Fetal MRI pp 215-234 | Cite as

MRI of the Normal Fetal Lung

  • Gregor Kasprian
Part of the Medical Radiology book series (MEDRAD)


Perinatal survival crucially depends on a sufficiently sized and functionally well-developed cardiopulmonary system. Especially, the stage of lung development and the biochemical and structural maturity of the fetal lung are the most important determinants for survival and after birth. Since our understanding of the complexity of the processes influencing lung growth has substantially improved, this knowledge can now be translated into clinical science. Fetal MR has opened a new exciting field in the prenatal assessment of lung maturity, since it noninvasively provides important data on the size, structure, and biochemical maturity of the fetal lung. In order to confidently diagnose developmental pathologies of the growing respiratory system and evaluate their impact on extrauterine life, it is of utmost importance to be fully aware of the potential and limitations of new MR imaging methods in the characterization of normal fetal lung development.


Fetal Lung Pulmonary Hypoplasia Fetal Motion Lung Fluid Amniotic Fluid Sample 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ahlfeld F (1888) Über bisher noch nicht beschriebene intrauterine Bewegungen des Kindes. Verhandlungen der Deutschen Gesellschaft für Gynäkologie, 2. Versammlung, HalleGoogle Scholar
  2. Ba’ath ME, Jesudason EC, Losty PD (2007) How useful is the lung-to-head ratio in predicting outcome in the fetus with congenital diaphragmatic hernia? A systematic review and meta-analysis. Ultrasound Obstet Gynecol 30:897–906PubMedCrossRefGoogle Scholar
  3. Baarsma R, Bekedam DJ, Visser GH (1993) Qualitative abnormal fetal breathing movements, associated with tracheal atresia. Early Hum Dev 32:63–69PubMedCrossRefGoogle Scholar
  4. Badalian SS, Fox HE, Zimmer EZ, Fifer WP, Stark RI (1996) Patterns of perinasal fluid flow and contractions of the diaphragm in the human fetus. Ultrasound Obstet Gynecol 8:109–113PubMedCrossRefGoogle Scholar
  5. Balassy C, Brugger PC, Csapo B, Mittermayer C, Kasprian G, Prayer D (2004) In vivo investigation of fetal lung maturation with MRI. Eur Radiol 14:220–221Google Scholar
  6. Balassy C, Kasprian G, Brugger PC, Weber M, Csapo B, Mittermayer C, Hormann M, Prayer D (2007) MRI investigation of normal fetal lung maturation using signal intensities on different imaging sequences. Eur Radiol 17:835–842PubMedCrossRefGoogle Scholar
  7. Balassy C, Kasprian G, Brugger PC, Csapo B, Weber M, Hormann M, Bankier A, Bammer R, Herold CJ, Prayer D (2008) Diffusion-weighted MR imaging of the normal fetal lung. Eur Radiol 18:700–706PubMedCrossRefGoogle Scholar
  8. Brace RA, Wlodek ME, Cock ML, Harding R (1994) Swallowing of lung liquid and amniotic fluid by the ovine fetus under normoxic and hypoxic conditions. Am J Obstet Gynecol 171:764–770PubMedGoogle Scholar
  9. Brewerton LJ, Chari RS, Liang Y, Bhargava R (2005) Fetal lung-to-liver signal intensity ratio at MR imaging: development of a normal scale and possible role in predicting pulmonary hypoplasia in utero. Radiology 235:1005–1010. Epub 2005 Apr 1021Google Scholar
