Antenatal subpial hemorrhage diagnosed by fetal magnetic resonance imaging: imaging spectrum and autopsy findings

Subpial hemorrhage is a rare intracranial hemorrhage typically described in neonates. We report the first prenatal diagnosis of subpial hemorrhage in a 28-year-old primigravida, defined on fetal magnetic resonance imaging (MRI) by its hallmark cortical inward depression (“cortical buckling”) and restricted diffusion on the apparent diffusion coefficient map, and later confirmed by autopsy. This case implicates intrinsic fetal factors—rather than birth trauma or neonatal asphyxia—in subpial hemorrhage pathogenesis and highlights the critical role of fetal MRI in distinguishing subpial hemorrhage from other fetal hemorrhages, with important implications for prenatal counseling and perinatal management.