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Moscatelli S, Avesani M, Borrelli N, Sabatino J, Pergola V, Leo I, Montanaro C, Contini FV, Gaudieri G, Ielapi J, Motta R, Merrone MA, Di Salvo G. Complete Transposition of the Great Arteries in the Pediatric Field: A Multimodality Imaging Approach. CHILDREN (BASEL, SWITZERLAND) 2024; 11:626. [PMID: 38929206 PMCID: PMC11202141 DOI: 10.3390/children11060626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/07/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
The complete transposition of the great arteries (C-TGA) is a congenital cardiac anomaly characterized by the reversal of the main arteries. Early detection and precise management are crucial for optimal outcomes. This review emphasizes the integral role of multimodal imaging, including fetal echocardiography, transthoracic echocardiography (TTE), cardiovascular magnetic resonance (CMR), and cardiac computed tomography (CCT) in the diagnosis, treatment planning, and long-term follow-up of C-TGA. Fetal echocardiography plays a pivotal role in prenatal detection, enabling early intervention strategies. Despite technological advances, the detection rate varies, highlighting the need for improved screening protocols. TTE remains the cornerstone for initial diagnosis, surgical preparation, and postoperative evaluation, providing essential information on cardiac anatomy, ventricular function, and the presence of associated defects. CMR and CCT offer additional value in C-TGA assessment. CMR, free from ionizing radiation, provides detailed anatomical and functional insights from fetal life into adulthood, becoming increasingly important in evaluating complex cardiac structures and post-surgical outcomes. CCT, with its high-resolution imaging, is indispensable in delineating coronary anatomy and vascular structures, particularly when CMR is contraindicated or inconclusive. This review advocates for a comprehensive imaging approach, integrating TTE, CMR, and CCT to enhance diagnostic accuracy, guide therapeutic interventions, and monitor postoperative conditions in C-TGA patients. Such a multimodal strategy is vital for advancing patient care and improving long-term prognoses in this complex congenital heart disease.
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Affiliation(s)
- Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 5NP, UK
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital of Padua, 35128 Padua, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO Dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Jolanda Sabatino
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy (I.L.)
| | - Valeria Pergola
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, University Hospital of Padua, 35128 Padua, Italy; (V.P.)
| | - Isabella Leo
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy (I.L.)
| | - Claudia Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 5NP, UK
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 5NP, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Francesca Valeria Contini
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University Hospital of Cagliari, Strada Statale 554, Km 4.500, 09042 Monserrato, Italy
- Pediatric Cardiology and Congenital Heart Disease Unit, Brotzu Hospital, 09134 Cagliari, Italy
| | - Gabriella Gaudieri
- Adult Congenital Heart Disease Unit, AO Dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Jessica Ielapi
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy (I.L.)
| | - Raffaella Motta
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, University Hospital of Padua, 35128 Padua, Italy; (V.P.)
| | - Marco Alfonso Merrone
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
- Division of Cardiology and Cardio Lab, Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital of Padua, 35128 Padua, Italy
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Gottschalk I, Walter A, Menzel T, Weber EC, Wendt S, Sreeram N, Gembruch U, Berg C, Abel JS. D-Transposition of the great arteries with restrictive foramen ovale in the fetus: the dilemma of predicting the need for postnatal urgent balloon atrial septostomy. Arch Gynecol Obstet 2024; 309:1353-1367. [PMID: 36971845 PMCID: PMC10894161 DOI: 10.1007/s00404-023-06997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Restrictive foramen ovale (FO) in dextro-transposition of the great arteries (d-TGA) with intact ventricular septum may lead to severe life-threatening hypoxia within the first hours of life, making urgent balloon atrial septostomy (BAS) inevitable. Reliable prenatal prediction of restrictive FO is crucial in these cases. However, current prenatal echocardiographic markers show low predictive value, and prenatal prediction often fails with fatal consequences for a subset of newborns. In this study, we described our experience and aimed to identify reliable predictive markers for BAS. METHODS We included 45 fetuses with isolated d-TGA that were diagnosed and delivered between 2010 and 2022 in two large German tertiary referral centers. Inclusion criteria were the availability of former prenatal ultrasound reports, of stored echocardiographic videos and still images, which had to be obtained within the last 14 days prior to delivery and that were of sufficient quality for retrospective re-analysis. Cardiac parameters were retrospectively assessed and their predictive value was evaluated. RESULTS Among the 45 included fetuses with d-TGA, 22 neonates had restrictive FO postnatally and required urgent BAS within the first 24 h of life. In contrast, 23 neonates had normal FO anatomy, but 4 of them unexpectedly showed inadequate interatrial mixing despite their normal FO anatomy, rapidly developed hypoxia and also required urgent BAS ('bad mixer'). Overall, 26 (58%) neonates required urgent BAS, whereas 19 (42%) achieved good O2 saturation and did not undergo urgent BAS. In the former prenatal ultrasound reports, restrictive FO with subsequent urgent BAS was correctly predicted in 11 of 22 cases (50% sensitivity), whereas a normal FO anatomy was correctly predicted in 19 of 23 cases (83% specificity). After current re-analysis of the stored videos and images, we identified three highly significant markers for restrictive FO: a FO diameter < 7 mm (p < 0.01), a fixed (p = 0.035) and a hypermobile (p = 0.014) FO flap. The maximum systolic flow velocities in the pulmonary veins were also significantly increased in restrictive FO (p = 0.021), but no cut-off value to reliably predict restrictive FO could be identified. If the above markers are applied, all 22 cases with restrictive FO and all 23 cases with normal FO anatomy could correctly be predicted (100% positive predictive value). Correct prediction of urgent BAS also succeeded in all 22 cases with restrictive FO (100% PPV), but naturally failed in 4 of the 23 cases with correctly predicted normal FO ('bad mixer') (82.6% negative predictive value). CONCLUSION Precise assessment of FO size and FO flap motility allows a reliable prenatal prediction of both restrictive and normal FO anatomy postnatally. Prediction of likelihood of urgent BAS also succeeds reliably in all fetuses with restrictive FO, but identification of the small subset of fetuses that also requires urgent BAS despite their normal FO anatomy fails, because the ability of sufficient postnatal interatrial mixing cannot be predicted prenatally. Therefore, all fetuses with prenatally diagnosed d-TGA should always be delivered in a tertiary center with cardiac catheter stand-by, allowing BAS within the first 24 h after birth, regardless of their predicted FO anatomy.
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Affiliation(s)
- I Gottschalk
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - A Walter
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - T Menzel
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - E C Weber
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - S Wendt
- Heartcenter, Department of Cardiac Surgery, Cardiothoracic Intensive Care and Thoracic Surgery, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - N Sreeram
- Department of Pediatric Cardiology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - C Berg
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - J S Abel
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
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Vollbrecht TM, Bissell MM, Kording F, Geipel A, Isaak A, Strizek BS, Hart C, Barker AJ, Luetkens JA. Fetal Cardiac MRI Using Doppler US Gating: Emerging Technology and Clinical Implications. Radiol Cardiothorac Imaging 2024; 6:e230182. [PMID: 38602469 PMCID: PMC11056758 DOI: 10.1148/ryct.230182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 04/12/2024]
Abstract
Fetal cardiac MRI using Doppler US gating is an emerging technique to support prenatal diagnosis of congenital heart disease and other cardiovascular abnormalities. Analogous to postnatal electrocardiographically gated cardiac MRI, this technique enables directly gated MRI of the fetal heart throughout the cardiac cycle, allowing for immediate data reconstruction and review of image quality. This review outlines the technical principles and challenges of cardiac MRI with Doppler US gating, such as loss of gating signal due to fetal movement. A practical workflow of patient preparation for the use of Doppler US-gated fetal cardiac MRI in clinical routine is provided. Currently applied MRI sequences (ie, cine or four-dimensional flow imaging), with special consideration of technical adaptations to the fetal heart, are summarized. The authors provide a literature review on the clinical benefits of Doppler US-gated fetal cardiac MRI for gaining additional diagnostic information on cardiovascular malformations and fetal hemodynamics. Finally, future perspectives of Doppler US-gated fetal cardiac MRI and further technical developments to reduce acquisition times and eliminate sources of artifacts are discussed. Keywords: MR Fetal, Ultrasound Doppler, Cardiac, Heart, Congenital, Obstetrics, Fetus Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Thomas M. Vollbrecht
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Malenka M. Bissell
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Fabian Kording
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Annegret Geipel
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Alexander Isaak
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Brigitte S. Strizek
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Christopher Hart
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Alex J. Barker
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Julian A. Luetkens
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
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Vollbrecht TM, Hart C, Zhang S, Katemann C, Sprinkart AM, Isaak A, Attenberger U, Pieper CC, Kuetting D, Geipel A, Strizek B, Luetkens JA. Deep learning denoising reconstruction for improved image quality in fetal cardiac cine MRI. Front Cardiovasc Med 2024; 11:1323443. [PMID: 38410246 PMCID: PMC10894983 DOI: 10.3389/fcvm.2024.1323443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/10/2024] [Indexed: 02/28/2024] Open
Abstract
Purpose This study aims to evaluate deep learning (DL) denoising reconstructions for image quality improvement of Doppler ultrasound (DUS)-gated fetal cardiac MRI in congenital heart disease (CHD). Methods Twenty-five fetuses with CHD (mean gestational age: 35 ± 1 weeks) underwent fetal cardiac MRI at 3T. Cine imaging was acquired using a balanced steady-state free precession (bSSFP) sequence with Doppler ultrasound gating. Images were reconstructed using both compressed sensing (bSSFP CS) and a pre-trained convolutional neural network trained for DL denoising (bSSFP DL). Images were compared qualitatively based on a 5-point Likert scale (from 1 = non-diagnostic to 5 = excellent) and quantitatively by calculating the apparent signal-to-noise ratio (aSNR) and contrast-to-noise ratio (aCNR). Diagnostic confidence was assessed for the atria, ventricles, foramen ovale, valves, great vessels, aortic arch, and pulmonary veins. Results Fetal cardiac cine MRI was successful in 23 fetuses (92%), with two studies excluded due to extensive fetal motion. The image quality of bSSFP DL cine reconstructions was rated superior to standard bSSFP CS cine images in terms of contrast [3 (interquartile range: 2-4) vs. 5 (4-5), P < 0.001] and endocardial edge definition [3 (2-4) vs. 4 (4-5), P < 0.001], while the extent of artifacts was found to be comparable [4 (3-4.75) vs. 4 (3-4), P = 0.40]. bSSFP DL images had higher aSNR and aCNR compared with the bSSFP CS images (aSNR: 13.4 ± 6.9 vs. 8.3 ± 3.6, P < 0.001; aCNR: 26.6 ± 15.8 vs. 14.4 ± 6.8, P < 0.001). Diagnostic confidence of the bSSFP DL images was superior for the evaluation of cardiovascular structures (e.g., atria and ventricles: P = 0.003). Conclusion DL image denoising provides superior quality for DUS-gated fetal cardiac cine imaging of CHD compared to standard CS image reconstruction.