  10. Burri PH (1997) Structural Aspects of Prenatal and Postnatal Development and Growth of the Lung. In: McDonald JA (ed) Lung growth and development. Marcel Dekker, New York, pp 1–35Google Scholar
  11. Busing KA, Kilian AK, Schaible T, Debus A, Weiss C, Neff KW (2008) Reliability and validity of MR image lung volume measurement in fetuses with congenital diaphragmatic hernia and in vitro lung models. Radiology 246:553–561PubMedCrossRefGoogle Scholar
  12. Cannie M, Jani JC, De Keyzer F, Devlieger R, Van Schoubroeck D, Witters I, Marchal G, Dymarkowski S, Deprest JA (2006) Fetal body volume: use at MR imaging to quantify relative lung volume in fetuses suspected of having pulmonary hypoplasia. Radiology 241:847–853PubMedCrossRefGoogle Scholar
  13. Cannie MM, Jani JC, Van Kerkhove F, Meerschaert J, De Keyzer F, Lewi L, Deprest JA, Dymarkowski S (2008) Fetal body volume at MR imaging to quantify total fetal lung volume: normal ranges. Radiology 247:197–203PubMedCrossRefGoogle Scholar
  14. Cayea PD, Grant DC, Doubilet PM, Jones TB (1985) Prediction of fetal lung maturity: inaccuracy of study using conventional ultrasound instruments. Radiology 155:473–475PubMedGoogle Scholar
  15. Clifton MS, Joe BN, Zektzer AS, Kurhanewicz J, Vigneron DB, Coakley FV, Nobuhara KK, Swanson MG (2006) Feasibility of magnetic resonance spectroscopy for evaluating fetal lung maturity. J Pediatr Surg 41:768–773PubMedCrossRefGoogle Scholar
  16. Coakley FV, Lopoo JB, Lu Y, Hricak H, Albanese CT, Harrison MR, Filly RA (2000) Normal and hypoplastic fetal lungs: volumetric assessment with prenatal single-shot rapid acquisition with relaxation enhancement MR imaging. Radiology 216:107–111PubMedGoogle Scholar
  17. Cosmi EV, Anceschi MM, Cosmi E, Piazze JJ, La Torre R (2003) Ultrasonographic patterns of fetal breathing movements in normal pregnancy. Int J Gynaecol Obstet 80:285–290PubMedCrossRefGoogle Scholar
  18. de Vries JI, Fong BF (2007) Changes in fetal motility as a result of congenital disorders: an overview. Ultrasound Obstet Gynecol 29:590–599PubMedCrossRefGoogle Scholar
  19. de Vries JI, Visser GH, Prechtl HF (1982) The emergence of fetal behaviour. I. Qualitative aspects. Early Hum Dev 7:301–322PubMedCrossRefGoogle Scholar
  20. Duncan KR, Gowland PA, Freeman A, Moore R, Baker PN, Johnson IR (1999a) The changes in magnetic resonance properties of the fetal lungs: a first result and a potential tool for the non-invasive in utero demonstration of fetal lung maturation. Br J Obstet Gynaecol 106:122–125PubMedCrossRefGoogle Scholar
  21. Duncan KR, Gowland PA, Moore RJ, Baker PN, Johnson IR (1999b) Assessment of fetal lung growth in utero with echo-planar MR imaging. Radiology 210:197–200PubMedGoogle Scholar
  22. Fenton BW, Lin CS, Macedonia C, Schellinger D, Ascher S (2001) The fetus at term: in utero volume-selected proton MR spectroscopy with a breath-hold technique–a feasibility study. Radiology 219:563–566PubMedGoogle Scholar
  23. Fong K, Ohlsson A, Zalev A (1988) Fetal thoracic circumference: a prospective cross-sectional study with real-time ultrasound. Am J Obstet Gynecol 158:1154–1160PubMedGoogle Scholar
  24. Gerards FA, Twisk JW, Bakker M, Barkhof F, van Vugt JM (2007) Fetal lung volume: three-dimensional ultrasonography compared with magnetic resonance imaging. Ultrasound Obstet Gynecol 29:533–536PubMedCrossRefGoogle Scholar
