Characterization of the Hyperintense Bronchus Sign as a Fetal MRI Marker of Airway Obstruction

Florian Prayer, Amy R Mehollin-Ray, Christopher C Cassady, Gerlinde M Gruber, Peter C Brugger, Anke Scharrer, Martin Metzelder, Julia Binder, Azadeh Hojreh, Michael Weber, Helmut Prosch, Daniela Prayer, Gregor Kasprian

Research output: Journal article (peer-reviewed)Journal article

3 Citations (Scopus)


Background Fetal MRI-based differential diagnosis of congenital lung malformations is difficult because of the paucity of well-described imaging markers. Purpose To characterize the hyperintense bronchus sign (HBS) in in vivo fetal MRI of congenital lung malformation cases. Materials and Methods In this retrospective two-center study, fetal MRI scans obtained in fetuses with congenital lung malformations at US (January 2002 to September 2018) were reviewed for the HBS, a tubular or branching hyperintense structure within a lung lesion on T2-weighted images. The frequency of the HBS and respective gestational ages in weeks and days were analyzed. Areas under the curve (AUCs), 95% CIs, and P values of the HBS regarding airway obstruction, as found in histopathologic and postnatal CT findings as the reference standards, were calculated for different gestational ages. Results A total of 177 fetuses with congenital lung malformations (95 male fetuses) and 248 fetal MRI scans obtained at a median gestational age of 25.6 weeks (interquartile range, 8.9 weeks) were included. The HBS was found in 79% (53 of 67) of fetuses with bronchial atresia, 71% (39 of 55) with bronchopulmonary sequestration (BPS), 43% (three of seven) with hybrid lesion, 15% (six of 40) with congenital cystic adenomatoid malformation, and 13% (one of eight) with bronchogenic cyst at a median gestational age of 24.9 weeks (interquartile range, 9.7 weeks). HBS on MRI scans at any gestational age had an AUC of 0.76 (95% CI: 0.70, 0.83; P = .04) for the presence of isolated or BPS-associated airway obstruction at histopathologic analysis and postnatal CT. The AUC of HBS on fetal MRI scans obtained until gestational age of 26 weeks (AUC, 0.83; 95% CI: 0.75, 0.91; P < .001) was significantly higher (P = .045) than that for fetal MRI scans obtained after gestational age 26 weeks (AUC, 0.69; 95% CI: 0.57, 0.80; P = .004). Conclusion The hyperintense bronchus sign is a frequently detectable feature at fetal MRI and is associated with airway obstruction particularly before gestational age 26 weeks. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Dubinsky in this issue.

Original languageEnglish
Pages (from-to)423-430
Number of pages8
Issue number2
Publication statusPublished - Aug 2021


  • Airway Obstruction/diagnostic imaging
  • Bronchi/diagnostic imaging
  • Bronchogenic Cyst/congenital
  • Bronchopulmonary Sequestration/diagnostic imaging
  • Cystic Adenomatoid Malformation of Lung, Congenital/diagnostic imaging
  • Diagnosis, Differential
  • Female
  • Gestational Age
  • Humans
  • Lung/diagnostic imaging
  • Magnetic Resonance Imaging/methods
  • Male
  • Pregnancy
  • Prenatal Diagnosis/methods
  • Retrospective Studies
  • Tomography, X-Ray Computed

ASJC Scopus subject areas

  • Radiology, Nuclear Medicine and Imaging


Dive into the research topics of 'Characterization of the Hyperintense Bronchus Sign as a Fetal MRI Marker of Airway Obstruction'. Together they form a unique fingerprint.

Cite this