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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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Maher S, Seed M. Fetal Cardiovascular MR Imaging. Magn Reson Imaging Clin N Am 2024; 32:479-487. [PMID: 38944435 DOI: 10.1016/j.mric.2024.04.008] [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] [Indexed: 07/01/2024]
Abstract
Prenatal diagnosis of congenital heart disease allows for appropriate planning of delivery and an opportunity to inform families about the prognosis of the cardiac malformation. On occasion, prenatal therapies may be offered to improve perinatal outcomes. While ultrasound is the primary diagnostic method, advances have led to interest in fetal MRI for its potential to aid in clinical decision-making. This review explores technical innovations and the clinical utility of fetal cardiovascular magnetic resonance (CMR), highlighting its role in diagnosing and planning interventions for complex heart conditions. Future directions include the prediction of perinatal physiology and guidance of delivery planning.
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Affiliation(s)
- Samer Maher
- Department of Physiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada
| | - Mike Seed
- Cardiology, The Hospital for Sick Children, University of Toronto, 170 Elizabeth Street, Toronto, Ontario, Canada.
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Minocha PK, Englund EK, Friesen RM, Fujiwara T, Smith SA, Meyers ML, Browne LP, Barker AJ. 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; 60:365-374. [PMID: 37855630 PMCID: PMC11026299 DOI: 10.1002/jmri.29077] [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: 07/31/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Recent advances in hardware and software permit the use of cardiac MRI of late gestation fetuses, however there is a paucity of MRI-based reference values. PURPOSE To provide initial data on fetal cardiac MRI-derived cardiac dimensions, volumes, ventricular function, and left ventricular longitudinal strain in healthy developing fetuses >30 weeks gestational age. STUDY TYPE Prospective. POPULATION Twenty-five third trimester (34 ± 1 weeks, range of 32-37 weeks gestation) women with healthy developing fetuses. FIELD STRENGTH/SEQUENCE Studies were performed at 1.5 T and 3 T. Cardiac synchronization was achieved with a Doppler ultrasound device. The protocol included T2 single shot turbo spin echo stacks for fetal weight and ultrasound probe positioning, and multiplanar multi-slice cine balanced steady state free precession gradient echo sequences. ASSESSMENT Primary analyses were performed by a single observer. Weight indexed right ventricular (RV) and left ventricular (LV) volumes and function were calculated from short axis (SAX) stacks. Cardiac dimensions were calculated from the four-chamber and SAX stacks. Single plane LV longitudinal strain was calculated from the four-chamber stack. Interobserver variability was assessed in 10 participants. Cardiac MRI values were compared against available published normative fetal echocardiogram data using z-scores. STATISTICAL TESTS Mean and SDs were calculated for baseline maternal/fetal demographics, cardiac dimensions, volumes, ventricular function, and left ventricular longitudinal strain. Bland-Altman and intraclass correlation coefficient analysis was performed to test interobserver variability. RESULTS The mean gestational age was 34 ± 1.4 weeks. The mean RV and LV end diastolic volumes were 3.1 ± 0.6 mL/kg and 2.4 ± 0.5 mL/kg respectively. The mean RV cardiac output was 198 ± 49 mL/min/kg while the mean LV cardiac output was 173 ± 43 mL/min/kg. DATA CONCLUSION This paper reports initial reference values obtained by cardiac MRI in healthy developing third trimester fetuses. MRI generally resulted in slightly larger indexed values (by z-score) compared to reports in literature using fetal echocardiography. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Prashant K. Minocha
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado School of Medicine, USA
| | - Erin K. Englund
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Richard M. Friesen
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado School of Medicine, USA
| | - Takashi Fujiwara
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Sarah A. Smith
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Mariana L. Meyers
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Lorna P. Browne
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Alex J. Barker
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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4
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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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Fricke K, Ryd D, Weismann CG, Hanséus K, Hedström E, Liuba P. Fetal cardiac magnetic resonance imaging of the descending aorta in suspected left-sided cardiac obstructions. Front Cardiovasc Med 2023; 10:1285391. [PMID: 38107261 PMCID: PMC10725198 DOI: 10.3389/fcvm.2023.1285391] [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: 08/29/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Background Severe left-sided cardiac obstructions are associated with high morbidity and mortality if not detected in time. The correct prenatal diagnosis of coarctation of the aorta (CoA) is difficult. Fetal cardiac magnetic resonance imaging (CMR) may improve the prenatal diagnosis of complex congenital heart defects. Flow measurements in the ascending aorta could aid in predicting postnatal CoA, but its accurate visualization is challenging. Objectives To compare the flow in the descending aorta (DAo) and umbilical vein (UV) in fetuses with suspected left-sided cardiac obstructions with and without the need for postnatal intervention and healthy controls by fetal phase-contrast CMR flow. A second objective was to determine if adding fetal CMR to echocardiography (echo) improves the fetal CoA diagnosis. Methods Prospective fetal CMR phase-contrast flow in the DAo and UV and echo studies were conducted between 2017 and 2022. Results A total of 46 fetuses with suspected left-sided cardiac obstructions [11 hypoplastic left heart syndrome (HLHS), five critical aortic stenosis (cAS), and 30 CoA] and five controls were included. Neonatal interventions for left-sided cardiac obstructions (n = 23) or comfort care (n = 1 with HLHS) were pursued in all 16 fetuses with suspected HLHS or cAS and in eight (27%) fetuses with true CoA. DAo or UV flow was not different in fetuses with and without need of intervention. However, DAo and UV flows were lower in fetuses with either retrograde isthmic systolic flow [DAo flow 253 (72) vs. 261 (97) ml/kg/min, p = 0.035; UV flow 113 (75) vs. 161 (81) ml/kg/min, p = 0.04] or with suspected CoA and restrictive atrial septum [DAo flow 200 (71) vs. 268 (94) ml/kg/min, p = 0.04; UV flow 89 vs. 159 (76) ml/kg/min, p = 0.04] as well as in those without these changes. Adding fetal CMR to fetal echo predictors for postnatal CoA did not improve the diagnosis of CoA. Conclusion Fetal CMR-derived DAo and UV flow measurements do not improve the prenatal diagnosis of left-sided cardiac obstructions, but they could be important in identifying fetuses with a more severe decrease in blood flow across the left side of the heart. The physiological explanation may be a markedly decreased left ventricular cardiac output with subsequent retrograde systolic isthmic flow and decreased total DAo flow.