  25. Gerards FA, Twisk JW, Fetter WP, Wijnaendts LC, van Vugt JM (2008) Predicting pulmonary hypoplasia with 2- or 3-dimensional ultrasonography in complicated pregnancies. Am J Obstet Gynecol 198(140):e141–e146Google Scholar
  26. Gluud C, Gluud LL (2005) Evidence based diagnostics. BMJ 330:724–726PubMedCrossRefGoogle Scholar
  27. Hall SM, Hislop AA, Haworth SG (2002) Origin, differentiation, and maturation of human pulmonary veins. Am J Respir Cell Mol Biol 26:333–340PubMedCrossRefGoogle Scholar
  28. Harding R, Hooper SB (1996) Regulation of lung expansion and lung growth before birth. J Appl Physiol 81:209–224PubMedGoogle Scholar
  29. Heling KS, Tennstedt C, Chaoui R, Kalache KD, Hartung J, Bollmann R (2001) Reliability of prenatal sonographic lung biometry in the diagnosis of pulmonary hypoplasia. Prenat Diagn 21:649–657PubMedCrossRefGoogle Scholar
  30. Heling KS, Wauer RR, Hammer H, Bollmann R, Chaoui R (2005) Reliability of the lung-to-head ratio in predicting outcome and neonatal ventilation parameters in fetuses with congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 25:112–118PubMedCrossRefGoogle Scholar
  31. Hislop A, Reid L (1973) Lung development in relation to gas exchange capacity. Bull Physiopathol Respir (Nancy) 9:1317–1343Google Scholar
  32. Ikeda K, Hokuto I, Mori K, Hayashida S, Tokieda K, Tanigaki S, Tanaka M, Yuasa Y (2000) Intrauterine MRI with single-shot fast-spin echo imaging showed different signal intensities in hypoplastic lungs. J Perinat Med 28:151–154PubMedCrossRefGoogle Scholar
  33. Inanlou MR, Baguma-Nibasheka M, Kablar B (2005) The role of fetal breathing-like movements in lung organogenesis. Histol Histopathol 20:1261–1266PubMedGoogle Scholar
  34. Jani J, Breysem L, Maes F, Boulvain M, Roubliova X, Lewi L, Vaast P, Biard JM, Cannie M, Deprest J (2005) Accuracy of magnetic resonance imaging for measuring fetal sheep lungs and other organs. Ultrasound Obstet Gynecol 25:270–276PubMedCrossRefGoogle Scholar
  35. Jani J, Keller RL, Benachi A, Nicolaides KH, Favre R, Gratacos E, Laudy J, Eisenberg V, Eggink A, Vaast P, Deprest J (2006) Prenatal prediction of survival in isolated left-sided diaphragmatic hernia. Ultrasound Obstet Gynecol 27:18–22PubMedCrossRefGoogle Scholar
  36. Jesudason EC, Smith NP, Connell MG, Spiller DG, White MR, Fernig DG, Losty PD (2005) Developing rat lung has a sided pacemaker region for morphogenesis-related airway peristalsis. Am J Respir Cell Mol Biol 32:118–127. Epub 2004 Dec 2002Google Scholar
  37. Kasprian G, Balassy C, Brugger PC, Prayer D (2006) MRI of normal and pathological fetal lung development. Eur J Radiol 57:261–270PubMedCrossRefGoogle Scholar
  38. Keller TM, Rake A, Michel SC, Seifert B, Wisser J, Marincek B, Kubik-Huch RA (2004) MR assessment of fetal lung ­development using lung volumes and signal intensities. Eur Radiol 14:984–989. Epub 2004 Mar 2011Google Scholar
  39. Kim DH, Vahidi K, Caughey AB, Coakley FV, Vigneron DB, Kurhanewicz J, Mow B, Joe BN (2008) In vivo (1)H magnetic resonance spectroscopy of amniotic fluid and fetal lung at 1.5 T: technical challenges. J Magn Reson Imaging 28:1033–1038PubMedCrossRefGoogle Scholar