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Affiliation(s)
- Thomas M Vollbrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Shuo Zhang
- Philips GmbH Market DACH, PD Clinical Science, Hamburg, Germany
| | | | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
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5
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Desmond A, Nguyen K, Watterson CT, Sklansky M, Satou GM, Prosper AE, Garg M, Van Arsdell GS, Finn JP, Afshar Y. Integration of Prenatal Cardiovascular Magnetic Resonance Imaging in Congenital Heart Disease. J Am Heart Assoc 2023; 12:e030640. [PMID: 37982254 PMCID: PMC10727279 DOI: 10.1161/jaha.123.030640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Standard of care echocardiography can have limited diagnostic accuracy in certain cases of fetal congenital heart disease. Prenatal cardiovascular magnetic resonance (CMR) imaging has potential to provide additional anatomic imaging information, including excellent soft tissue images in multiple planes, improving prenatal diagnostics and in utero hemodynamic assessment. We conducted a literature review of fetal CMR, including its development and implementation into clinical practice, and compiled and analyzed the results. Our findings included the fact that technological and innovative approaches are required to overcome some of the challenges in fetal CMR, in part due to the dynamic nature of the fetal heart. A number of reconstruction algorithms and cardiac gating strategies have been developed over time to improve fetal CMR image quality, allowing unique investigations into fetal hemodynamics, oxygenation, and growth. Studies demonstrate that incorporating CMR in the prenatal arena influences postnatal clinical management. With further refinement and experience, fetal CMR in congenital heart disease continues to evolve and demonstrate ongoing potential as a complementary imaging modality to fetal echocardiography in the care of these patients.
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Affiliation(s)
- Angela Desmond
- Division of Neonatology, Department of PediatricsUCLA Mattel Children’s HospitalLos AngelesCAUSA
| | - Kim‐Lien Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
- Division of CardiologyDavid Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
| | | | - Mark Sklansky
- Division of Pediatric Cardiology, Department of PediatricsDavid Geffen School of Medicine, UCLA Mattel Children’s HospitalLos AngelesCAUSA
| | - Gary M. Satou
- Division of Pediatric Cardiology, Department of PediatricsDavid Geffen School of Medicine, UCLA Mattel Children’s HospitalLos AngelesCAUSA
| | - Ashley E. Prosper
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
- Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
| | - Meena Garg
- Division of Neonatology, Department of PediatricsUCLA Mattel Children’s HospitalLos AngelesCAUSA
| | - Glen S. Van Arsdell
- Division of Cardiac Surgery, Department of SurgeryDavid Geffen School of Medicine, UCLALos AngelesCAUSA
| | - J. Paul Finn
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
- Division of CardiologyDavid Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and GynecologyDavid Geffen School of Medicine, UCLALos AngelesCAUSA
- Molecular Biology InstituteUniversity of CaliforniaLos AngelesCAUSA
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Guo N, Zhou K, Li Y, Luo S, Liu L, Liu H. A cohort study to investigate the potential indicators for prenatal echocardiographic detection of suspected coarctation of the aorta. Front Cardiovasc Med 2023; 10:1279453. [PMID: 38028462 PMCID: PMC10667901 DOI: 10.3389/fcvm.2023.1279453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Suspected coarctation of the aorta (CoA) is a common fetal echocardiographic presentation. However, the prenatal findings did not indicate a satisfied accuracy in determining the truly CoA after birth, which made the prenatal diagnosis of CoA still as a critical challenge with high false positive rate. Thus, this research is aimed to distinguish the potential prenatal parameters influencing the fetal echocardiographic images and enhance the true positive diagnostic rate of CoA fetuses which require early clinical intervention in postnatal life. Methods A retrospective study had been designed and fetuses with suspected with CoA had been included from Jan 2016 to Dec 2021 in our center. The fetal echocardiography and related clinical information had been collected. And the postnatal diagnosis had been reached by echocardiography or CTA. Then, all the parameters had been analyzed by univariate analysis, and a multivariate logistic regression analysis was further involved to determine the independent parameters influencing the accuracy of diagnosis CoA fetuses. Moreover, such results had been validated by nomogram analysis and ROC curve. Results Among the included 44 liveborn infants who presented suspected CoA in fetal cardiac screening, 18 cases had been proved to be CoA postnatally (Group P). The true positive rate for this study was 40.9% (18/44). The abnormal atrial hemodynamic status (AAHs) and the gestational week of delivery (GWoD) were associated with the postnatal CoA confirmation among prenatal suspected fetuses. The ROC curve of predicting probability of the mode combined with two independent factors of absence of AAH and GWoD (AUC = 0.880, 95% CI 0.763-0.997) presented a satisfied efficacy in distinguishing postnatal positive CoA diagnosis. The nomogram plot had been be utilized in CoA prediction (model likelihood ratio test, p < 0.0001). Conclusions AAH and GWoD had been identified as independent factors of predictive accuracy in detecting postnatal CoA among prenatal suspected fetuses. The prediction mode based on nomogram scores could be used to predict the risk of occurring CoA fetuses.
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Affiliation(s)
- Nan Guo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Ultrasonic Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kaiyu Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yifei Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shuhua Luo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hanmin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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7
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Udine M, Loke YH, Goudar S, Donofrio MT, Truong U, Krishnan A. The current state and potential innovation of fetal cardiac MRI. Front Pediatr 2023; 11:1219091. [PMID: 37520049 PMCID: PMC10375913 DOI: 10.3389/fped.2023.1219091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Fetal cardiac MRI is a rapidly evolving form of diagnostic testing with utility as a complementary imaging modality for the diagnosis of congenital heart disease and assessment of the fetal cardiovascular system. Previous technical limitations without cardiac gating for the fetal heart rate has been overcome with recent technology. There is potential utility of fetal electrocardiography for direct cardiac gating. In addition to anatomic assessment, innovative technology has allowed for assessment of blood flow, 3D datasets, and 4D flow, providing important insight into fetal cardiovascular physiology. Despite remaining technical barriers, with increased use of fCMR worldwide, it will become an important clinical tool to improve the prenatal care of fetuses with CHD.
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Affiliation(s)
- Michelle Udine
- Division of Cardiology, Children’s National Hospital, Washington, DC, United States
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8
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Piek M, Ryd D, Töger J, Testud F, Hedström E, Aletras AH. Fetal 3D cardiovascular cine image acquisition using radial sampling and compressed sensing. Magn Reson Med 2023; 89:594-604. [PMID: 36156292 PMCID: PMC10087603 DOI: 10.1002/mrm.29467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To explore a fetal 3D cardiovascular cine acquisition using a radial image acquisition and compressed-sensing reconstruction and compare image quality and scan time with conventional multislice 2D imaging. METHODS Volumetric fetal cardiac data were acquired in 26 volunteers using a radial 3D balanced SSFP pulse sequence. Cardiac gating was performed using a Doppler ultrasound device. Images were reconstructed using a parallel-imaging and compressed-sensing algorithm. Multiplanar reformatting to standard cardiac views was performed before image analysis. Clinical 2D images were used for comparison. Qualitative and quantitative image evaluation were performed by two experienced observers (scale: 1-4). Volumes, mass, and function were assessed. RESULTS Average scan time for the 3D imaging was 6 min, including one localizer. A 2D imaging stack covering the entire heart including localizer sequences took at least 6.5 min, depending on planning complexity. The 3D acquisition was successful in 7 of 26 subjects (27%). Overall image contrast and perceived resolution were lower in the 3D images. Nonetheless, the 3D images had, on average, a moderate cardiac diagnostic quality (median [range]: 3 [1-4]). Standard clinical 2D acquisitions had a high cardiac diagnostic quality (median [range]: 4 [3, 4]). Cardiac measurements were not different between 2D and 3D images (all p > 0.16). CONCLUSION The presented free-breathing whole-heart fetal 3D radial cine MRI acquisition and reconstruction method enables retrospective visualization of all cardiac views while keeping examination times short. This proof-of-concept work produced images with diagnostic quality, while at the same time reducing the planning complexity to a single localizer.