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Affiliation(s)
- Katrin Fricke
- Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - Constance G. Weismann
- Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian University, Munich, Germany
| | - Katarina Hanséus
- Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Diagnostic Radiology, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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7
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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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8
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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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9
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van Amerom JFP, Goolaub DS, Schrauben EM, Sun L, Macgowan CK, Seed M. Fetal cardiovascular blood flow MRI: techniques and applications. Br J Radiol 2023; 96:20211096. [PMID: 35687661 PMCID: PMC10321246 DOI: 10.1259/bjr.20211096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/11/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
Abstract
Fetal cardiac MRI is challenging due to fetal and maternal movements as well as the need for a reliable cardiac gating signal and high spatiotemporal resolution. Ongoing research and recent technical developments to address these challenges show the potential of MRI as an adjunct to ultrasound for the assessment of the fetal heart and great vessels. MRI measurements of blood flow have enabled the assessment of normal fetal circulation as well as conditions with disrupted circulations, such as congenital heart disease, along with associated organ underdevelopment and hemodynamic instability. This review provides details of the techniques used in fetal cardiovascular blood flow MRI, including single slice and volumetric imaging sequences, post-processing and analysis, along with a summary of applications in human studies and animal models.
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Affiliation(s)
- Joshua FP van Amerom
- Division of Translational Medicine, SickKids Research Institute, Toronto, Canada
| | | | - Eric M Schrauben
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
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10
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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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11
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Moscatelli S, Leo I, Lisignoli V, Boyle S, Bucciarelli-Ducci C, Secinaro A, Montanaro C. Cardiovascular Magnetic Resonance from Fetal to Adult Life-Indications and Challenges: A State-of-the-Art Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050763. [PMID: 37238311 DOI: 10.3390/children10050763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Cardiovascular magnetic resonance (CMR) imaging offers a comprehensive, non-invasive, and radiation-free imaging modality, which provides a highly accurate and reproducible assessment of cardiac morphology and functions across a wide spectrum of cardiac conditions spanning from fetal to adult life. It minimises risks to the patient, particularly the risks associated with exposure to ionising radiation and the risk of complications from more invasive haemodynamic assessments. CMR utilises high spatial resolution and provides a detailed assessment of intracardiac and extracardiac anatomy, ventricular and valvular function, and flow haemodynamic and tissue characterisation, which aid in the diagnosis, and, hence, with the management of patients with cardiac disease. This article aims to discuss the role of CMR and the indications for its use throughout the different stages of life, from fetal to adult life.
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Affiliation(s)
- Sara Moscatelli
- Inherited Cardiovascular Diseases, Great Ormond Street, Children NHS Foundation Trust, London WC1N 3JH, UK
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Veronica Lisignoli
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
- Adult Congenital Heart Disease Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Siobhan Boyle
- Adult Congenital Heart Disease Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
- Cardiology Department, Logan Hospital, Loganlea Rd, Meadowbrook, QLD 4131, Australia
| | - Chiara Bucciarelli-Ducci
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College University, London SW7 2BX, UK
| | - Aurelio Secinaro
- Radiology Department, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | - Claudia Montanaro
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
- Adult Congenital Heart Disease Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 5NP, UK
- National Heart and Lung Institute, Imperial Collage London, Dovehouse St, London SW3 6LY, UK
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12
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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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13
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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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14
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Yeh CY, Lee HH, Islam MM, Chien CH, Atique S, Chan L, Lin MC. Development and Validation of Machine Learning Models to Classify Artery Stenosis for Automated Generating Ultrasound Report. Diagnostics (Basel) 2022; 12:diagnostics12123047. [PMID: 36553056 PMCID: PMC9776545 DOI: 10.3390/diagnostics12123047] [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: 10/13/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
Duplex ultrasonography (DUS) is a safe, non-invasive, and affordable primary screening tool to identify the vascular risk factors of stroke. The overall process of DUS examination involves a series of complex processes, such as identifying blood vessels, capturing the images of blood vessels, measuring the velocity of blood flow, and then physicians, according to the above information, determining the severity of artery stenosis for generating final ultrasound reports. Generation of transcranial doppler (TCD) and extracranial carotid doppler (ECCD) ultrasound reports involves a lot of manual review processes, which is time-consuming and makes it easy to make errors. Accurate classification of the severity of artery stenosis can provide an early opportunity for decision-making regarding the treatment of artery stenosis. Therefore, machine learning models were developed and validated for classifying artery stenosis severity based on hemodynamic features. This study collected data from all available cases and controlled at one academic teaching hospital in Taiwan between 1 June 2020, and 30 June 2020, from a university teaching hospital and reviewed all patients' medical records. Supervised machine learning models were developed to classify the severity of artery stenosis. The receiver operating characteristic curve, accuracy, sensitivity, specificity, and positive and negative predictive value were used for model performance evaluation. The performance of the random forest model was better compared to the logistic regression model. For ECCD reports, the accuracy of the random forest model to predict stenosis in various sites was between 0.85 and 1. For TCD reports, the overall accuracy of the random forest model to predict stenosis in various sites was between 0.67 and 0.86. The findings of our study suggest that a machine learning-based model accurately classifies artery stenosis, which indicates that the model has enormous potential to facilitate screening for artery stenosis.