  40. Kok RD, van den Berg PP, van den Bergh AJ, Nijland R, Heerschap A (2002) MR spectroscopy in the human fetus. Radiology 223:584; author reply 584–585Google Scholar
  41. Kotecha S (2000) Lung growth for beginners. Paediatr Respir Rev 1:308–313PubMedCrossRefGoogle Scholar
  42. Krieglsteiner P, Schneider R, Kopcke H, Tolle W, Johannigmann J, Blumel G (1976) Prenatal prediction of respiratory distress syndrome. Measurement of surface properties and Lecithin/Sphingomyelin ratio in human amniotic fluid. J Perinat Med 4:261–270PubMedCrossRefGoogle Scholar
  43. Kuwashima S, Nishimura G, Iimura F, Kohno T, Watanabe H, Kohno A, Fujioka M (2001) Low-intensity fetal lungs on MRI may suggest the diagnosis of pulmonary hypoplasia. Pediatr Radiol 31:669–672PubMedCrossRefGoogle Scholar
  44. Langston C, Kida K, Reed M, Thurlbeck WM (1984) Human lung growth in late gestation and in the neonate. Am Rev Respir Dis 129:607–613PubMedGoogle Scholar
  45. Laudy JA, Wladimiroff JW (2000) The fetal lung. 1: Developmental aspects. Ultrasound Obstet Gynecol 16:284–290PubMedCrossRefGoogle Scholar
  46. Levine D, Barnewolt CE, Mehta TS, Trop I, Estroff J, Wong G (2003) Fetal thoracic abnormalities: MR imaging. Radiology 228:379–388. Epub 2003 Jun 23Google Scholar
  47. Manganaro L, Perrone A, Sassi S, Fierro F, Savelli S, Di Maurizio M, Tomei A, Francioso A, La Barbera L, Giancotti A, Ballesio L (2008) Diffusion-weighted MR imaging and apparent diffusion coefficient of the normal fetal lung: preliminary experience. Prenat Diagn 28: 745–748PubMedCrossRefGoogle Scholar
  48. McCray PB Jr, Bettencourt JD, Bastacky J (1992) Developing bronchopulmonary epithelium of the human fetus secretes fluid. Am J Physiol 262:L270–L279PubMedGoogle Scholar
  49. McGowan PE, Reglinski J, Wilson R, Walker JJ, Wisdoms S, McKillop JH (1993) Quantitative 1H-NMR analysis of amniotic fluid. J Pharm Biomed Anal 11:629–632PubMedCrossRefGoogle Scholar
  50. Merz E, Miric-Tesanic D, Bahlmann F, Weber G, Hallermann C (1999) Prenatal sonographic chest and lung measurements for predicting severe pulmonary hypoplasia. Prenat Diagn 19:614–619PubMedCrossRefGoogle Scholar
  51. Metkus AP, Filly RA, Stringer MD, Harrison MR, Adzick NS (1996) Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg 31:148–151; discussion 151–142Google Scholar
  52. Meyberg-Solomayer GC, Wallwiener D, Solomayer E (2007) Maternal breath-holding and the valsalva maneuver: methods to overcome fetal breathing movements during Doppler sonography. Ultrasound Med Biol 33:1586–1591PubMedCrossRefGoogle Scholar
  53. Moore RJ, Strachan B, Tyler DJ, Baker PN, Gowland PA (2001) In vivo diffusion measurements as an indication of fetal lung maturation using echo planar imaging at 0.5T. Magn Reson Med 45:247–253PubMedCrossRefGoogle Scholar
  54. Natale R, Nasello-Paterson C, Connors G (1988) Patterns of fetal breathing activity in the human fetus at 24 to 28 weeks of gestation. Am J Obstet Gynecol 158:317–321PubMedGoogle Scholar
  55. Nelson TR, Gillies RJ, Powell DA, Schrader MC, Manchester DK, Pretorius DH (1987) High resolution proton NMR spectroscopy of human amniotic fluid. Prenat Diagn 7:363–372PubMedCrossRefGoogle Scholar
