The Role of Fetal MRI in the Evaluation of Ventriculomegaly: A Scoping Review

Background/Objectives: Fetal MRI is used increasingly to detect fetal brain anomalies despite limited high-quality evidence. The common anomaly, ventriculomegaly, exemplifies the challenge of using fetal MRI for neurodevelopmental prognostication. Methods: This scoping review followed JBI guidelines. Four electronic databases were searched without restriction. Screened studies were eligible where they included primary data with fetal MRI showing ventriculomegaly and clinical investigations, management, or fetal outcomes. A descriptive numerical summary with data-driven bivariate and multivariate analysis of case-level data was undertaken. Results: A total of 345 studies were included (1027 cases, 121 cohorts). Fetal MRI was performed at a mean of 28 weeks’ gestation. It yielded additional or different imaging findings to US in 60.1%. Fetal results differed from neonatal MRI in 52.8%. Discrepancy between imaging modalities has increased from 1986–2025. About 69.1% of fetuses were liveborn, 28.9% were terminated and 1.9% died in utero. Postnatal neurosurgery was common after severe ventriculomegaly (36.7%). Neurodevelopmental issues were common (63.5%), especially where additional brain anomalies were detected on fetal MRI (OR 6.40 (95% CI 4.02–10.2), p < 0.001). Conclusions: Fetal MRI may contribute to neurodevelopmental prognostication in fetal ventriculomegaly in conjunction with other investigations. Available evidence is of mixed quality with variable reporting, relying on retrospective studies and non-standardized outcome measures. Long-term prospective studies are required.