Objective: The objective of this article is to present the fetal MRI patterns of complex genitourinary abnormalities including epispadias-exstrophy complex, cloacal malformation, urogenital sinus anomaly, posterior urethral valves, and other causes that result in lower urinary tract dilatation without oligohydramnios. Relevant embryology will be reviewed, and practical points will be provided that can aid in interpretation.
Conclusion: Complex genitourinary abnormalities have recognizable imaging findings on fetal MRI. Imaging findings may be subtle; a high index of suspicion and a systematic checklist are useful for accurate diagnosis. Familiarity with fetal MRI patterns of complex genitourinary abnormalities is crucial for making more precise diagnoses that will likely impact pregnancy management, counseling, and postnatal treatment.