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Evaluation of fetal nasal cavity in bilateral congenital dacryocystocele: 3D reconstruction and virtual navigation by magnetic resonance imaging

2019; Wiley; Volume: 55; Issue: 1 Linguagem: Inglês

10.1002/uog.21898

1469-0705

Pedro Teixeira Castro, Ana Paula Pinho Matos, Heron Werner, Jorge Lopes, Gerson Ribeiro, Edward Araujo Júnior,

Teratomas and Epidermoid Cysts

Congenital dacryocystocele (CD) is a rare condition that presents as a periorbital cyst on prenatal examination. CD has a high rate of spontaneous resolution pre- and postnatally; however, more severe malformations can present as facial cysts, such as encephalocele, venous lymphatic malformation, hemangioma, dermoid cyst, teratoma and rhabdomyosarcoma1. In cases of face and neck malformation or tumor, magnetic resonance imaging (MRI) can provide accurate images and may aid in parental counseling2. In this report, we demonstrate the application of three-dimensional (3D) reconstruction of magnetic resonance images of the fetal upper airways using virtual navigation (VN) for evaluation of tumor extent and nasal permeability in a case of bilateral CD. A 32-year-old woman, gravida 2 para 1, with normal first- and second-trimester scans, was referred to the Department of Fetal Medicine at CDPI (Rio de Janeiro, Brazil) after bilateral periorbital cystic masses were observed during a fetal growth evaluation scan at 28 weeks. It was not possible to evaluate the extent of the masses during the ultrasound scan. MRI examination was performed using a 1.5-Tesla scanner (Magnetom Aera, Siemens, Erlangen, Germany), as described previously3 (Figure 1). 3D reconstruction of the fetal airway was performed by overlapping image layers from the MRI datasets using the software Mimics (Materialize, Leuven, Belgium). The 3D model was acquired successfully. The periorbital swelling on both sides of the fetal face was easily reconstructed and identified. The nasal cavities were individualized and successfully delimited. Intranasal VN, as well as segmentation of the dacryocystocele cysts, was possible. We observed partial compromise of the left nasal cavity resulting from minor protrusion of the cyst; on the right side, the cyst did not reach the nasal cavity (Figure 2, Videoclip S1). The pregnancy continued without complication and a neonate weighing 3215 g was delivered via Cesarean section at 38 weeks. At birth, the right cyst was not visible on clinical examination and the left cyst presented as a small swelling. Based on the absence of respiratory complications, conservative treatment was indicated, and spontaneous resolution of the CD occurred by 6 months of age. 3D reconstruction and VN is a non-invasive approach that provides immersive virtual reality in the assessment of fetal structures4. The excellent contrast between tissues and spatial relationship between anatomical structures provided by MRI produces information that is not obtainable by other methods. In fetal cervical tumors, 3D VN across the trachea and bronchi allows assessment of the patency of these structures to plan a possible ex-utero intrapartum treatment procedure after delivery3. 3D VN through the urinary tract allows identification of the site of obstruction in fetuses with lower urinary tract obstruction and possible intrauterine fetal cystoscopy planning5. In the present case, 3D VN identified clearly the partial compromise of the left nasal cavity resulting from minor protrusion of the cyst. Such findings may help a multidisciplinary team to identify the postnatal treatment options as well as provide better parental counseling in pregnancies with fetal facial tumor. In summary, we have described a technique for 3D VN in a fetus with upper-airway malformation. Future studies evaluating other fetal facial malformations are necessary to validate this approach. Videoclip S1 Three-dimensional reconstruction with virtual navigation, based on magnetic resonance images, of head and face of 28-week fetus with bilateral congenital dacryocystocele. Periorbital swelling can be observed on both sides. Partial protrusion of dacryocystocele (light blue) can be seen on entering left nasal cavity. Distance between cyst and nasal cavity can be observed in right nasal cavity. Using transparency mode, it is possible to evaluate the cysts and their relationship with nasal cavity and eyes (gray). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.