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Affiliation(s)
- Chih-Yang Yeh
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsun-Hua Lee
- Department of Neurology, Taipei Medical University Hospital, Taipei Medical University, Taipei 11031, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Dizziness and Balance Disorder Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Md. Mohaimenul Islam
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Chiu-Hui Chien
- Division of Operation Performance, Center for Management and Development, Taipei Medical University, Taipei 11031, Taiwan
| | - Suleman Atique
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, 1430 Ås, Norway
- Department of Health Informatics, College of Public Health and Health Informatics, University of Hail, Hail 55476, Saudi Arabia
| | - Lung Chan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence: (L.C.); (M.-C.L.)
| | - Ming-Chin Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Correspondence: (L.C.); (M.-C.L.)
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15
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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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16
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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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17
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Schulz A, Lloyd DFA, van Poppel MPM, Roberts TA, Steinweg JK, Pushparajah K, Hajnal JV, Razavi R. Structured analysis of the impact of fetal motion on phase-contrast MRI flow measurements with metric optimized gating. Sci Rep 2022; 12:5395. [PMID: 35354868 PMCID: PMC8967860 DOI: 10.1038/s41598-022-09327-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/21/2022] [Indexed: 01/19/2023] Open
Abstract
The impact of fetal motion on phase contrast magnetic resonance imaging (PC-MRI) with metric optimized gating (MOG) remains unknown, despite being a known limitation to prenatal MRI. This study aims to describe the effect of motion on fetal flow-measurements using PC-MRI with MOG and to generate a scoring-system that could be used to predict motion-corrupted datasets at the time of acquisition. Ten adult volunteers underwent PC-MRI with MOG using a motion-device to simulate reproducible in-plane motion encountered in fetuses. PC-MRI data were acquired on ten fetuses. All ungated images were rated on their quality from 0 (no motion) to 2 (severe motion). There was no significant difference in measured flows with in-plane motion during the first and last third of sequence acquisition. Movement in the middle section of acquisition produced a significant difference while all referring ungated images were rated with a score of 2. Intra-Class-Correlation (ICC) for flow-measurements in adult and fetal datasets was lower for datasets with scores of 2. For fetal applications, the use of a simple three-point scoring system reliably identifies motion-corrupted sequences from unprocessed data at the time of acquisition, with a high score corresponding to significant underestimation of flow values and increased interobserver variability.
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Affiliation(s)
- Alexander Schulz
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK. .,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - David F A Lloyd
- School of Biomedical Engineering and Imaging Sciences, King's College London, 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
| | - Milou P M van Poppel
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Thomas A Roberts
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Johannes K Steinweg
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King's College London, 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
| | - Joseph V Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, 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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18
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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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19
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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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20
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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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21
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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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22
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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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23
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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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24
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Roberts TA, van Amerom JFP, Uus A, Lloyd DFA, van Poppel MPM, Price AN, Tournier JD, Mohanadass CA, Jackson LH, Malik SJ, Pushparajah K, Rutherford MA, Razavi R, Deprez M, Hajnal JV. Fetal whole heart blood flow imaging using 4D cine MRI. Nat Commun 2020; 11:4992. [PMID: 33020487 PMCID: PMC7536221 DOI: 10.1038/s41467-020-18790-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/10/2020] [Indexed: 12/26/2022] Open
Abstract
Prenatal detection of congenital heart disease facilitates the opportunity for potentially life-saving care immediately after the baby is born. Echocardiography is routinely used for screening of morphological malformations, but functional measurements of blood flow are scarcely used in fetal echocardiography due to technical assumptions and issues of reliability. Magnetic resonance imaging (MRI) is readily used for quantification of abnormal blood flow in adult hearts, however, existing in utero approaches are compromised by spontaneous fetal motion. Here, we present and validate a novel method of MRI velocity-encoding combined with a motion-robust reconstruction framework for four-dimensional visualization and quantification of blood flow in the human fetal heart and major vessels. We demonstrate simultaneous 4D visualization of the anatomy and circulation, which we use to quantify flow rates through various major vessels. The framework introduced here could enable new clinical opportunities for assessment of the fetal cardiovascular system in both health and disease.
