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Dargahpour Barough M, Tavares de Sousa M, Hergert B, Fischer R, Huber L, Seliger JM, Kaul MG, Adam G, Herrmann J, Bannas P, Schoennagel BP. Myocardial strain assessment in the human fetus by cardiac MRI using Doppler ultrasound gating and feature tracking. Eur Radiol 2024; 34:4920-4927. [PMID: 38195730 PMCID: PMC11254999 DOI: 10.1007/s00330-023-10551-0] [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: 08/29/2023] [Revised: 11/10/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Assessment of myocardial strain by feature tracking magnetic resonance imaging (FT-MRI) in human fetuses with and without congenital heart disease (CHD) using cardiac Doppler ultrasound (DUS) gating. METHODS A total of 43 human fetuses (gestational age 28-41 weeks) underwent dynamic cardiac MRI at 3 T. Cine balanced steady-state free-precession imaging was performed using fetal cardiac DUS gating. FT-MRI was analyzed using dedicated post-processing software. Endo- and epicardial contours were manually delineated from fetal cardiac 4-chamber views, followed by automated propagation to calculate global longitudinal strain (GLS) of the left (LV) and right ventricle (RV), LV radial strain, and LV strain rate. RESULTS Strain assessment was successful in 38/43 fetuses (88%); 23 of them had postnatally confirmed diagnosis of CHD (e.g., coarctation, transposition of great arteries) and 15 were heart healthy. Five fetuses were excluded due to reduced image quality. In fetuses with CHD compared to healthy controls, median LV GLS (- 13.2% vs. - 18.9%; p < 0.007), RV GLS (- 7.9% vs. - 16.2%; p < 0.006), and LV strain rate (1.4 s-1 vs. 1.6 s-1; p < 0.003) were significantly higher (i.e., less negative). LV radial strain was without a statistically significant difference (20.7% vs. 22.6%; p = 0.1). Bivariate discriminant analysis for LV GLS and RV GLS revealed a sensitivity of 67% and specificity of 93% to differentiate between fetuses with CHD and healthy fetuses. CONCLUSION Myocardial strain was successfully assessed in the human fetus, performing dynamic fetal cardiac MRI with DUS gating. Our study indicates that strain parameters may allow for differentiation between fetuses with and without CHD. CLINICAL RELEVANCE STATEMENT Myocardial strain analysis by cardiac MRI with Doppler ultrasound gating and feature tracking may provide a new diagnostic approach for evaluation of fetal cardiac function in congenital heart disease. KEY POINTS • MRI myocardial strain analysis has not been performed in human fetuses so far. • Myocardial strain was assessed in human fetuses using cardiac MRI with Doppler ultrasound gating. • MRI myocardial strain may provide a new diagnostic approach to evaluate fetal cardiac function.
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Affiliation(s)
- Maryam Dargahpour Barough
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Manuela Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Bettina Hergert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Roland Fischer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Lukas Huber
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Jan Moritz Seliger
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Michael Gerhard Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
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Lopez Gonzalez R, Holmes WM. Editorial for "Reference Values for Fetal Cardiac Dimensions, Volumes, Ventricular Function and Left Ventricular Longitudinal Strain Using Doppler Ultrasound Gated Cardiac Magnetic Resonance Imaging in Healthy Third Trimester Fetuses". J Magn Reson Imaging 2024; 60:375-376. [PMID: 37855664 DOI: 10.1002/jmri.29075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Rosario Lopez Gonzalez
- Department of Clinical Physics and Bioengineering, National Health Service Greater Glasgow and Clyde, Glasgow, UK
- Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - William M Holmes
- Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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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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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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Kühle H, Cho SKS, Barber N, Goolaub DS, Darby JRT, Morrison JL, Haller C, Sun L, Seed M. Advanced imaging of fetal cardiac function. Front Cardiovasc Med 2023; 10:1206138. [PMID: 37288263 PMCID: PMC10242056 DOI: 10.3389/fcvm.2023.1206138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Over recent decades, a variety of advanced imaging techniques for assessing cardiovascular physiology and cardiac function in adults and children have been applied in the fetus. In many cases, technical development has been required to allow feasibility in the fetus, while an appreciation of the unique physiology of the fetal circulation is required for proper interpretation of the findings. This review will focus on recent advances in fetal echocardiography and cardiovascular magnetic resonance (CMR), providing examples of their application in research and clinical settings. We will also consider future directions for these technologies, including their ongoing technical development and potential clinical value.