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Affiliation(s)
- Marjolein Piek
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anthony H Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Moerdijk AS, Claessens NH, van Ooijen IM, van Ooij P, Alderliesten T, Grotenhuis HB, Benders MJNL, Bohte AE, Breur JMPJ, Charisopoulou D, Clur SA, Cornette JMJ, Fejzic Z, Franssen MTM, Frerich S, Geerdink LM, Go ATJI, Gommers S, Helbing WA, Hirsch A, Holtackers RJ, Klein WM, Krings GJ, Lamb HJ, Nijman M, Pajkrt E, Planken RN, Schrauben EM, Steenhuis TJ, ter Heide H, Vanagt WYR, van Beynum IM, van Gaalen MD, van Iperen GG, van Schuppen J, Willems TP, Witters I. Fetal MRI of the heart and brain in congenital heart disease. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:59-68. [PMID: 36343660 DOI: 10.1016/s2352-4642(22)00249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
Antenatal assessment of congenital heart disease and associated anomalies by ultrasound has improved perinatal care. Fetal cardiovascular MRI and fetal brain MRI are rapidly evolving for fetal diagnostic testing of congenital heart disease. We give an overview on the use of fetal cardiovascular MRI and fetal brain MRI in congenital heart disease, focusing on the current applications and diagnostic yield of structural and functional imaging during pregnancy. Fetal cardiovascular MRI in congenital heart disease is a promising supplementary imaging method to echocardiography for the diagnosis of antenatal congenital heart disease in weeks 30-40 of pregnancy. Concomitant fetal brain MRI is superior to brain ultrasound to show the complex relationship between fetal haemodynamics in congenital heart disease and brain development.
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Affiliation(s)
- Anouk S Moerdijk
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nathalie Hp Claessens
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inge M van Ooijen
- Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pim van Ooij
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Thomas Alderliesten
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
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10
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Can Prenatal Diagnosis of Total Anomalous Pulmonary Venous Return (TAPVR) Using Routine Fetal Ultrasound be Improved? A Case-Control Study. Radiol Res Pract 2022; 2022:7141866. [PMID: 36624806 PMCID: PMC9825205 DOI: 10.1155/2022/7141866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/02/2023] Open
Abstract
Objectives To determine the most common fetal ultrasound markers of total anomalous pulmonary venous return (TAPVR) during mid-trimester ultrasound using standardly obtained images and evaluate the performance of diagnostic algorithms for improving prenatal diagnosis. Methods This was a matched case-control study at a regional referral centre (2005 to 2019). Cases of TAPVR were matched to controls 1 : 4 by date of birth and biologic sex. Postprocessing review of stored fetal ultrasound images was performed by two blinded and independent observers in a standardized fashion using nine sonographic markers: (i) left/right heart disproportion; (ii) abnormal distribution of great vessels; (iii) pulmonary vein entry into the left atrium (LA); (iv) confluence behind the LA; (v) abnormal coronary sinus; (vi) absence of the Coumadin ridge; (vii) aortic diameter; (viii) distance between LA and aorta; and (ix) post-LA space index >1.27. Descriptive and inferential statistics were used to present results and compare cases and controls. Diagnostic algorithms were compared by sensitivity/specificity. Results 21 cases of isolated TAPVR were matched to 84 controls (n = 105). The most common ultrasound marker of TAPVR was absence of pulmonary vein entry into the LA (42.9%), followed by abnormal Coumadin ridge (38.1%). Cases of TAPVR had significantly larger post-LA spaces than controls (p < 0.0001) and wider aortic diameters (p=0.006). A diagnostic algorithm stratifying on absence of pulmonary veins followed by an abnormal Coumadin ridge, can correctly identify cases of TAPVR with high specificity (90.5%) and moderate sensitivity (61.9%). Conversely, a diagnostic algorithm using the presence of any 3 abnormal markers had improved specificity (94.1%) but poorer sensitivity (23.8%). Conclusions Using standardly obtained images from routine fetal ultrasound, improved prenatal detection of isolated TAPVR is possible. A standardized diagnostic approach can be highly specific for fetal TAPVR, however, algorithms that are sufficiently sensitive for screening in the general population are still needed.
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11
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The Evolution and Developing Importance of Fetal Magnetic Resonance Imaging in the Diagnosis of Congenital Cardiac Anomalies: A Systematic Review. J Clin Med 2022; 11:jcm11237027. [PMID: 36498602 PMCID: PMC9738414 DOI: 10.3390/jcm11237027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Magnetic Resonance Imaging (MRI) is a reliable method, with a complementary role to Ultrasound (US) Echocardiography, that can be used to fully comprehend and precisely diagnose congenital cardiac malformations. Besides the anatomical study of the fetal cardiovascular system, it allows us to study the function of the fetal heart, remaining, at the same time, a safe adjunct to the classic fetal echocardiography. MRI also allows for the investigation of cardiac and placental diseases by providing information about hematocrit, oxygen saturation, and blood flow in fetal vessels. It is crucial for fetal medicine specialists and pediatric cardiologists to closely follow the advances of fetal cardiac MRI in order to provide the best possible care. In this review, we summarize the advance in techniques and their practical utility to date.
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12
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Knapp J, Tavares de Sousa M, Schönnagel BP. Fetal Cardiovascular MRI - A Systemic Review of the Literature: Challenges, New Technical Developments, and Perspectives. ROFO-FORTSCHR RONTG 2022; 194:841-851. [PMID: 35905903 DOI: 10.1055/a-1761-3500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Fetal magnetic resonance imaging (MRI) has become a valuable adjunct to ultrasound in the prenatal diagnosis of congenital pathologies of the central nervous system, thorax, and abdomen. Fetal cardiovascular magnetic resonance (CMR) was limited, mainly by the lack of cardiac gating, and has only recently evolved due to technical developments. METHOD A literature search was performed on PubMed, focusing on technical advancements to perform fetal CMR. In total, 20 publications on cardiac gating techniques in the human fetus were analyzed. RESULTS Fetal MRI is a safe imaging method with no developmental impairments found to be associated with in utero exposure to MRI. Fetal CMR is challenging due to general drawbacks (e. g., fetal motion) and specific limitations such as the difficulty to generate a cardiac gating signal to achieve high spatiotemporal resolution. Promising technical advancements include new methods for fetal cardiac gating, based on novel post-processing approaches and an external hardware device, as well as motion compensation and acceleration techniques. CONCLUSION Newly developed direct and indirect gating approaches were successfully applied to achieve high-quality morphologic and functional imaging as well as quantitative assessment of fetal hemodynamics in research settings. In cases when prenatal echocardiography is limited, e. g., by an unfavorable fetal position in utero, or when its results are inconclusive, fetal CMR could potentially serve as a valuable adjunct in the prenatal assessment of congenital cardiovascular malformations. However, sufficient data on the diagnostic performance and clinical benefit of new fetal CMR techniques is still lacking. KEY POINTS · New fetal cardiac gating methods allow high-quality fetal CMR.. · Motion compensation and acceleration techniques allow for improvement of image quality.. · Fetal CMR could potentially serve as an adjunct to fetal echocardiography in the future.. CITATION FORMAT · Knapp J, Tavares de Sousa M, Schönnagel BP. Fetal Cardiovascular MRI - A Systemic Review of the Literature: Challenges, New Technical Developments, and Perspectives. Fortschr Röntgenstr 2022; 194: 841 - 851.
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Affiliation(s)
- Janine Knapp
- Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Björn P Schönnagel
- Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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13
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Berggren K, Ryd D, Heiberg E, Aletras AH, Hedström E. Super-Resolution Cine Image Enhancement for Fetal Cardiac Magnetic Resonance Imaging. J Magn Reson Imaging 2021; 56:223-231. [PMID: 34652860 DOI: 10.1002/jmri.27956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Fetal cardiac magnetic resonance imaging (MRI) improves the diagnosis of congenital heart defects, but is sensitive to fetal motion due to long image acquisition time. This may be overcome with faster image acquisition with low resolution, followed by image enhancement to provide clinically useful images. PURPOSE To combine phase-encoding undersampling with super-resolution neural networks to achieve high-resolution fetal cine cardiac MR images with short acquisition time. STUDY TYPE Prospective. SUBJECTS Twenty-eight fetuses (gestational week 36 [interquartile range 33-38 weeks]). FIELD STRENGTH/SEQUENCE 1.5 T, balanced steady-state free precession (bSSFP) cine sequence. ASSESSMENT Images were acquired using fully sampled Doppler ultrasound-gated clinical bSSFP cine as reference, with equivalent cine sequences with decreased phase-encoding resolution (25%, 33%, and 50% of clinical standard). Two super-resolution methods based on convolutional neural networks were proposed and evaluated (phasrGAN and phasrresnet). Data were partitioned into training (36 cine slices), validation (3 cine slices), and test sets (67 cine slices) without overlap. Conventional reconstruction methods using bicubic interpolation and k-space zeropadding were used for comparison. Three blinded observers scored image quality between 1 and 10. STATISTICAL TESTS Image scores are reported as median [interquartile range] and were compared using Mann-Whitney's nonparametric test with P < 0.05 showing statistically significant differences. RESULTS Both proposed methods showed no significant difference in image quality compared to clinical images (8 [7-8.5]) down to 33% (phasrGAN 8 [6.5-8]; phasrresnet 8 [7-8], all P ≥ 0.19) phase-encoding resolution, i.e., up to three times faster image acquisition, whereas bicubic interpolation and k-space zeropadding showed significantly lower quality for 33% phase-encoding resolution (both 7 [6-8]). DATA CONCLUSION Super-resolution enhancement can be used for fetal cine cardiac MRI to reduce image acquisition time while maintaining image quality. This may lead to an improved success rate for fetal cine MR imaging, as the impact of fetal motion is lessened by shortened acquisitions. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Klas Berggren
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Anthony H Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
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14
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Sun L, Lee FT, van Amerom JFP, Freud L, Jaeggi E, Macgowan CK, Seed M. Update on fetal cardiovascular magnetic resonance and utility in congenital heart disease. JOURNAL OF CONGENITAL CARDIOLOGY 2021. [DOI: 10.1186/s40949-021-00059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Congenital heart disease (CHD) is the most common birth defect, affecting approximately eight per thousand newborns. Between one and two neonates per thousand have congenital cardiac lesions that require immediate post-natal treatment to stabilize the circulation, and the management of these patients in particular has been greatly enhanced by prenatal detection. The antenatal diagnosis of CHD has been made possible through the development of fetal echocardiography, which provides excellent visualization of cardiac anatomy and physiology and is widely available. However, late gestational fetal echocardiographic imaging can be hampered by suboptimal sonographic windows, particularly in the setting of oligohydramnios or adverse maternal body habitus.