  56. Nimrod C, Davies D, Iwanicki S, Harder J, Persaud D, Nicholson S (1986) Ultrasound prediction of pulmonary hypoplasia. Obstet Gynecol 68:495–498PubMedGoogle Scholar
  57. Odom MW, Ballard PL (1997) Developmental and hormonal regulation of the surfactant system. In: McDonald JA (ed) Lung growth and development. Marcel Dekker, New York, pp 495–575Google Scholar
  58. Osada H, Kaku K, Masuda K, Iitsuka Y, Seki K, Sekiya S (2004) Quantitative and qualitative evaluations of fetal lung with MR imaging. Radiology 231:887–892. Epub 2004 Apr 2029Google Scholar
  59. Powell MC, Worthington BS, Buckley JM, Symonds EM (1988) Magnetic resonance imaging (MRI) in obstetrics. II. Fetal anatomy. Br J Obstet Gynaecol 95:38–46PubMedCrossRefGoogle Scholar
  60. Prayer D, Kasprian G, Krampl E, Ulm B, Witzani L, Prayer L, Brugger PC (2006) MRI of normal fetal brain development. Eur J Radiol 57:199–216PubMedCrossRefGoogle Scholar
  61. Rasanen J, Wood DC, Weiner S, Ludomirski A, Huhta JC (1996) Role of the pulmonary circulation in the distribution of human fetal cardiac output during the second half of pregnancy. Circulation 94:1068–1073PubMedCrossRefGoogle Scholar
  62. Rayburn WF (1995) Fetal movement monitoring. Clin Obstet Gynecol 38:59–67PubMedCrossRefGoogle Scholar
  63. Reid L (1977) 1976 Edward B.D. Neuhauser lecture: the lung: growth and remodeling in health and disease. AJR Am J Roentgenol 129:777–788PubMedCrossRefGoogle Scholar
  64. Rypens F, Metens T, Rocourt N, Sonigo P, Brunelle F, Quere MP, Guibaud L, Maugey-Laulom B, Durand C, Avni FE, Eurin D (2001) Fetal lung volume: estimation at MR imaging-initial results. Radiology 219:236–241PubMedGoogle Scholar
  65. Sanchez-Esteban J, Wang Y, Cicchiello LA, Rubin LP (2002) Cyclic mechanical stretch inhibits cell proliferation and induces apoptosis in fetal rat lung fibroblasts. Am J Physiol Lung Cell Mol Physiol 282:L448–L456PubMedGoogle Scholar
  66. Sbragia L, Paek BW, Filly RA, Harrison MR, Farrell JA, Farmer DL, Albanese CT (2000) Congenital diaphragmatic hernia without herniation of the liver: does the lung-to-head ratio predict survival? J Ultrasound Med 19:845–848PubMedGoogle Scholar
  67. Schittny JC, Miserocchi G, Sparrow MP (2000) Spontaneous peristaltic airway contractions propel lung liquid through the bronchial tree of intact and fetal lung explants. Am J Respir Cell Mol Biol 23:11–18PubMedCrossRefGoogle Scholar
  68. Scott JE, Yang SY, Stanik E, Anderson JE (1993) Influence of strain on [3H]thymidine incorporation, surfactant-related phospholipid synthesis, and cAMP levels in fetal type II alveolar cells. Am J Respir Cell Mol Biol 8:258–265PubMedCrossRefGoogle Scholar
  69. Sedin G, Bogner P, Berenyi E, Repa I, Nyul Z, Sulyok E (2000) Lung water and proton magnetic resonance relaxation in preterm and term rabbit pups: their relation to tissue hyaluronan. Pediatr Res 48:554–559PubMedCrossRefGoogle Scholar
  70. Sims CJ, Fujito DT, Burholt DR, Dadok J, Giles HR, Wilkinson DA (1993) Quantification of human amniotic fluid constituents by high resolution proton nuclear magnetic resonance (NMR) spectroscopy. Prenat Diagn 13:473–480PubMedCrossRefGoogle Scholar