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Affiliation(s)
- Henriette Kühle
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Cardiac and Thoracic Surgery, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Division of Cardiac Surgery, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Steven K. S. Cho
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, SA, Australia
| | - Nathaniel Barber
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Datta Singh Goolaub
- Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jack R. T. Darby
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, SA, Australia
| | - Janna L. Morrison
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, SA, Australia
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christoph Haller
- Division of Cardiac Surgery, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Liqun Sun
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mike Seed
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Tan S, Nemeth P. Editorial: In vivo and in vitro models for research in pathology. Pathol Oncol Res 2023; 29:1611196. [PMID: 37082270 PMCID: PMC10111255 DOI: 10.3389/pore.2023.1611196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Affiliation(s)
- Songwen Tan
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China
- *Correspondence: Songwen Tan, ; Peter Nemeth,
| | - Peter Nemeth
- Department of Immunology and Biotechnology, University of Pécs, Medical School, Pécs, Hungary
- *Correspondence: Songwen Tan, ; Peter Nemeth,
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Vollbrecht TM, Hart C, Zhang S, Katemann C, Isaak A, Pieper CC, Kuetting D, Faridi B, Strizek B, Attenberger U, Kipfmueller F, Herberg U, Geipel A, Luetkens JA. Fetal Cardiac Cine MRI with Doppler US Gating in Complex Congenital Heart Disease. Radiol Cardiothorac Imaging 2023; 5:e220129. [PMID: 36860838 PMCID: PMC9969216 DOI: 10.1148/ryct.220129] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 02/25/2023]
Abstract
Purpose To apply Doppler US (DUS)-gated fetal cardiac cine MRI in clinical routine and investigate diagnostic performance in complex congenital heart disease (CHD) compared with that of fetal echocardiography. Materials and Methods In this prospective study (May 2021 to March 2022), women with fetuses with CHD underwent fetal echocardiography and DUS-gated fetal cardiac MRI on the same day. For MRI, balanced steady-state free precession cine images were acquired in the axial and optional sagittal and/or coronal orientations. Overall image quality was assessed on a four-point Likert scale (from 1 = nondiagnostic to 4 = good image quality). The presence of abnormalities in 20 fetal cardiovascular features was independently assessed by using both modalities. The reference standard was postnatal examination results. Differences in sensitivities and specificities were determined by using a random-effects model. Results The study included 23 participants (mean age, 32 years ± 5 [SD]; mean gestational age, 36 weeks ± 1). Fetal cardiac MRI was completed in all participants. The median overall image quality of DUS-gated cine images was 3 (IQR, 2.5-4). In 21 of 23 participants (91%), underlying CHD was correctly assessed by using fetal cardiac MRI. In one case, the correct diagnosis was made by using MRI only (situs inversus and congenitally corrected transposition of the great arteries). Sensitivities (91.8% [95% CI: 85.7, 95.1] vs 93.6% [95% CI: 88.8, 96.2]; P = .53) and specificities (99.9% [95% CI: 99.2, 100] vs 99.9% [95% CI: 99.5, 100]; P > .99) for the detection of abnormal cardiovascular features were comparable between MRI and echocardiography, respectively. Conclusion Using DUS-gated fetal cine cardiac MRI resulted in performance comparable with that of using fetal echocardiography for diagnosing complex fetal CHD.Keywords: Pediatrics, MR-Fetal (Fetal MRI), Cardiac, Heart, Congenital, Fetal Imaging, Cardiac MRI, Prenatal, Congenital Heart DiseaseClinical trial registration no. NCT05066399 Supplemental material is available for this article. © RSNA, 2023See also the commentary by Biko and Fogel in this issue.