Main body
Recent advances in fetal cardiovascular magnetic resonance (CMR) technology now provide a feasible alternative that could be helpful when echocardiography is inconclusive or limited. Fetal CMR has also been used to study fetal circulatory physiology in human fetuses with CHD, providing new insights into how these common anatomical abnormalities impact the distribution of blood flow and oxygen across the fetal circulation. In combination with conventional fetal and neonatal magnetic resonance imaging (MRI) techniques, fetal CMR can be used to explore the relationship between abnormal cardiovascular physiology and fetal development. Similarly, fetal CMR has been successfully applied in large animal models of the human fetal circulation, aiding in the evaluation of experimental interventions aimed at improving in utero development. With the advent of accelerated image acquisition techniques, post-processing approaches to correcting motion artifacts and commercial MRI compatible cardiotocography units for acquiring gated fetal cardiac imaging, an increasing number of CMR methods including angiography, ventricular volumetry, and the quantification of vessel blood flow and oxygen content are now possible.
Conclusion
Fetal CMR has reached an exciting stage whereby it may now be used to enhance the assessment of cardiac morphology and fetal hemodynamics in the setting of prenatal CHD.
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15
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Salehi D, Fricke K, Bhat M, Arheden H, Liuba P, Hedström E. Utility of Fetal Cardiovascular Magnetic Resonance for Prenatal Diagnosis of Complex Congenital Heart Defects. JAMA Netw Open 2021; 4:e213538. [PMID: 33779747 PMCID: PMC8008290 DOI: 10.1001/jamanetworkopen.2021.3538] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/06/2021] [Indexed: 12/17/2022] Open
Abstract
Importance Prenatal diagnosis of complex congenital heart defects reduces mortality and morbidity in affected infants. However, fetal echocardiography can be limited by poor acoustic windows, and there is a need for improved diagnostic methods. Objective To assess the clinical utility of fetal cardiovascular magnetic resonance imaging in cases in which fetal echocardiography could not visualize all relevant anatomy. Design, Setting, and Participants This cohort study was conducted between January 20, 2017, and June 29, 2020, at Skåne University Hospital (Lund, Sweden), a tertiary center for pediatric cardiology and thoracic surgery. Participants were fetuses referred for fetal cardiovascular magnetic resonance examination by a pediatric cardiologist after an inconclusive echocardiograph. Exposures Fetal cardiovascular magnetic resonance examination requested by the patient's pediatric cardiologist. Main Outcomes and Measures Any change in patient management because of diagnostic information gained from fetal cardiovascular magnetic resonance imaging. Results A total of 31 fetuses underwent cardiovascular magnetic resonance examination at a median gestational age of 36 weeks (range, 31-39 weeks). Overall, fetal cardiovascular magnetic resonance imaging had clinical utility, affecting patient management and/or parental counseling in 26 cases (84%). For aortic arch anatomy including signs of coarctation (20 fetuses), fetal cardiovascular magnetic resonance imaging added diagnostic information in 16 cases (80%). For assessment of univentricular vs biventricular outcome in borderline left ventricle, unbalanced atrioventricular septal defect, and pulmonary atresia with intact ventricular septum (15 fetuses), fetal cardiovascular magnetic resonance imaging visualized intracardiac anatomy and ventricular function, allowing assessment of outcome in 13 cases (87%). In 4 fetuses with hypoplastic left heart syndrome, fetal cardiovascular magnetic resonance imaging helped delivery planning in 3 cases (75%). Finally, fetal cardiovascular magnetic resonance imaging provided valuable information for parental counseling in 21 cases (68%). Conclusions and Relevance In this cohort study, fetal cardiovascular magnetic resonance imaging added clinically useful information to what was available from echocardiography. These findings suggest that fetal CMR has the potential to affect clinical decision-making in challenging cases of congenital heart defects with inconclusive data from echocardiography. Fetal cardiovascular magnetic resonance imaging showed an association with clinical decision-making, including mode of delivery and early postnatal care, as well as with parental counseling.
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Affiliation(s)
- Daniel Salehi
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katrin Fricke
- Pediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Misha Bhat
- Pediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Pediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Alphonso N, Angelini A, Barron DJ, Bellsham-Revell H, Blom NA, Brown K, Davis D, Duncan D, Fedrigo M, Galletti L, Hehir D, Herberg U, Jacobs JP, Januszewska K, Karl TR, Malec E, Maruszewski B, Montgomerie J, Pizzaro C, Schranz D, Shillingford AJ, Simpson JM. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force. Eur J Cardiothorac Surg 2020; 58:416-499. [DOI: 10.1093/ejcts/ezaa188] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annalisa Angelini
- Department of Cardiac, Thoracic Vascular Sciences and Public health, University of Padua Medical School, Padua, Italy
| | - David J Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Katherine Brown
- Paediatric Intensive Care, Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Deborah Davis
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Daniel Duncan
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Marny Fedrigo
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Lorenzo Galletti
- Unit of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - David Hehir
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Katarzyna Januszewska
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | | | - Edward Malec
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James Montgomerie
- Department of Anesthesia, Birmingham Children’s Hospital, Birmingham, UK
| | - Christian Pizzaro
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Amanda J Shillingford
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Tavares de Sousa M, Hecher K, Kording F, Yamamura J, Lenz A, Adam G, Bannas P, Schoennagel BP. Fetal dynamic magnetic resonance imaging using Doppler ultrasound gating for the assessment of the aortic isthmus: A feasibility study. Acta Obstet Gynecol Scand 2020; 100:67-73. [PMID: 32649773 DOI: 10.1111/aogs.13957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cardiovascular magnetic resonance imaging (MRI) is established in cardiac evaluation in postnatal life, but its application to the fetus has been hampered by technical limitations. We aimed to investigate the feasibility of dynamic MRI of the fetal aortic isthmus using a magnetic resonance-compatible Doppler ultrasound device for cardiac gating. MATERIAL AND METHODS This prospective study included 19 fetuses at a median gestational age of 32.3 weeks (range 26-38 weeks). Imaging of the fetal aortic isthmus was assessed by (a) dynamic steady-state free precession MRI using a magnetic resonance-compatible Doppler ultrasound device for cardiac gating and (b) echocardiography. Diameters of the aortic isthmus were compared by two blinded observers. Magnetic resonance image quality was assessed independently by two observers using a four-point scale (1 = low quality, 4 = high quality). Furthermore, we performed four-dimensional flow MRI of the fetal aorta in three of these fetuses. RESULTS The Doppler ultrasound device for cardiac gating allowed successful dynamic MRI examinations of the aortic isthmus in 18/19 (95%) fetuses. Evaluation of the fetal aortic isthmus was possible by both MRI (15/18, 83%) and echocardiography (16/18, 89%) (P < .05). Diameters of the aortic isthmus were concordant for MRI (3.8 ± 0.9 mm) and echocardiography (4.0 ± 1.1 mm), with a variability of 10.8% (bias -2.3%, 95% limits of agreement -23.9% to 19.3%). Overall magnetic resonance image quality was good (score 4 in 67% and score 3 in 23%) with good inter-observer agreement (κ = 0.75; 95% CI 0.5-1). Fetal four-dimensional flow MRI allowed visualization of aortic flow dynamics. CONCLUSIONS Doppler ultrasound-gating allows dynamic MRI of the fetal aorta with the potential to serve as a complementary imaging tool in cases where echocardiography is inconclusive.