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Affiliation(s)
- Thomas A Roberts
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK.
| | - Joshua F P van Amerom
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Alena Uus
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - David F A Lloyd
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, SE1 7EH, UK
| | - Milou P M van Poppel
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, SE1 7EH, UK
| | - Anthony N Price
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Jacques-Donald Tournier
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Chloe A Mohanadass
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Laurence H Jackson
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Shaihan J Malik
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, SE1 7EH, UK
| | - Mary A Rutherford
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Centre for the Developing Brain, King's College London, London, SE1 7EH, UK
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, SE1 7EH, UK
| | - Maria Deprez
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Joseph V Hajnal
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
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25
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Goolaub DS, Xu J, Schrauben E, Sun L, Roy CW, Marini D, Seed M, Macgowan CK. Fetal Flow Quantification in Great Vessels Using Motion-Corrected Radial Phase Contrast MRI: Comparison With Cartesian. J Magn Reson Imaging 2020; 53:540-551. [PMID: 32815242 DOI: 10.1002/jmri.27334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Phase contrast MRI in the great vessels is a potential clinical tool for managing fetal pathologies. One challenge is the uncontrollable fetal motion, potentially corrupting flow quantifications. PURPOSE To demonstrate improvements in fetal blood flow quantification in great vessels using retrospectively motion-corrected golden-angle radial phase contrast MRI relative to Cartesian phase contrast MRI. STUDY TYPE Method comparison. PHANTOM/SUBJECTS Computer simulation. Seventeen pregnant volunteers. FIELD STRENGTH/SEQUENCE 1.5T and 3T. Cartesian and golden-angle radial phase contrast MRI. ASSESSMENT Through computer simulations, radial (with and without retrospective motion correction) and Cartesian phase contrast MRI were compared using flow deviations. in vivo Cartesian and radial phase contrast MRI measurements and reconstruction qualities were compared in pregnancies. Cartesian data were reconstructed into gated reconstructions (CINEs) after cardiac gating with metric optimized gating (MOG). For radial data, real-time reconstructions were performed for motion correction and MOG followed by CINE reconstructions. STATISTICAL TESTS Wilcoxon signed-rank test. Linear regression. Bland-Altman plots. Student's t-test. RESULTS Simulations showed significant improvements (P < 0.05) in flow accuracy and reconstruction quality with motion correction ([mean/peak] flow errors with ±5 mm motion corruption: Cartesian [35 ± 1/115 ± 7] mL/s, motion uncorrected radial [25 ± 1/75 ± 2] mL/s and motion-corrected radial [1.0 ± 0.5/-5 ± 1] mL/s). in vivo Cartesian reconstructions without motion correction had lower quality than the motion-corrected radial reconstructions (P < 0.05). Across all fetal mean flow measurements, the bias [limits of agreement] between the two measurements were -0.2 [-76, 75] mL/min/kg, while the linear regression coefficients were (Mradial = 0.81 × MCartesian + 29.8 [mL/min/kg], r2 = 0.67). The corresponding measures for the peak fetal flows were -23 [-214, 167] mL/min/kg and (Pradial = 0.95 × PCartesian -1.2 [mL/min/kg], r2 = 0.80). Cartesian reconstructions of low quality showed significantly higher estimated mean and peak (P < 0.05) flows than the corresponding radial reconstructions. DATA CONCLUSION Simulations showed that radial phase contrast MRI with motion compensation improved flow accuracy. For fetal measurements, motion-corrected radial reconstructions showed better image quality than, and different flow values from, Cartesian reconstructions. Level of Evidence 1. Technical Efficacy Stage 1. J. MAGN. RESON. IMAGING 2021;53:540-551.
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Affiliation(s)
- Datta Singh Goolaub
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Division of Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jiawei Xu
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Schrauben
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Liqun Sun
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher W Roy
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Davide Marini
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mike Seed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher K Macgowan
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Division of Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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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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Dong SZ, Zhu M, Ji H, Ren JY, Liu K. Fetal cardiac MRI: a single center experience over 14-years on the potential utility as an adjunct to fetal technically inadequate echocardiography. Sci Rep 2020; 10:12373. [PMID: 32704065 PMCID: PMC7378840 DOI: 10.1038/s41598-020-69375-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/07/2020] [Indexed: 12/26/2022] Open
Abstract
Unlike ultrasound (US) imaging, foetal magnetic resonance imaging (MRI) is not significantly limited by maternal obesity, oligohydramnios, uterine myoma, twins, and foetal lie, which impair US visualization of the foetus. The present study aimed to introduce our foetal cardiac MRI scanning technology and over 14-years of experience on the potential utility of foetal cardiac MRI examination as an adjunct to foetal technically inadequate echocardiography (Echo). This retrospective review included 1,573 pregnant women [1,619 foetuses (46 twins)] referred for a foetal cardiac MRI because of technically limited Echo. Foetal cardiac MRI was performed using two 1.5 T units. Among the 1,619 foetuses referred for cardiac MRI, 1,379 (85.2%) cases were followed up using postnatal imaging and/or surgery, 240 (14.8%), including three twins, had no follow-up confirmation because of pregnancy termination without autopsy or loss to follow-up. The results of the present study indicated that foetal cardiac MRI examinations can be a useful adjunct to foetal echocardiography when the technical limitations of echocardiography make it inadequate for diagnosis.