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Liu K, Zhu M, Zhang YQ, Chen LJ, Dong SZ. Utility of fetal cardiac magnetic resonance imaging in assessing the cardiac axis in fetuses with congenital heart disease. Pediatr Radiol 2023; 53:910-919. [PMID: 36602571 DOI: 10.1007/s00247-022-05582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Fetal dedicated echocardiography is the standard to measure the fetal cardiac axis. However, fetal screening ultrasound (US) or fetal dedicated echocardiography may be technically limited. OBJECTIVE The purpose of this study was to explore the accuracy of fetal cardiac magnetic resonance imaging (MRI) to measure the cardiac axis in fetuses with congenital heart disease as an adjunct to fetal dedicated echocardiography and to assess the predictive value of fetal cardiac MRI measurements in distinguishing healthy fetuses from fetuses with congenital heart disease. MATERIALS AND METHODS This is a retrospective study of fetuses referred to our hospital for a fetal cardiac MRI from November 2019 to December 2021. Cardiac axes were measured in the 4-chamber view of the fetal heart using fetal cardiac MRI and dedicated echocardiography, or only using fetal cardiac MRI when screening US was technically limited. The fetuses were divided into a congenital heart disease group and a healthy control group. We used Bland-Altman analysis and the intraclass correlation coefficient (ICC) to assess the agreement of cardiac axis measurements in fetuses with congenital heart disease obtained by cardiac MRI and by fetal dedicated echocardiography. Receiver operating characteristic (ROC) curve analysis of the fetal cardiac axes in the congenital heart disease and healthy fetus groups assessed the predictive value of the cardiac axis measurements. RESULTS This retrospective study included 431 women (162 carrying fetuses with congenital heart disease, 269 carrying healthy fetuses). Cardiac axes were measured in the 162 fetuses with congenital heart disease using fetal cardiac MRI and dedicated echocardiography. Cardiac axes were measured in the 269 healthy control fetuses using fetal cardiac MRI when fetal screening US was technically limited. The interobserver analysis and intraobserver analysis showed that the cardiac axis measured by fetal cardiac MRI and fetal dedicated echocardiography was repeatable (ICC>0.90). In 162 fetuses with congenital heart disease, Bland-Altman analysis showed a strong agreement between cardiac MRI and fetal dedicated echocardiography measurements for the cardiac axis. The ICC for the cardiac axis values between cardiac MRI and fetal dedicated echocardiography measurements was 0.99. In fetuses with congenital heart disease, 64.2% (104/162) had an abnormal cardiac axis. For the fetal cardiac axis in both the 162 fetuses with congenital heart disease and the 269 healthy fetuses, the area under the ROC curve reached 0.85 (95% confidence interval: 0.80-0.89; P<0.0001). CONCLUSION The cardiac axis can be accurately measured using fetal cardiac MRI when fetal dedicated echocardiography/fetal screening US is technically limited. The cardiac axis measurements by fetal cardiac MRI are consistent with known cardiac axis measurements by fetal dedicated echocardiography. The frequency of abnormal cardiac axis depends on the type of congenital heart disease.
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Affiliation(s)
- Ke Liu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, People's Republic of China
| | - Ming Zhu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, People's Republic of China
| | - Yu-Qi Zhang
- Department of Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Jun Chen
- Department of Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Su-Zhen Dong
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, People's Republic of China.
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Beer M, Schönnagel B, Herrmann J, Klömpken S, Schaal M, Kaestner M, Apitz C, Brunner H. Non-invasive pediatric cardiac imaging-current status and further perspectives. Mol Cell Pediatr 2022; 9:21. [PMID: 36575291 PMCID: PMC9794482 DOI: 10.1186/s40348-022-00153-z] [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: 09/16/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Non-invasive cardiac imaging has a growing role in diagnosis, differential diagnosis, therapy planning, and follow-up in children and adolescents with congenital and acquired cardiac diseases. This review is based on a systematic analysis of international peer-reviewed articles and additionally presents own clinical experiences. It provides an overview of technical advances, emerging clinical applications, and the aspect of artificial intelligence. MAIN BODY The main imaging modalities are echocardiography, CT, and MRI. For echocardiography, strain imaging allows a novel non-invasive assessment of tissue integrity, 3D imaging rapid holistic overviews of anatomy. Fast cardiac CT imaging new techniques-especially for coronary assessment as the main clinical indication-have significantly improved spatial and temporal resolution in adjunct with a major reduction in ionizing dose. For cardiac MRI, assessment of tissue integrity even without contrast agent application by mapping sequences is a major technical breakthrough. Fetal cardiac MRI is an emerging technology, which allows structural and functional assessment of fetal hearts including even 4D flow analyses. Last but not least, artificial intelligence will play an important role for improvements of data acquisition and interpretation in the near future. CONCLUSION Non-invasive cardiac imaging plays an integral part in the workup of children with heart disease. In recent years, its main application congenital heart disease has been widened for acquired cardiac diseases.
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Affiliation(s)
- Meinrad Beer
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Björn Schönnagel
- grid.13648.380000 0001 2180 3484Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- grid.13648.380000 0001 2180 3484Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Klömpken
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Matthias Schaal
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Michael Kaestner
- grid.410712.10000 0004 0473 882XDivision of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Christian Apitz
- grid.410712.10000 0004 0473 882XDivision of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Horst Brunner
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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10
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Hassan HGEMA, Habeeb NMM, Ibrahim AS, Megahed SR, Yassin A. Feasibility study in assessment of congenital cardiovascular malformation by recent technique of fetal cardiac MR imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00771-7] [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
Abnormalities of the cardiovascular system are the most common congenital diseases in the fetus and the first cause of infant mortality. Echocardiography is still the method of choice to visualize the fetal cardiac cardiovascular abnormalities, yet cardiovascular magnetic resonance (CMR) is relatively unaffected by maternal and fetal conditions such as maternal obesity, uterine myoma, twins, oligohydramnios, fetal position and rib calcification, which particularly impair sonographic visualization of the fetal heart. Fetal cardiac MR imaging is a novel MRI technique which can provide valuable information that could add to the prenatal diagnosis and evaluation of cardiac and most of extra-cardiac anomalies. In this work, we aimed to highlight the advantage of FCMRI over fetal echocardiography in assessment of fetal congenital cardiac anomalies.