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Affiliation(s)
- Manuela Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Cho SKS, Darby JRT, Saini BS, Lock MC, Holman SL, Lim JM, Perumal SR, Macgowan CK, Morrison JL, Seed M. Feasibility of ventricular volumetry by cardiovascular MRI to assess cardiac function in the fetal sheep. J Physiol 2020; 598:2557-2573. [PMID: 32378201 DOI: 10.1113/jp279054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
KEY POINTS The application of fetal cardiovascular magnetic resonance imaging (CMR) to assess fetal cardiovascular physiology and cardiac function through the quantification of ventricular volumes has previously been investigated, but the approach has not yet been fully validated. Ventricular output measurements calculated from heart rate and stroke volumes (SV) of the right and left ventricles measured by ventricular volumetry (VV) exhibited a high level of agreement with phase-contrast (PC) blood flow measurements in the main pulmonary artery and ascending aorta, respectively. Ejection fraction of the right ventricle, which is lower than that of the left ventricle in postnatal subjects, was similar to the left ventricular ejection fraction in the fetus; probably due to the different loading conditions present in the fetal circulation. This study provides evidence to support the reliability of VV in the sheep fetus, providing evidence for its use in animal models of human diseases affecting the fetal circulation. ABSTRACT The application of ventricular volumetry (VV) by cardiovascular magnetic resonance imaging (CMR) in the fetus remains challenging due to the small size of the fetal heart and high heart rate. The reliability of this technique in utero has not yet been established. The aim of this study was to assess the feasibility and reliability of VV in a fetal sheep model of human pregnancy. Right and left ventricular outputs by stroke volume (SV) measured using VV were compared with 2D phase-contrast (PC) CMR measurements of blood flow in the main pulmonary artery (MPA) and ascending aorta (AAo). At 124-140 days (d) gestation, singleton bearing Merino ewes underwent CMR under general anaesthesia using fetal femoral artery catheters, implanted at 109-117d, to trigger cine steady state free precession acquisitions of ventricular short-axis stacks. The short-axis cine stacks were segmented at end-systole and end-diastole, yielding right and left ventricular SV, ejection fraction, and cardiac outputs (SV × heart rate). PC cine acquisitions of MPA and AAo were analysed to measure blood flow, which served as comparators for the right and left cardiac outputs by VV. There was good correlation and agreement between VV and PC measures of ventricular outputs with no significant bias (r2 = 0.926; P < 0.0001; Bias = -4.7 ± 10.5 ml min-1 kg-1 ; 95% limits of agreement: -15.9 to 25.2 ml min-1 kg-1 ). This study validates fetal VV by CMR in a large animal model of human pregnancy and provides preliminary reference values of fetal sheep right and left ventricles in late gestation.
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Affiliation(s)
- Steven K S Cho
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Early Origins of Adult Health Research Group, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia.,Division of Cardiology, Hospital for Sick Children, Toronto, Canada
| | - Jack R T Darby
- Early Origins of Adult Health Research Group, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Brahmdeep S Saini
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, Hospital for Sick Children, Toronto, Canada
| | - Mitchell C Lock
- Early Origins of Adult Health Research Group, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Stacey L Holman
- Early Origins of Adult Health Research Group, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Jessie Mei Lim
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Hospital for Sick Children, Toronto, Canada
| | - Sunthara Rajan Perumal
- Preclinical, Imaging & Research Laboratories, South Australian Health & Medical Research Institute, Adelaide, Australia
| | - Christopher K Macgowan
- Translational Medicine, Hospital for Sick Children, Toronto, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Mike Seed
- Division of Cardiology, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
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19
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Sun L, Marini D, Saini B, Schrauben E, Macgowan CK, Seed M. Understanding Fetal Hemodynamics Using Cardiovascular Magnetic Resonance Imaging. Fetal Diagn Ther 2020; 47:354-362. [PMID: 32062652 DOI: 10.1159/000505091] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022]
Abstract
Human fetal circulatory physiology has been investigated extensively using grey-scale ultrasound, which provides excellent visualization of cardiac anatomy and function, while velocity profiles in the heart and vessels can be interrogated using Doppler. Measures of cerebral and placental vascular resistance, as well as indirect measures of intracardiac pressure obtained from the velocity waveform in the ductus venosus are routinely used to guide the management of fetal cardiovascular and placental disease. However, the characterization of some key elements of cardiovascular physiology such as vessel blood flow and the oxygen content of blood in the arteries and veins, as well as fetal oxygen delivery and consumption are not readily measured using ultrasound. To study these parameters, we have historically relied on data obtained using invasive measurements made in animal models, which are not equivalent to the human in every respect. Over recent years, a number of technical advances have been made that have allowed us to examine the human fetal circulatory system using cardiovascular magnetic resonance (CMR). The combination of vessel blood flow measurements made using cine phase contrast magnetic resonance imaging and vessel blood oxygen saturation and hematocrit measurements made using T1 and T2 mapping have enabled us to emulate those classic fetal sheep experiments defining the distribution of blood flow and oxygen transport across the fetal circulation in the human fetus. In addition, we have applied these techniques to study the relationship between abnormal fetal cardiovascular physiology and fetal development in the setting of congenital heart disease and placental insufficiency. CMR has become an important diagnostic tool in the assessment of cardiovascular physiology in the setting of postnatal cardiovascular disease, and is now being applied to the fetus to enhance our understanding of normal and abnormal fetal circulatory physiology and its impact on fetal well-being.
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Affiliation(s)
- Liqun Sun
- Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Davide Marini
- Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brahmdeep Saini
- Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Schrauben
- Division of Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher K Macgowan
- Division of Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Mike Seed
- Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada, .,Department of Paediatrics and Medical Imaging, University of Toronto, Toronto, Ontario, Canada,
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20
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Abstract
Magnetic resonance imaging (MRI) is an appealing technology for fetal cardiovascular assessment. It can be used to visualize fetal cardiac and vascular anatomy, to quantify fetal blood flow, and to quantify fetal blood oxygen saturation and hematocrit. However, there are practical limitations to the use of conventional MRI for fetal cardiovascular assessment, including the small size and high heart rate of the human fetus, the lack of conventional cardiac gating methods to synchronize data acquisition, and the potential corruption of MRI data due to maternal respiration and unpredictable fetal movements. In this review, we discuss recent technical advances in accelerated imaging, image reconstruction, cardiac gating, and motion compensation that have enabled dynamic MRI of the fetal heart.
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21
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Marini D, Xu J, Sun L, Jaeggi E, Seed M. Current and future role of fetal cardiovascular MRI in the setting of fetal cardiac interventions. Prenat Diagn 2019; 40:71-83. [PMID: 31834624 DOI: 10.1002/pd.5626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022]
Abstract
Over recent years, technical developments resulting in the feasibility of fetal cardiovascular magnetic resonance (CMR) have provided a new diagnostic tool for studying the human fetal heart and circulation. During the same period, we have witnessed the arrival of several minimally invasive fetal cardiac interventions (FCI) as a possible form of treatment in selected congenital heart diseases (CHDs). The role of fetal CMR in the planning and monitoring of FCI is not yet clear. Indeed, high-quality fetal CMR is not available or routinely offered at most centers caring for patients with prenatally detected CHD. However, in theory, fetal CMR could have much to offer in the setting of FCI by providing complementary anatomic and physiologic information relating to the specific intervention under consideration. Similarly, fetal CMR may be useful as an alternative imaging modality when ultrasound is hampered by technical limitations, for example, in the setting of oligohydramnios and in late gestation. In this review, we summarize current experience of the use of fetal CMR in the diagnosis and monitoring of fetuses with cardiopathies in the setting of a range of invasive in utero cardiac and vascular interventions and medical treatments and speculate about future directions for this versatile imaging medium.
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Affiliation(s)
- Davide Marini
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jiawei Xu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Liqun Sun
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Edgar Jaeggi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike Seed
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
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22
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Roy CW, Marini D, Lloyd DFA, Mawad W, Yoo SJ, Schrauben EM, Jaeggi E, Seed M, Macgowan CK. Preliminary Experience Using Motion Compensated CINE Magnetic Resonance Imaging to Visualise Fetal Congenital Heart Disease. Circ Cardiovasc Imaging 2019; 11:e007745. [PMID: 30558501 DOI: 10.1161/circimaging.118.007745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recent advances in cardiovascular magnetic resonance (CMR) imaging have facilitated CINE imaging of the fetal heart. In this work, a preliminary investigation of the utility of multislice CINE CMR for assessing fetal congenital heart disease is performed and compared with echocardiography. METHODS AND RESULTS Multislice CINE CMR and echocardiography images were acquired in 25 pregnant women wherein the fetus had a suspected congenital heart defect based on routine obstetric ultrasound. Pathognomonic images were identified for each subject for qualitative comparison of CMR and echocardiography. Quantitative comparison of CMR and echocardiography was then performed by 2 reviewers using a binary scoring of 9 fetal cardiac anatomic features (identifiable/not-identifiable). Pathognomonic images demonstrated the ability of CMR to visualize a variety of congenital heart defects. Overall CMR was able to identify the majority of the 9 assessed fetal cardiac anatomic features (reviewer 1, 7.1±2.1; reviewer 2, 6.7±2.3). Although both reviewers identified more anatomic features with echocardiography (reviewer 1, 7.8±2.3; reviewer 2, 7.5±2.4; P=0.01), combining information from both modalities enabled identification of additional anatomic features across subjects (reviewer 1, 8.4±1.3; reviewer 2, 8.4±1.2). The primary limiting factor for CMR was inadequate coverage of the fetal cardiac anatomy or noncontiguous slices because of gross fetal movement. CONCLUSIONS CINE CMR enables visualization of fetal congenital heart disease. This work demonstrates the potential of CMR for diagnosing congenital heart disease in utero in conjunction with echocardiography during late gestation.
