultrasound in certain instances such as assessing brain cortication (the formation of folds), assessing the posterior fossa (a part of the skull cavity that houses complex structures for normal brain function), in oligohydramnios (when amniotic fluid is low) and when mothers have a high body mass index (BMI). 

How are quality images obtained?

Dr Raubenheimer says that fetal movement had been an obstacle in getting good quality MR images in the past. “But with today’s magnets and the use of faster imaging sequences, we can obtain excellent image quality,” she explains.

That said, a very busy baby can call for considerable skill and patience from the radiographer, and at SCP Radiology fetal MRI scans are done exclusively by the lead MRI radiographer, Andrea Nagel.

Safety is of utmost importance, and present data shows “no conclusively documented deleterious effects of MR imaging on the developing fetus at 1.5 T”.* For the peace of mind of expectant mothers, Dr Raubenheimer adds that MR does not use ionising radiation, and intravenous contrast is not administered in fetal MRI. “Theoretical concerns about tissue heating and acoustic injury are addressed by working within strict parameters.”

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About referral and funding

Fetal MRI is covered by medical aids but, as is the case with all other MRI scans, preauthorisation will be needed.

It is preferable that patients are referred from a Fetal Medicine Specialist after a detailed ultrasound. “Having access to ultrasound reports and knowing the exact gestation are crucial to an accurate MRI report,” Dr Raubenheimer emphasises. In general, she is in close communication with her colleagues in fetal medicine when it comes to individual patients.

More about Dr Lauren Raubenheimer

Dr Raubenheimer obtained her MBChB with first class honours from the University of Cape Town, and her radiology qualification with distinction from the same institution.

After graduating, she worked in both the public and private sectors in South Africa, and developed a special interest in fetal imaging and neuroradiology. She enrolled for the European Diploma in Neuroradiology (EDiNR) and, in 2019, did an observership in fetal and neonatal brain MRI at the St Thomas’ Hospital Centre for the Developing Brain in London, under the guidance of Prof. Rutherford.

“Since then I have reported fetal MRIs for Groote Schuur Hospital as a volunteer medical specialist from 2019 to 2023,” she says, “as well as private-sector fetal MRIs, first in Stellenbosch and more recently at Mediclinic Cape Gate in partnership with SCP.”

Aside from her fetal imaging work, she also currently does contract reporting for an international radiology provider.

Lastly, on a personal note

“I have had an interest in neuroradiology, especially paediatric neuroradiology, since my registrar days,” Dr Raubenheimer recalls. “I was lucky enough to be invited to work under Prof. Rutherford and she has been an invaluable and ongoing mentor. 

“When a couple discovers the baby that they carry has an abnormality, the emotional impact is enormous and can be life changing. As a mother myself I have a huge emotional investment in my work. I hope that my findings give parents more answers as they navigate a difficult path.”

She says that, in many cases, the timing and route of delivery, as well as the neonatal care that will be required, can be planned in advance with help from an MRI. “Nothing is better than confirming only a minor abnormality with a good prognosis and giving parents some reassurance.”

Parents who want to read more about the safety of and preparation for fetal MRI, can download SCP’s information sheet here.

* Source: ACR–SPR PRACTICE PARAMETER FOR THE SAFE AND OPTIMAL PERFORMANCE OF FETAL MAGNETIC RESONANCE IMAGING.