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Affiliation(s)
- Su-Zhen Dong
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.
| | - Ming Zhu
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.
| | - Hui Ji
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Jing-Ya Ren
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Ke Liu
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
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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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Saini BS, Darby JRT, Portnoy S, Sun L, van Amerom J, Lock MC, Soo JY, Holman SL, Perumal SR, Kingdom JC, Sled JG, Macgowan CK, Morrison JL, Seed M. Normal human and sheep fetal vessel oxygen saturations by T2 magnetic resonance imaging. J Physiol 2020; 598:3259-3281. [PMID: 32372463 DOI: 10.1113/jp279725] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022] Open
Abstract
KEY POINTS Human fetal Doppler ultrasound and invasive blood gas measurements obtained by cordocentesis or at the time of delivery reveal similarities with sheep (an extensively used model for human fetal cardiovascular physiology). Oxygen saturation (SO2 ) measurements in human fetuses have been limited to the umbilical and scalp vessels, providing little information about normal regional SO2 differences in the fetus. Blood T2 MRI relaxometry presents a non-invasive measure of SO2 in the major fetal vessels. This study presents the first in vivo validation of fetal vessel T2 oximetry against the in vitro T2-SO2 relationship using catheterized sheep fetuses and compares the normal SO2 in the major vessels between the human and sheep fetal circulations. Human fetal vessel SO2 by T2 MRI confirms many similarities with the sheep fetal circulation and is able to demonstrate regional differences in SO2 ; in particular the significantly higher SO2 in the left versus right heart. ABSTRACT Blood T2 magnetic resonance imaging (MRI) relaxometry non-invasively measures oxygen saturation (SO2 ) in major vessels but has not been validated in fetuses in vivo. We compared the blood T2-SO2 relationship in vitro (tubes) and in vivo (vessels) in sheep, and measured SO2 across the normal human and sheep fetal circulations by T2. Singleton pregnant ewes underwent surgery to implant vascular catheters. In vitro and in vivo sheep blood T2 measurements were related to corresponding SO2 measured using a blood gas analyser, as well as relating T2 and SO2 of human fetal blood in vitro. MRI oximetry was performed in the major vessels of 30 human fetuses at 36 weeks (term, 40 weeks) and 10 fetal sheep (125 days; term, 150 days). The fidelity of in vivo fetal T2 oximetry was confirmed through comparison of in vitro and in vivo sheep blood T2-SO2 relationships (P = 0.1). SO2 was similar between human and sheep fetuses, as was the fetal oxygen extraction fraction (human, 33 ± 11%; sheep, 34 ± 7%; P = 0.798). The presence of streaming in the human fetal circulation was demonstrated by the SO2 gradient between the ascending aorta (68 ± 10%) and the main pulmonary artery (49 ± 9%; P < 0.001). Human and sheep fetal vessel MRI oximetry based on T2 is a validated approach that confirms the presence of streaming of umbilical venous blood towards the heart and brain. Streaming is important in ensuring oxygen delivery to these organs and its disruption may have important implications for organ development, especially in conditions such as congenital heart disease and fetal growth restriction.
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Affiliation(s)
- Brahmdeep S Saini
- Institute of Medical Science, University of Toronto, Toronto, Ontario, M5S 1A8, Canada.,Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada
| | - Jack R T Darby
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Sharon Portnoy
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, M5G 0A4, Canada
| | - Liqun Sun
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada
| | - Joshua van Amerom
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada
| | - Mitchell C Lock
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Jia Yin Soo
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Stacey L Holman
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Sunthara R Perumal
- Preclinical Imaging and Research Laboratories, South Australian Health and Medical Research Institute, Adelaide, South Australia, 5086, Australia
| | - John C Kingdom
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, M5G 1E2, Canada
| | - John G Sled
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, M5G 0A4, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, M5G 1L7, Canada
| | - Christopher K Macgowan
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, M5G 0A4, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, M5G 1L7, Canada
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Mike Seed
- Institute of Medical Science, University of Toronto, Toronto, Ontario, M5S 1A8, Canada.,Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, M5G 1E2, Canada
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Advances in fetal echocardiography: myocardial deformation analysis, cardiac MRI and three-dimensional printing. Curr Opin Cardiol 2020; 34:35-40. [PMID: 30444761 DOI: 10.1097/hco.0000000000000584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Advances in ultrasound technology have led to new ways of evaluating cardiac function and structure, including myocardial deformation imaging (strain and strain rate), cardiac MRI and three-dimensional (3D) printing. As ultrasound technology has improved, it has become possible to use these modalities to evaluate the fetal heart. This article will review some of the more recent developments in applying these techniques to the evaluation of fetal cardiac structure and function. RECENT FINDINGS Myocardial deformation analyses have led to the establishment of normative values for strain and strain rate in the fetal heart and have also been used to evaluate fetal heart function in both fetal disease states and maternal disease states. Technological advances in MRI technology, 3D imaging and 3D printing have opened up new methods of evaluating fetal structural heart disease. SUMMARY A deeper understanding of the subtleties of myocardial dysfunction in various fetal and maternal disease states may elucidate the pathophysiology involved and lead to new treatment and/or counseling paradigms that may ultimately affect outcome. Similarly, the ability to image the fetal heart in new ways, including fetal MRI and 3D printing, could potentially change fetal counseling techniques and prenatal planning.