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Affiliation(s)
- Christopher W Roy
- Department of Medical Biophysics, University of Toronto, Canada (C.W.R., C.K.M.).,Division of Translational Medicine (C.W.R., E.M.S., E.J., C.K.M)
| | - Davide Marini
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada (D.M., W.M., S.-J.Y., E.J., M.S.)
| | - David F A Lloyd
- Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (D.F.A.L.).,Departments of Paediatric and Fetal Cardiology, Evelina Children's Hospital, London, United Kingdom (D.F.A.L.)
| | - Wadi Mawad
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada (D.M., W.M., S.-J.Y., E.J., M.S.)
| | - Shi-Joon Yoo
- Departments of Pediatrics and Diagnostic Imaging, University of Toronto, Canada (S.-J.Y., E.J., M.S.).,Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada (D.M., W.M., S.-J.Y., E.J., M.S.)
| | - Eric M Schrauben
- Division of Translational Medicine (C.W.R., E.M.S., E.J., C.K.M)
| | - Edgar Jaeggi
- Departments of Pediatrics and Diagnostic Imaging, University of Toronto, Canada (S.-J.Y., E.J., M.S.).,Division of Translational Medicine (C.W.R., E.M.S., E.J., C.K.M).,Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada (D.M., W.M., S.-J.Y., E.J., M.S.)
| | - Mike Seed
- Departments of Pediatrics and Diagnostic Imaging, University of Toronto, Canada (S.-J.Y., E.J., M.S.).,Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada (D.M., W.M., S.-J.Y., E.J., M.S.)
| | - Christopher K Macgowan
- Department of Medical Biophysics, University of Toronto, Canada (C.W.R., C.K.M.).,Division of Translational Medicine (C.W.R., E.M.S., E.J., C.K.M)
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23
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Vigneswaran TV, Allan L, Charakida M, Durward A, Simpson JM, Nicolaides KH, Zidere V. Prenatal diagnosis and clinical implications of an apparently isolated right aortic arch. Prenat Diagn 2019; 38:1055-1061. [PMID: 30421794 DOI: 10.1002/pd.5388] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To define the associations of a prenatally diagnosed, apparently isolated right aortic arch (RAA) with chromosomal or genetic abnormalities and tracheal compression. METHODS This was a retrospective study of apparently isolated RAA assessed by fetal cardiologists and fetal medicine specialists at Kings College Hospital, London between 2000 and 2017. RESULTS The search identified 138 cases of apparently isolated RAA. Invasive testing was performed in 75, and chromosomal or genetic anomalies were identified in 16 (22%), and the most common was 22q11 microdeletion. An aberrant left subclavian artery was seen in 51% of cases. Symptoms of a vascular ring were present in 24 of 97 (25%) children who were reviewed after birth. Bronchoscopy was performed in 33 children, and significant tracheal compression was diagnosed in 28, including 18 of 19 symptomatic and 10 of 14 asymptomatic children. CONCLUSIONS An apparently isolated RAA is associated with a high incidence of chromosomal or genetic abnormalities and a high incidence of tracheal compression in symptomatic and asymptomatic patients. Prenatal counselling for genetic associations and postnatal airway assessment in the context of the vascular anatomy is recommended.
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Affiliation(s)
- Trisha V Vigneswaran
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Lindsey Allan
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Marietta Charakida
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Andrew Durward
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - John M Simpson
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Kypros H Nicolaides
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Vita Zidere
- Harris Birthright Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK.,Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
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24
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Shah K. 50 Years Ago in The Journal ofPediatrics: Sonar as a Method for Studying Prenatal Development. J Pediatr 2019; 211:171. [PMID: 31349915 DOI: 10.1016/j.jpeds.2019.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Haris K, Hedström E, Kording F, Bidhult S, Steding-Ehrenborg K, Ruprecht C, Heiberg E, Arheden H, Aletras AH. Free-breathing fetal cardiac MRI with doppler ultrasound gating, compressed sensing, and motion compensation. J Magn Reson Imaging 2019; 51:260-272. [PMID: 31228302 PMCID: PMC6916642 DOI: 10.1002/jmri.26842] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/04/2019] [Indexed: 12/23/2022] Open
Abstract
Background Fetal cardiovascular MRI complements ultrasound to assess fetal cardiovascular pathophysiology. Purpose To develop a free‐breathing method for retrospective fetal cine MRI using Doppler ultrasound (DUS) cardiac gating and tiny golden angle radial sampling (tyGRASP) for accelerated acquisition capable of detecting fetal movements for motion compensation. Study Type Feasibility study. Subjects Nine volunteers (gestational week 34–40). Short‐axis and four‐chamber views were acquired during maternal free‐breathing and breath‐hold. Field Strength/Sequence 1.5T cine balanced steady‐state free precession. Assessment A self‐gated reconstruction method was improved for clinical application by using 1) retrospective DUS gating, and 2) motion detection and rejection/correction algorithms for compensating for fetal motion. The free‐breathing reconstructions were qualitatively and quantitatively assessed, and DUS‐gating was compared with self‐gating in breath‐hold reconstructions. A scoring of 1–4 for overall image quality, cardiac, and extracardiac diagnostic quality was used. Statistical Tests Friedman's test was used to assess differences in qualitative scoring between observers. A Wilcoxon matched‐pairs signed rank test was used to assess differences between breath‐hold and free‐breathing acquisitions and between observers' quantitative measurements. Results In all cases, 111 free‐breathing and 145 breath‐hold acquisitions, the automatically calculated DUS‐based cardiac gating signal provided reconstructions of diagnostic quality (median score 4, range 1–4). Free‐breathing did not affect the DUS‐based cardiac gated retrospective radial reconstruction with respect to image or diagnostic quality (all P > 0.06). Motion detection with rejection/correction in k‐space produced high‐quality free‐breathing DUS‐based reconstructions [median 3, range (2–4)], whereas free‐breathing self‐gated methods failed in 80 out of 88 cases to produce a stable gating signal. Data Conclusion Free‐breathing fetal cine cardiac MRI based on DUS gating and tyGRASP with motion compensation yields diagnostic images. This simplifies acquisition for the pregnant woman and thus could help increase fetal cardiac MRI acceptance in the clinic. Level of Evidence: 2 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;51:260–272.
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Affiliation(s)
- Kostas Haris
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Bidhult
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
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26
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Marini D, van Amerom J, Saini BS, Sun L, Seed M. MR imaging of the fetal heart. J Magn Reson Imaging 2019; 51:1030-1044. [PMID: 31190452 DOI: 10.1002/jmri.26815] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022] Open
Abstract
In the last decade, technological advances have enabled the acquisition of high spatial and temporal resolution cardiac magnetic resonance imaging (MRI) in the fetus. Fetal cardiac MRI has emerged as an alternative to ultrasound, which may be helpful to confirm a diagnosis of congenital heart disease when ultrasound assessment is hampered, for example in late gestation or in the setting of oligohydramnios. MRI also provides unique physiologic information, including vessel blood flow, oxygen saturation and hematocrit, which may be helpful to investigate cardiac and placental diseases. In this review, we summarize some of the main techniques and significant advances in the field to date. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2020;51:1030-1044.
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Affiliation(s)
- Davide Marini
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Joshua van Amerom
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Brahmdeep S Saini
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Liqun Sun
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Mike Seed
- Division of Pediatric Cardiology, Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
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27
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Lloyd DFA, Pushparajah K, Simpson JM, van Amerom JFP, van Poppel MPM, Schulz A, Kainz B, Deprez M, Lohezic M, Allsop J, Mathur S, Bellsham-Revell H, Vigneswaran T, Charakida M, Miller O, Zidere V, Sharland G, Rutherford M, Hajnal JV, Razavi R. Three-dimensional visualisation of the fetal heart using prenatal MRI with motion-corrected slice-volume registration: a prospective, single-centre cohort study. Lancet 2019; 393:1619-1627. [PMID: 30910324 PMCID: PMC6484696 DOI: 10.1016/s0140-6736(18)32490-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/13/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Two-dimensional (2D) ultrasound echocardiography is the primary technique used to diagnose congenital heart disease before birth. There is, however, a longstanding need for a reliable form of secondary imaging, particularly in cases when more detailed three-dimensional (3D) vascular imaging is required, or when ultrasound windows are of poor diagnostic quality. Fetal MRI, which is well established for other organ systems, is highly susceptible to fetal movement, particularly for 3D imaging. The objective of this study was to investigate the combination of prenatal MRI with novel, motion-corrected 3D image registration software, as an adjunct to fetal echocardiography in the diagnosis of congenital heart disease. METHODS Pregnant women carrying a fetus with known or suspected congenital heart disease were recruited via a tertiary fetal cardiology unit. After initial validation experiments to assess the general reliability of the approach, MRI data were acquired in 85 consecutive fetuses, as overlapping stacks of 2D images. These images were then processed with a bespoke open-source reconstruction algorithm to produce a super-resolution 3D volume of the fetal thorax. These datasets were assessed with measurement comparison with paired 2D ultrasound, structured anatomical assessment of the 2D and 3D data, and contemporaneous, archived clinical fetal MRI reports, which were compared with postnatal findings after delivery. FINDINGS Between Oct 8, 2015, and June 30, 2017, 101 patients were referred for MRI, of whom 85 were eligible and had fetal MRI. The mean gestational age at the time of MRI was 32 weeks (range 24-36). High-resolution (0·50-0·75 mm isotropic) 3D datasets of the fetal thorax were generated in all 85 cases. Vascular measurements showed good overall agreement with 2D echocardiography in 51 cases with paired data (intra-class correlation coefficient 0·78, 95% CI 0·68-0·84), with fetal vascular structures more effectively visualised with 3D MRI than with uncorrected 2D MRI (657 [97%] of 680 anatomical areas identified vs 358 [53%] of 680 areas; p<0·0001). When a structure of interest was visualised in both 2D and 3D data (n=358), observers gave a higher diagnostic quality score for 3D data in 321 (90%) of cases, with 37 (10%) scores tied with 2D data, and no lower scores than for 2D data (Wilcoxon signed rank test p<0·0001). Additional anatomical features were described in ten cases, of which all were confirmed postnatally. INTERPRETATION Standard fetal MRI with open-source image processing software is a reliable method of generating high-resolution 3D imaging of the fetal vasculature. The 3D volumes produced show good spatial agreement with ultrasound, and significantly improved visualisation and diagnostic quality compared with source 2D MRI data. This freely available combination requires minimal infrastructure, and provides safe, powerful, and highly complementary imaging of the fetal cardiovascular system. FUNDING Wellcome Trust/EPSRC Centre for Medical Engineering, National Institute for Health Research.