Results
Fifty-Two fetuses with suspected or diagnosed congenital cardiac anomalies. All cases underwent detailed history taking, underwent fetal echocardiography using suitable curvilinear probe and performed according to standard protocol, then fetal cardiac MR was done with Balanced fast field echo, Black blood single shot, white blood Cine, Real-time 3D dynamic sequences, images were acquired in the transverse, four-chamber, short-axis, coronal and oblique sagittal views. Findings of fetal echocardiography were compared with that of cardiac MRI and with standard post-natal echocardiography. Prenatal Echo and fetal cardiac MRI showed significant moderate agreement between the two modalities in the detection of different congenital cardiac anomalies, Kappa test: 0.500; p value 0.021. Fetal MRI had a significant role in detection of extra cardiac anomalies in most cases. Comparing to gold standard post-natal echo. Accuracy of fetal CMRI is 95.5% and of fetal Echo is 86.4% regarding overall cardiac anomalies:
Conclusion
Fetal cardiac MR imaging as an adjunct to fetal echocardiography may provide valuable information that could add to the prenatal diagnosis and evaluation of cardiac and most of extra cardiac anomalies.
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11
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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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12
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Goncalves LF, Lindblade CL, Cornejo P, Patel MC, McLaughlin ES, Bardo DME. Contribution of fetal magnetic resonance imaging in fetuses with congenital heart disease. Pediatr Radiol 2022; 52:513-526. [PMID: 34842935 DOI: 10.1007/s00247-021-05234-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 09/18/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing evidence supports an association among congenital heart disease (CHD), structural brain lesions on neuroimaging, and increased risk of neurodevelopmental delay and other structural anomalies. Fetal MRI has been found to be effective in demonstrating fetal structural and developmental abnormalities. OBJECTIVE To determine the contribution of fetal MRI to identifying cardiovascular and non-cardiovascular anomalies in fetuses with CHD compared to prenatal US and fetal echocardiography. MATERIALS AND METHODS We performed a retrospective study of fetuses with CHD identified by fetal echocardiography. Exams were performed on 1.5-tesla (T) or 3-T magnets using a balanced turbo field echo sequence triggered by an external electrocardiogram simulator with a fixed heart rate of 140 beats per minute (bpm). Fetal echocardiography was performed by pediatric cardiologists and detailed obstetrical US by maternal-fetal medicine specialists prior to referral to MRI. We compared the sensitivity of fetal MRI and fetal echocardiography for the diagnosis of cardiovascular anomalies, as well as the sensitivity of fetal MRI and referral US for the diagnosis of non-cardiac anomalies. We performed statistical analysis using the McNemar test. RESULTS We identified 121 anomalies in 31 fetuses. Of these, 73 (60.3%) were cardiovascular and 48 (39.7%) involved other organ systems. Fetal echocardiography was more sensitive for diagnosing cardiovascular anomalies compared to fetal MRI, but the difference was not statistically significant (85.9%, 95% confidence interval [CI] 77.8-94.0% vs. 77.5%, 95% CI 67.7-87.2%, respectively; McNemar test 2.29; P=0.13). The sensitivity of fetal MRI was higher for diagnosing extracardiac anomalies when compared to referral US (84.1%, 95% CI 73.3-94.9% vs. 31.8%, 95% CI 18.1-45.6%, respectively; McNemar test 12.9; P<0.001). The additional information provided by fetal MRI changed prognosis, counseling or management for 10/31 fetuses (32.2%), all in the group of 19 fetuses with anomalies in other organs and systems besides CHD. CONCLUSION Fetal MRI performed in a population of fetuses with CHD provided additional information that altered prognosis, counseling or management in approximately one-third of the fetuses, mainly by identifying previously unknown anomalies in other organs and systems.
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Affiliation(s)
- Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
- University of Arizona College of Medicine, Phoenix, AZ, USA.
- Department of Radiology, Creighton University, Phoenix, AZ, USA.