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31
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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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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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33
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Manning WJ. Journal of Cardiovascular Magnetic Resonance: 2017/2018 in review. J Cardiovasc Magn Reson 2019; 21:79. [PMID: 31884956 PMCID: PMC6936125 DOI: 10.1186/s12968-019-0594-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
There were 89 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 76 original research papers, 4 reviews, 5 technical notes, 1 guideline, and 3 corrections. The volume was down slightly from 2017 with a corresponding 15% decrease in manuscript submissions from 405 to 346 and thus reflects a slight increase in the acceptance rate from 25 to 26%. The decrease in submissions for the year followed the initiation of the increased author processing charge (APC) for Society for Cardiovascular Magnetic Resonance (SCMR) members for manuscripts submitted after June 30, 2018. The quality of the submissions continues to be high. The 2018 JCMR Impact Factor (which is published in June 2019) was slightly lower at 5.1 (vs. 5.46 for 2017; as published in June 2018. The 2018 impact factor means that on average, each JCMR published in 2016 and 2017 was cited 5.1 times in 2018. Our 5 year impact factor was 5.82.In accordance with Open-Access publishing guidelines of BMC, the JCMR articles are published on-line in a continuus fashion in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful for the JCMR audience to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and contemporaneous JCMR publications. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, as in the past two years, I have used this publication to also convey information regarding the editorial process and as a "State of our JCMR."This is the 12th year of JCMR as an open-access publication with BMC (formerly known as Biomed Central). The timing of the JCMR transition to the open access platform was "ahead of the curve" and a tribute to the vision of Dr. Matthias Friedrich, the SCMR Publications Committee Chair and Dr. Dudley Pennell, the JCMR editor-in-chief at the time. The open-access system has dramatically increased the reading and citation of JCMR publications and I hope that you, our authors, will continue to send your very best, high quality manuscripts to JCMR for consideration. It takes a village to run a journal and I thank our very dedicated Associate Editors, Guest Editors, Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. This entire process would also not be possible without the dedication and efforts of our managing editor, Diana Gethers. Finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 4th year as your editor-in-chief. It has been a tremendous experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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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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Ryd D, Sun L, Steding-Ehrenborg K, Bidhult S, Kording F, Ruprecht C, Macgowan CK, Seed M, Aletras AH, Arheden H, Hedström E. Quantification of blood flow in the fetus with cardiovascular magnetic resonance imaging using Doppler ultrasound gating: validation against metric optimized gating. J Cardiovasc Magn Reson 2019; 21:74. [PMID: 31783877 PMCID: PMC6883707 DOI: 10.1186/s12968-019-0586-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Fetal cardiovascular magnetic resonance (CMR) imaging is used clinically and for research, but has been previously limited due to lack of direct gating methods. A CMR-compatible Doppler ultrasound (DUS) gating device has resolved this. However, the DUS-gating method is not validated against the current reference method for fetal phase-contrast blood flow measurements, metric optimized gating (MOG). Further, we investigated how different methods for vessel delineation affect flow volumes and observer variability in fetal flow acquisitions. AIMS To 1) validate DUS gating versus MOG for quantifying fetal blood flow; 2) assess repeatability of DUS gating; 3) assess impact of region of interest (ROI) size on flow volume; and 4) compare time-resolved and static delineations for flow volume and observer variability. METHODS Phase-contrast CMR was acquired in the fetal descending aorta (DAo) and umbilical vein by DUS gating and MOG in 22 women with singleton pregnancy in gestational week 360 (265-400) with repeated scans in six fetuses. Impact of ROI size on measured flow was assessed for ROI:s 50-150% of the vessel diameter. Four observers from two centers provided time-resolved and static delineations. Bland-Altman analysis was used to determine agreement between both observers and methods. RESULTS DAo flow was 726 (348-1130) ml/min and umbilical vein flow 366 (150-782) ml/min by DUS gating. Bias±SD for DUS-gating versus MOG were - 45 ± 122 ml/min (-6 ± 15%) for DAo and 19 ± 136 ml/min (2 ± 24%) for umbilical vein flow. Repeated flow measurements in the same fetus showed similar volumes (median CoV = 11% (DAo) and 23% (umbilical vein)). Region of interest 50-150% of vessel diameter yielded flow 35-120%. Bias±SD for time-resolved versus static DUS-gated flow was 33 ± 39 ml/min (4 ± 6%) for DAo and 11 ± 84 ml/min (2 ± 15%) for umbilical vein flow. CONCLUSIONS Quantification of blood flow in the fetal DAo and umbilical vein using DUS-gated phase-contrast CMR is feasible and agrees with the current reference method. Repeatability was generally high for CMR fetal blood flow assessment. An ROI similar to the vessel area or slightly larger is recommended. A static ROI is sufficient for fetal flow quantification using currently available CMR sequences.