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Affiliation(s)
- David F A Lloyd
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joshua F P van Amerom
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Milou P M van Poppel
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Alexander Schulz
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Bernard Kainz
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Computing (BioMedIA), Imperial College London, London, UK
| | - Maria Deprez
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Maelene Lohezic
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Joanna Allsop
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Sujeev Mathur
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hannah Bellsham-Revell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Trisha Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marietta Charakida
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gurleen Sharland
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mary Rutherford
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Joseph V Hajnal
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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28
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Bhat M, Haris K, Bidhult S, Liuba P, Aletras AH, Hedström E. Fetal iGRASP cine CMR assisting in prenatal diagnosis of complicated cardiac malformation with impact on delivery planning. Clin Physiol Funct Imaging 2019; 39:231-235. [PMID: 30785656 PMCID: PMC6850003 DOI: 10.1111/cpf.12566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/17/2019] [Indexed: 12/18/2022]
Abstract
Limited visualization of the fetal heart and vessels by fetal ultrasound due to suboptimal fetal position, patient habitus and skeletal calcification may lead to missed diagnosis, overdiagnosis and parental uncertainty. Counselling and delivery planning may in those cases also be tentative. The recent fetal cardiac magnetic resonance (CMR) reconstruction method utilizing tiny golden‐angle iGRASP (iterative Golden‐angle RAdial Sparse Parallel MRI) allows for cine imaging of the fetal heart for use in clinical practice. This case describes an unbalanced common atrioventricular canal where limited ultrasound image quality and visibility of the aortic arch precluded confirming or ruling out presence of a ventricular septal defect. Need of prostaglandins or neonatal intervention was thus uncertain. Cardiovascular magnetic resonance imaging confirmed ultrasound findings and added value by ruling out a significant ventricular septal defect and diagnosing arch hypoplasia. This confirmed the need of patient relocation for delivery at a paediatric cardiothoracic surgery centre and prostaglandins could be initiated before the standard postnatal ultrasound. The applied CMR method can thus improve diagnosis of complicated fetal cardiac malformation and has direct clinical impact.
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Affiliation(s)
- Misha Bhat
- Pediatric Cardiac Center, Skåne University Hospital and Lund University, Lund, Sweden
| | - Kostas Haris
- Laboratory of Computing, Medical Informatics and Biomedical - Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, and Lund University, Lund, Sweden
| | - Sebastian Bidhult
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, and Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Petru Liuba
- Pediatric Cardiac Center, Skåne University Hospital and Lund University, Lund, Sweden
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical - Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, and Lund University, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, and Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Diagnostic Radiology, Skåne University Hospital and Lund University, Lund, Sweden
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29
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Hunter LE, Seale AN. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Prenatal diagnosis of congenital heart disease. Echo Res Pract 2018; 5:R81-R100. [PMID: 30012852 PMCID: PMC6107762 DOI: 10.1530/erp-18-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
This review article will guide the reader through the background of prenatal screening for congenital heart disease. The reader will be given insight into the normal screening views, common abnormalities, risk stratification of lesions and also recent advances in prenatal cardiology.
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Affiliation(s)
- Lindsey E Hunter
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Anna N Seale
- Department of Paediatric Cardiology, Birmingham Children’s Hospital, Birmingham, UK
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30
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Vigneswaran TV, Kapravelou E, Bell AJ, Nyman A, Pushparajah K, Simpson JM, Durward A, Zidere V. Correlation of Symptoms with Bronchoscopic Findings in Children with a Prenatal Diagnosis of a Right Aortic Arch and Left Arterial Duct. Pediatr Cardiol 2018; 39:665-673. [PMID: 29307026 DOI: 10.1007/s00246-017-1804-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/22/2017] [Indexed: 12/31/2022]
Abstract
A right aortic arch (RAA) with a left arterial duct (LAD) together encircle the trachea and have the potential to cause tracheobronchial compression and published guidelines recommend bronchoscopy in symptomatic patients. The aim of the study was to describe the incidence of tracheal compression in a cohort of prenatally diagnosed RAA and LAD. Retrospective review of clinical course and imaging of prenatal cases of RAA and LAD assessed with flexible bronchoscopy over an 11-year period. 34 cases of prenatally diagnosed RAA with LAD underwent bronchoscopy at median age of 9 months (range 0.4-123) of whom 11 had respiratory symptoms and 23 were asymptomatic. In the neonatal period, three cases demonstrated respiratory symptoms. An aberrant left subclavian artery (ALSA) was identified in 29 cases. Pulsatile tracheal compression was identified in 32/34 (94%) cases and two cases showed normal tracheal appearances. Significant tracheal compression (> 70% occlusion) was present in 25/34 (74%) cases of which 16 were asymptomatic. Significant carinal compression (> 70% occlusion) was identified in 14/34 (42%) cases, an ALSA was observed in 13/14. Surgical relief of a vascular ring has been performed in 27 (79%) cases at a median age of 15 months (range 0.6-128 months). At surgery, a fibrous remnant of an atretic left aortic arch was identified in 11/27 (41%) cases. Significant tracheal compression may be present in infants even without symptoms. If early relief of airway compression is to be achieved to promote normal development of tracheal cartilage, early bronchoscopy should be considered.
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Affiliation(s)
- Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK. .,Fetal Medicine Research Institute, King's College Hospital, 16-20 Windsor Walk, London, SE5 8BB, UK.
| | - Eva Kapravelou
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK
| | - Aaron J Bell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK
| | - Andrew Nyman
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK
| | - Kuberan Pushparajah
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK.,Fetal Medicine Research Institute, King's College Hospital, 16-20 Windsor Walk, London, SE5 8BB, UK
| | - Andrew Durward
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK.,Fetal Medicine Research Institute, King's College Hospital, 16-20 Windsor Walk, London, SE5 8BB, UK
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31
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Kording F, Schoennagel BP, de Sousa MT, Fehrs K, Adam G, Yamamura J, Ruprecht C. Evaluation of a Portable Doppler Ultrasound Gating Device for Fetal Cardiac MR Imaging: Initial Results at 1.5T and 3T. Magn Reson Med Sci 2018; 17:308-317. [PMID: 29467359 PMCID: PMC6196307 DOI: 10.2463/mrms.mp.2017-0100] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Fetal cardiac MRI has the potential to play an important role in the assessment of fetal cardiac pathologies, but it is up to now not feasible due to a missing gating method. The purpose of this work was the evaluation of Doppler ultrasound (DUS) for external fetal cardiac gating with regard to compatibility, functionality, and reliability. Preliminary results were assessed performing fetal cardiac MRI. Methods: An MRI conditional DUS device was developed to obtain a gating signal from the fetal heart. The MRI compatibility was evaluated at 1.5T and 3T using B1 field maps and gradient echo images. The quality and sensitivity of the DUS device to detect the fetal heart motion for cardiac gating were evaluated outside the MRI room in 15 fetuses. A dynamic fetal cardiac phantom was employed to evaluate distortions of the DUS device and gating signal due to electromagnetic interferences at 1.5T and 3T. In the first in vivo experience, dynamic fetal cardiac images were acquired in four-chamber view at 1.5T and 3T in two fetuses. Results: The maximum change in the B1 field and signal intensity with and without the DUS device was <6.5% for 1.5T and 3T. The sensitivity of the DUS device to detect the fetal heartbeat was 99.1%. Validation of the DUS device using the fetal cardiac phantom revealed no electromagnetic interferences at 1.5T or 3T and a high correlation to the simulated heart frequencies. Fetal cardiac cine images were successfully applied and showed good image quality. Conclusion: An MR conditional DUS gating device was developed and evaluated revealing safety, compatibility, and reliability for different field strengths. In a preliminary experience, the DUS device was successfully applied for in vivo fetal cardiac imaging at 1.5T and 3T.
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Affiliation(s)
- Fabian Kording
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf.,northh medical GmbH
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf
| | | | - Kai Fehrs
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf.,northh medical GmbH
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf.,northh medical GmbH
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32
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Abstract
Fetal MRI is a level III diagnostic tool performed subsequently a level II prenatal ultrasound (US), in cases of inconclusive ultrasonographic diagnosis or when a further investigation is required to confirm or improve the diagnosis, to plan an appropriate pregnancy management. Fetal MRI plays an increasingly important role in the prenatal diagnosis of fetal neck, chest and abdominal malformations, even if its role has been amply demonstrated, especially, in the field of fetal CNS anomalies. Due to its multiparametricity and multiplanarity, MRI provides a detailed evaluation of the whole fetal respiratory, gastrointestinal and genitourinary systems, especially on T2-weighted (W) images, with a good tissue contrast resolution. In the evaluation of the digestive tract, T1-W sequences are very important in relation to the typical hyperintensity of the large intestine, due to the presence of meconium. The objective of this review is to focus on the application of fetal MRI in neck, chest and abdominal diseases.