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA.
| | - Christopher L Lindblade
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Mittun C Patel
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Ericka Scheller McLaughlin
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Dianna M E Bardo
- Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
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13
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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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14
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Leon RL, Ortigoza EB, Ali N, Angelis D, Wolovits JS, Chalak LF. Cerebral Blood Flow Monitoring in High-Risk Fetal and Neonatal Populations. Front Pediatr 2021; 9:748345. [PMID: 35087771 PMCID: PMC8787287 DOI: 10.3389/fped.2021.748345] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/15/2021] [Indexed: 12/18/2022] Open
Abstract
Cerebrovascular pressure autoregulation promotes stable cerebral blood flow (CBF) across a range of arterial blood pressures. Cerebral autoregulation (CA) is a developmental process that reaches maturity around term gestation and can be monitored prenatally with both Doppler ultrasound and magnetic resonance imaging (MRI) techniques. Postnatally, there are key advantages and limitations to assessing CA with Doppler ultrasound, MRI, and near-infrared spectroscopy. Here we review these CBF monitoring techniques as well as their application to both fetal and neonatal populations at risk of perturbations in CBF. Specifically, we discuss CBF monitoring in fetuses with intrauterine growth restriction, anemia, congenital heart disease, neonates born preterm and those with hypoxic-ischemic encephalopathy. We conclude the review with insights into the future directions in this field with an emphasis on collaborative science and precision medicine approaches.
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Affiliation(s)
- Rachel L Leon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Eric B Ortigoza
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Noorjahan Ali
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Dimitrios Angelis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Joshua S Wolovits
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lina F Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
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15
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Markenroth Bloch K, Kording F, Töger J. Doppler ultrasound cardiac gating of intracranial flow at 7T. BMC Med Imaging 2020; 20:128. [PMID: 33297985 PMCID: PMC7724705 DOI: 10.1186/s12880-020-00523-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultra-high field magnetic resonance imaging (MR) may be used to improve intracranial blood flow measurements. However, standard cardiac synchronization methods tend to fail at ultra-high field MR. Therefore, this study aims to investigate an alternative synchronization technique using Doppler ultrasound. METHODS Healthy subjects (n = 9) were examined with 7T MR. Flow was measured in the M1-branch of the middle cerebral artery (MCA) and in the cerebral aqueduct (CA) using through-plane phase contrast (2D flow). Flow in the circle of Willis was measured with three-dimensional, three-directional phase contrast (4D flow). Scans were gated with Doppler ultrasound (DUS) and electrocardiogram (ECG), and pulse oximetry data (POX) was collected simultaneously. False negative and false positive trigger events were counted for ECG, DUS and POX, and quantitative flow measures were compared. RESULTS There were fewer false positive triggers for DUS compared to ECG (5.3 ± 11 vs. 25 ± 31, p = 0.031), while no other measured parameters differed significantly. Net blood flow in M1 was similar between DUS and ECG for 2D flow (1.5 ± 0.39 vs. 1.6 ± 0.41, bias ± 1.96SD: - 0.021 ± 0.36) and 4D flow (1.8 ± 0.48 vs. 9 ± 0.59, bias ± 1.96SD: - 0.086 ± 0.57 ml). Net CSF flow per heart beat in the CA was also similar for DUS and ECG (3.6 ± 2.1 vs. 3.0 ± 5.8, bias ± 1.96SD: 0.61 ± 13.6 μl). CONCLUSION Gating with DUS produced fewer false trigger events than using ECG, with similar quantitative flow values. DUS gating is a promising technique for cardiac synchronization at 7T.
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Affiliation(s)
- Karin Markenroth Bloch
- The Swedish National 7T Facility, Lund University Bioimaging Center, Lund University, Klinikgatan 32, BMC D11, 22242, Lund, Sweden.
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg- Eppendorf, Hamburg, Germany.,Northh Medical GmbH, Röntgenstraße 24, 22335, Hamburg, Germany
| | - Johannes Töger
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University and Skane University Hospital Lund, Lund, Sweden
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16
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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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17
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Liu H, Shi W. WITHDRAWN: Effect of maternal rubella virus infection on fetal cardiac function and neural development by color doppler ultrasound (cardiography) information technology. Neurosci Lett 2020:S0304-3940(20)30479-1. [PMID: 32599316 DOI: 10.1016/j.neulet.2020.135209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 10/24/2022]
Abstract
This article has been withdrawn at the request of the Editor-in-Chief. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Haixia Liu
- Third Department of Ultrasound, Cangzhou Central Hospital, Cangzhou City 061001, Hebei Province, China
| | - Wei Shi
- Third Department of Ultrasound, Cangzhou Central Hospital, Cangzhou City 061001, Hebei Province, China.
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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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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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20
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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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