Prenatal Imaging Diagnosis of Suprarenal Lesions

Abstract

<b><i>Introduction:</i></b> Prenatal suprarenal lesions represent diverse pathologies. This study investigated prenatal imaging features and regression patterns associated with specific lesion diagnoses. <b><i>Methods:</i></b> This is a multicenter retrospective review of fetuses with prenatally diagnosed suprarenal lesions between 2001 and 2019. Prenatal ultrasound and MRI characteristics, postnatal imaging, and clinical course were reviewed<i>.</i> Prenatal imaging findings were compared by the most common diagnoses and regression patterns. <b><i>Results:</i></b> Forty-four fetuses were prenatally diagnosed with suprarenal lesions. Diagnoses included pulmonary sequestration (<i>n</i> = 12; 27.3%), adrenal hemorrhage (<i>n</i> = 12; 27.3%), upper quadrant cyst (including 2 duplication cysts, 1 splenic cyst, and 3 indeterminate cysts), neuroblastoma (<i>n</i> = 4), adrenal hyperplasia (<i>n</i> = 3), bilateral adrenal calcifications (<i>n</i> = 1), and indeterminate lesions (<i>n</i> = 6). Sequestrations were uniformly left-sided (100 vs. 50%; <i>p</i> = 0.014) and diagnosed earlier in gestation than adrenal hemorrhages (<i>p</i> = 0.025). Sequestrations were also significantly more likely to have a prenatal feeding vessel (<i>p</i> = 0.005), low T1 MRI signal (<i>p</i> = 0.015), and no MRI blood products (<i>p</i> = 0.018) compared to adrenal hemorrhages. When comparing all 44 patients, a prenatal feeding vessel and low T1 signal on prenatal MRI were significantly associated with lesion persistence (<i>p</i> = 0.003; <i>p</i> = 0.044). <b><i>Discussion/Conclusion:</i></b> Imaging findings on prenatal ultrasound and MRI aid in the diagnosis of suprarenal lesions, including differentiating pulmonary sequestrations and adrenal hemorrhages.