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33
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De Groote K, Vanhie E, Roets E, Ramaekers P, De Wilde H, Panzer J, Vandekerckhove K, Bove T, François K, Van Herck K, De Wolf D. Outcome after prenatal and postnatal diagnosis of complex congenital heart defects and the influence of genetic anomalies. Prenat Diagn 2017; 37:983-991. [DOI: 10.1002/pd.5117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/07/2017] [Accepted: 07/14/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Katya De Groote
- Department of Pediatrics, Paediatric Cardiology; Ghent University Hospital; Ghent Belgium
| | - Ellen Vanhie
- Department of Pediatrics; Ghent University Hospital; Ghent Belgium
| | - Ellen Roets
- Department of Obstetrics and Gynecology, Prenatal Diagnosis Centre; Ghent University Hospital; Ghent Belgium
| | - Paul Ramaekers
- Department of Obstetrics and Gynecology, Prenatal Diagnosis Centre; Ghent University Hospital; Ghent Belgium
| | - Hans De Wilde
- Department of Pediatrics, Paediatric Cardiology; Ghent University Hospital; Ghent Belgium
| | - Joseph Panzer
- Department of Pediatrics, Paediatric Cardiology; Ghent University Hospital; Ghent Belgium
| | - Kristof Vandekerckhove
- Department of Pediatrics, Paediatric Cardiology; Ghent University Hospital; Ghent Belgium
| | - Thierry Bove
- Department of Cardiac Surgery; Ghent University Hospital; Ghent Belgium
| | - Katrien François
- Department of Cardiac Surgery; Ghent University Hospital; Ghent Belgium
| | - Koen Van Herck
- Department of Public Health; Ghent University; Ghent Belgium
| | - Daniël De Wolf
- Department of Pediatrics, Paediatric Cardiology; Ghent University Hospital; Ghent Belgium
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34
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Abstract
This study aimed to evaluate the diagnostic accuracy of fetal magnetic resonance imaging (MRI) for persistent left superior vena cava (LSVC). Prenatal echocardiography (echo) and/or ultrasound (US) and MRI data for 49 fetuses with persistent LSVC, confirmed via postnatal diagnoses between January 2010 and October 2015, were retrospectively reviewed. All prenatal MRI was performed at 1.5 T. Imaging sequences included steady-state free-precession (SSFP), single-shot turbo spin echo (SSTSE), and other sequences. All 49 cases of fetal persistent LSVC were correctly diagnosed via MRI, but only 34 cases (69.4%) were correctly diagnosed via an initial US and/or echo before MRI. Of the 15 cases that were not correctly diagnosed via US and/or echo, 8 had congenital heart diseases (CHDs) and 7 were without CHDs; however, they were associated with extracardiac abnormalities or maternal obesity. Thirty-five cases were associated with other cardiovascular abnormalities; 8, with extracardiac abnormalities; and 6, with no associated condition. In 44 (89.8%) cases, the innominate veins were absent; the remaining cases had innominate veins. In 14.3% of patients (7 cases), the persistent LSVC drained directly into the atrium. Fetal MRI can detect persistent LSVC and play an adjunctive role along with US in the evaluation of persistent LSVC.
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35
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van Amerom JFP, Lloyd DFA, Price AN, Kuklisova Murgasova M, Aljabar P, Malik SJ, Lohezic M, Rutherford MA, Pushparajah K, Razavi R, Hajnal JV. Fetal cardiac cine imaging using highly accelerated dynamic MRI with retrospective motion correction and outlier rejection. Magn Reson Med 2017; 79:327-338. [PMID: 28370252 PMCID: PMC5763466 DOI: 10.1002/mrm.26686] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Development of a MRI acquisition and reconstruction strategy to depict fetal cardiac anatomy in the presence of maternal and fetal motion. METHODS The proposed strategy involves i) acquisition and reconstruction of highly accelerated dynamic MRI, followed by image-based ii) cardiac synchronization, iii) motion correction, iv) outlier rejection, and finally v) cardiac cine reconstruction. Postprocessing entirely was automated, aside from a user-defined region of interest delineating the fetal heart. The method was evaluated in 30 mid- to late gestational age singleton pregnancies scanned without maternal breath-hold. RESULTS The combination of complementary acquisition/reconstruction and correction/rejection steps in the pipeline served to improve the quality of the reconstructed 2D cine images, resulting in increased visibility of small, dynamic anatomical features. Artifact-free cine images successfully were produced in 36 of 39 acquired data sets; prolonged general fetal movements precluded processing of the remaining three data sets. CONCLUSIONS The proposed method shows promise as a motion-tolerant framework to enable further detail in MRI studies of the fetal heart and great vessels. Processing data in image-space allowed for spatial and temporal operations to be applied to the fetal heart in isolation, separate from extraneous changes elsewhere in the field of view. Magn Reson Med 79:327-338, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Joshua F P van Amerom
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - David F A Lloyd
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Anthony N Price
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Maria Kuklisova Murgasova
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Paul Aljabar
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Shaihan J Malik
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Maelene Lohezic
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Joseph V Hajnal
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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36
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Fievet A, Morel B, Sembély-Taveau C, Thoreau B, Perrotin F, Sirinelli D. [Fetal MRI practices in a university prenatal center]. ACTA ACUST UNITED AC 2017; 45:276-282. [PMID: 28343908 DOI: 10.1016/j.gofs.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/20/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Fetal MRI is a third intention examination to prenatal diagnosis. If its diagnostic value is well known in many pathologies, its place in the management of pregnancies remains unclear. METHODS We collected retrospectively demographical, radiological (fetal MRI indications, fetal anatomical region and diagnostic information provided by fetal MRI) and obstetrical data of pregnant patients in university prenatal center during a 5 years' period. RESULTS Among 2439 patients of the prenatal center, 196 (8%) patients with fetal MRI were included. The main anatomical regions studied were the brain (n=132, 67%), the thorax (n=31, 16%) and the abdomen (n=25, 13%). No cardiac fetal MRI was performed. Ninety-five percent of fetal MRI was consecutively of an ultrasound sign. Fetal brain MRI was abnormal in 65% of cases, the thoracic and abdominopelvic MRI in 81.5%. The ultrasound diagnosis was unchanged in 42%, completed in 50% and redirected in 8% of cases. A termination of pregnancy was deemed admissible in 31% of patients with MRI versus 21% in patients without MRI (P=0.001). CONCLUSION Fetal MRI requires selective indications and provides additional diagnostic information with important implications for the future of the pregnancy, particularly in case of severe and incurable pathologies. Our results could be useful as a reference basis for the comparison with others prenatal center practices.
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Affiliation(s)
- A Fievet
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
| | - B Morel
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France; Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours cedex 9, France.
| | - C Sembély-Taveau
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France
| | - B Thoreau
- Médecine interne, hôpital Bretonneau, CHRU de Tours, 10, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - F Perrotin
- Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours cedex 9, France; Pôle de gynécologie-obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe-de-Gouges, hôpital Bretonneau, CHRU de Tours, 10, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - D Sirinelli
- Radiologie pédiatrique, hôpital Clocheville, CHRU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France; Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37044 Tours cedex 9, France
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37
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Lloyd DFA, van Amerom JFP, Pushparajah K, Simpson JM, Zidere V, Miller O, Sharland G, Allsop J, Fox M, Lohezic M, Murgasova M, Malamateniou C, Hajnal JV, Rutherford M, Razavi R. An exploration of the potential utility of fetal cardiovascular MRI as an adjunct to fetal echocardiography. Prenat Diagn 2016; 36:916-925. [PMID: 27521762 PMCID: PMC5082528 DOI: 10.1002/pd.4912] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/01/2016] [Accepted: 08/09/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Fetal cardiovascular magnetic resonance imaging (MRI) offers a potential alternative to echocardiography, although in practice, its use has been limited. We sought to explore the need for additional imaging in a tertiary fetal cardiology unit and the usefulness of standard MRI sequences. METHODS Cases where the diagnosis was not fully resolved using echocardiography were referred for MRI. Following a three-plane localiser, fetal movement was assessed with a balanced steady-state free precession (bSSFP) cine. Single-shot fast spin echo and bSSFP sequences were used for diagnostic imaging. RESULTS Twenty-two fetal cardiac MRIs were performed over 12 months, at mean gestation of 32 weeks (26-38 weeks). The majority of referrals were for suspected vascular abnormalities (17/22), particularly involving the aortic arch (n = 10) and pulmonary vessels (n = 4). Single-shot fast spin echo sequences produced 'black-blood' images, useful for examining the extracardiac vasculature in these cases. BSSFP sequences were more useful for intracardiac structures. Real-time SSFP allowed for dynamic assessment of structures such as cardiac masses, with enhancement patterns also allowing for tissue characterisation in these cases. CONCLUSIONS Fetal vascular abnormalities such as coarctation can be difficult to diagnose by using ultrasound. Fetal MRI may have an adjunctive role in the evaluation of the extracardiac vascular anatomy and tissue characterisation. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.
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Affiliation(s)
- David F A Lloyd
- Evelina Children's Hospital, London, UK. .,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
| | - Joshua F P van Amerom
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Kuberan Pushparajah
- Evelina Children's Hospital, London, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | | | | | | | | | - Joanna Allsop
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Matthew Fox
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Maelene Lohezic
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Maria Murgasova
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Christina Malamateniou
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Jo V Hajnal
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Mary Rutherford
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Reza Razavi
- Evelina Children's Hospital, London, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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