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Affiliation(s)
- Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Liqun Sun
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Sebastian Bidhult
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher K. Macgowan
- Department of Medical Biophysics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Michael Seed
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
- Department of Diagnostic Imaging, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Anthony H. Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- School of Medicine, Laboratory of Computing, Medical Informatics and Biomedical, Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - 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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36
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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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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] [MESH Headings] [Grants] [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 CenterSkåne University Hospital and Lund UniversityLundSweden
| | - Kostas Haris
- Laboratory of Computing, Medical Informatics and Biomedical ‐ Imaging TechnologiesSchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
- Department of Clinical Sciences LundClinical PhysiologySkåne University Hospital, and Lund UniversityLundSweden
| | - Sebastian Bidhult
- Department of Clinical Sciences LundClinical PhysiologySkåne University Hospital, and Lund UniversityLundSweden
- Department of Biomedical EngineeringFaculty of EngineeringLund UniversityLundSweden
| | - Petru Liuba
- Pediatric Cardiac CenterSkåne University Hospital and Lund UniversityLundSweden
| | - Anthony H. Aletras
- Laboratory of Computing, Medical Informatics and Biomedical ‐ Imaging TechnologiesSchool of MedicineAristotle University of ThessalonikiThessalonikiGreece
- Department of Clinical Sciences LundClinical PhysiologySkåne University Hospital, and Lund UniversityLundSweden
| | - Erik Hedström
- Department of Clinical Sciences LundClinical PhysiologySkåne University Hospital, and Lund UniversityLundSweden
- Department of Clinical Sciences LundDiagnostic RadiologySkåne University Hospital and Lund UniversityLundSweden
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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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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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Roy CW, Marini D, Segars WP, Seed M, Macgowan CK. Fetal XCMR: a numerical phantom for fetal cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2019; 21:29. [PMID: 31118056 PMCID: PMC6532268 DOI: 10.1186/s12968-019-0539-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/15/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Validating new techniques for fetal cardiovascular magnetic resonance (CMR) is challenging due to random fetal movement that precludes repeat measurements. Consequently, fetal CMR development has been largely performed using physical phantoms or postnatal volunteers. In this work, we present an open-source simulation designed to aid in the development and validation of new approaches for fetal CMR. Our approach, fetal extended Cardiac-Torso cardiovascular magnetic resonance imaging (Fetal XCMR), builds on established methods for simulating CMR acquisitions but is tailored toward the dynamic physiology of the fetal heart and body. We present comparisons between the Fetal XCMR phantom and data acquired in utero, resulting in image quality, anatomy, tissue signals and contrast. METHODS Existing extended Cardiac-Torso models are modified to create maternal and fetal anatomy, combined according to simulated motion, mapped to CMR contrast, and converted to CMR data. To provide a comparison between the proposed simulation and experimental fetal CMR images acquired in utero, images from a typical scan of a pregnant woman are included and simulated acquisitions were generated using matching CMR parameters, motion and noise levels. Three reconstruction (static, real-time, and CINE), and two motion estimation methods (translational motion, fetal heart rate) from data acquired in transverse, sagittal, coronal, and short-axis planes of the fetal heart were performed to compare to in utero acquisitions and demonstrate feasibility of the proposed simulation framework. RESULTS Overall, CMR contrast, morphologies, and relative proportions of the maternal and fetal anatomy are well represented by the Fetal XCMR images when comparing the simulation to static images acquired in utero. Additionally, visualization of maternal respiratory and fetal cardiac motion is comparable between Fetal XCMR and in utero real-time images. Finally, high quality CINE image reconstructions provide excellent delineation of fetal cardiac anatomy and temporal dynamics for both data types. CONCLUSION The fetal CMR phantom provides a new method for evaluating fetal CMR acquisition and reconstruction methods by simulating the underlying anatomy and physiology. As the field of fetal CMR continues to grow, new methods will become available and require careful validation. The fetal CMR phantom is therefore a powerful and convenient tool in the continued development of fetal cardiac imaging.
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Affiliation(s)
- Christopher W. Roy
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Vaud Switzerland
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario Canada
- Division of Translational Medicine, Peter Gilgan Centre for Research & Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4 Canada
| | - Davide Marini
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario Canada
| | - William Paul Segars
- Department of Radiology, Duke University Medical Center, Durham, North Carolina USA
| | - Mike Seed
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario Canada
- Departments of Pediatrics and Diagnostic Imaging, University of Toronto, Toronto, Ontario Canada
| | - Christopher K. Macgowan
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario Canada
- Division of Translational Medicine, Peter Gilgan Centre for Research & Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4 Canada
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van Amerom JFP, Lloyd DFA, Deprez M, Price AN, Malik SJ, Pushparajah K, van Poppel MPM, Rutherford MA, Razavi R, Hajnal JV. Fetal whole-heart 4D imaging using motion-corrected multi-planar real-time MRI. Magn Reson Med 2019; 82:1055-1072. [PMID: 31081250 PMCID: PMC6617816 DOI: 10.1002/mrm.27798] [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: 12/02/2018] [Revised: 03/24/2019] [Accepted: 04/13/2019] [Indexed: 12/17/2022]
Abstract
Purpose To develop an MRI acquisition and reconstruction framework for volumetric cine visualization of the fetal heart and great vessels in the presence of maternal and fetal motion. Methods Four‐dimensional (4D) depiction was achieved using a highly‐accelerated multi‐planar real‐time balanced steady‐state free precession acquisition combined with retrospective image‐domain techniques for motion correction, cardiac synchronization and outlier rejection. The framework was validated using a numerical phantom and evaluated in a study of 20 mid‐ to late‐gestational age human fetal subjects (23‐33 weeks gestational age). Reconstructed MR data were compared with matched ultrasound. A preliminary assessment of flow‐sensitive reconstruction using the velocity information encoded in the phase of real‐time images is included. Results Reconstructed 4D data could be visualized in any two‐dimensional plane without the need for highly specific scan plane prescription prior to acquisition or for maternal breath hold to minimize motion. Reconstruction was fully automated aside from user‐specified masks of the fetal heart and chest. The framework proved robust when applied to fetal data and simulations confirmed that spatial and temporal features could be reliably recovered. Evaluation suggested the reconstructed framework has the potential to be used for comprehensive assessment of the fetal heart, either as an adjunct to ultrasound or in combination with other MRI techniques. Conclusions The proposed methods show promise as a framework for motion‐compensated 4D assessment of the fetal heart and great vessels.