  71. Smith FW, Adam AH, Phillips WD (1983) NMR imaging in pregnancy. Lancet 1:61–62PubMedCrossRefGoogle Scholar
  72. Songster GS, Gray DL, Crane JP (1989) Prenatal prediction of lethal pulmonary hypoplasia using ultrasonic fetal chest circumference. Obstet Gynecol 73:261–266PubMedGoogle Scholar
  73. Tanigaki S, Miyakoshi K, Tanaka M, Hattori Y, Matsumoto T, Ueno K, Uehara K, Nishimura O, Minegishi K, Ishimoto H, Shinmoto H, Ikeda K, Yoshimura Y (2004) Pulmonary hypoplasia: prediction with use of ratio of MR imaging-measured fetal lung volume to US-estimated fetal body weight. Radiology 232:767–772PubMedCrossRefGoogle Scholar
  74. Tekesin I, Anderer G, Hellmeyer L, Stein W, Kuhnert M, Schmidt S (2004) Assessment of fetal lung development by quantitative ultrasonic tissue characterization: a methodical study. Prenat Diagn 24:671–676PubMedCrossRefGoogle Scholar
  75. Thayyil S, Schievano S, Robertson NJ, Jones R, Chitty LS, Sebire NJ, Taylor AM (2008) A semi-automated method for non-invasive internal organ weight estimation by post-mortem magnetic resonance imaging in fetuses, newborns and children. Eur J Radiol 72:321–326Google Scholar
  76. Thompson HE, Makowski EL (1971) Estimation of birth weight and gestational age. Obstet Gynecol 37:44–47PubMedGoogle Scholar
  77. Thurlbeck WM (1982) Postnatal human lung growth. Thorax 37:564–571PubMedCrossRefGoogle Scholar
  78. Thurlbeck WM (1988) Lung growth. In: Thurlbeck WM (ed) Pathology of the lung. Georg Thieme, Stuttgart, pp 1–10Google Scholar
  79. Trudinger BJ, Knight PC (1980) Fetal age and patterns of human fetal breathing movements. Am J Obstet Gynecol 137:724–728PubMedGoogle Scholar
  80. Trudinger BJ, Gordon YB, Grudzinskas JG, Hull MG, Lewis PJ, Arrans ME (1979) Fetal breathing movements and other tests of fetal wellbeing: a comparative evaluation. Br Med J 2:577–579PubMedCrossRefGoogle Scholar
  81. Vintzileos AM, Campbell WA, Rodis JF, Nochimson DJ, Pinette MG, Petrikovsky BM (1989) Comparison of six different ultrasonographic methods for predicting lethal fetal pulmonary hypoplasia. Am J Obstet Gynecol 161:606–612PubMedGoogle Scholar
  82. Ward VL, Nishino M, Hatabu H, Estroff JA, Barnewolt CE, Feldman HA, Levine D (2006) Fetal lung volume measurements: determination with MR imaging–effect of various factors. Radiology 240:187–193PubMedCrossRefGoogle Scholar
  83. Weber H (1888) Über physiologische Atmungsbewegungen des Kindes im Uterus. Thesis. Marburg/Lahn, University of MarburgGoogle Scholar
  84. Wedegaertner U, Tchirikov M, Habermann C, Hecher K, Deprest J, Adam G, Schroeder HJ (2004) Fetal sheep with tracheal occlusion: monitoring lung development with MR imaging and B-mode US. Radiology 230:353–358. Epub 2003 Dec 2029Google Scholar
  85. Williams G, Coakley FV, Qayyum A, Farmer DL, Joe BN, Filly RA (2004) Fetal relative lung volume: quantification by using prenatal MR imaging lung volumetry. Radiology 233:457–462. Epub 2004 Sep 30Google Scholar
  86. Zeltner TB, Bertacchini M, Messerli A, Burri PH (1990) Morphometric estimation of regional differences in the rat lung. Exp Lung Res 16:145–158PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of RadiologyMedical University of ViennaViennaAustria

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