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Affiliation(s)
- Joshua F P van Amerom
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - David F A Lloyd
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Maria Deprez
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Anthony N Price
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Shaihan J Malik
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Milou P M van Poppel
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Joseph V Hajnal
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Centre for the Developing Brain, King's College London, London, United Kingdom
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Tavares de Sousa M, Hecher K, Yamamura J, Kording F, Ruprecht C, Fehrs K, Behzadi C, Adam G, Schoennagel BP. Dynamic fetal cardiac magnetic resonance imaging in four-chamber view using Doppler ultrasound gating in normal fetal heart and in congenital heart disease: comparison with fetal echocardiography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:669-675. [PMID: 30381848 DOI: 10.1002/uog.20167] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To investigate the diagnostic performance of dynamic fetal cardiac magnetic resonance imaging (MRI), using a MR-compatible Doppler ultrasound (DUS) device for fetal cardiac gating, in differentiating fetuses with congenital heart disease from those with a normal heart, and to compare the technique with fetal echocardiography. METHODS This was a prospective study of eight fetuses with a normal heart and four with congenital heart disease (CHD), at a median of 34 (range, 28-36) weeks' gestation. Dynamic fetal cardiac MRI was performed using a DUS device for direct cardiac gating. The four-chamber view was evaluated according to qualitative findings. Measurements of the length of the left and right ventricles, diameter of the tricuspid and mitral valves, myocardial wall thickness, transverse cardiac diameter and left ventricular planimetry were performed. Fetal echocardiography and postnatal diagnoses were considered the reference standards. RESULTS Direct cardiac gating allowed continuous triggering of the fetal heart, showing high temporal and spatial resolution. Both fetal cardiac MRI and echocardiography in the four-chamber view detected pathological findings in three of the 12 fetuses. Qualitative evaluation revealed overall consistency between echocardiography and MRI. On both echocardiography and MRI, quantitative measurements revealed significant differences between fetuses with a normal heart and those with CHD with respect to the length of the right (P < 0.01 for both) and left (P < 0.01 for both) ventricles and transverse cardiac diameter (P < 0.05 and P < 0.01, respectively). Tricuspid valve diameter on cardiac MRI was found to be significantly different in healthy fetuses from in those with CHD (P < 0.05). CONCLUSIONS For the first time, this study has shown that dynamic fetal cardiac MRI in the four-chamber view, using external cardiac gating, allows evaluation of cardiac anatomy and diagnosis of congenital heart disease in agreement with fetal echocardiography. Dynamic fetal cardiac MRI may be useful as a second-line investigation if conditions for fetal echocardiography are unfavorable. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Tavares de Sousa
- University Medical Center Hamburg-Eppendorf, Department of Obstetrics and Fetal Medicine, Hamburg, Germany
| | - K Hecher
- University Medical Center Hamburg-Eppendorf, Department of Obstetrics and Fetal Medicine, Hamburg, Germany
| | - J Yamamura
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - F Kording
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - C Ruprecht
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - K Fehrs
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - C Behzadi
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - G Adam
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - B P Schoennagel
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
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Fetal dynamic phase-contrast MR angiography using ultrasound gating and comparison with Doppler ultrasound measurements. Eur Radiol 2019; 29:4169-4176. [PMID: 30617486 DOI: 10.1007/s00330-018-5940-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/28/2018] [Accepted: 11/30/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the feasibility of fetal phase-contrast (PC)-MR angiography of the descending aorta (AoD) using an MR-compatible Doppler ultrasound sensor (DUS) for fetal cardiac gating and to compare velocimetry with Doppler ultrasound measurements. METHODS In this prospective study, 2D PC-MR angiography was performed in 12 human fetuses (mean gestational age 32.8 weeks) using an MR-compatible DUS for gating of the fetal heart at 1.5 T. Peak flow velocities in the fetal AoD were compared with Doppler ultrasound measurements performed on the same day. Reproducibility of PC-MR measurements was tested by repeated PC-MR in five fetuses. RESULTS Dynamic PC-MR angiography in the AoD was successfully performed in all fetuses using the DUS, with an average fetal heart rate of 140 bpm (range 129-163). Time-velocity curves revealed typical arterial blood flow patterns. PC-MR mean flow velocity and mean flux were 21.2 cm/s (range 8.6-36.8) and 8.4 ml/s (range 3.2-14.6), respectively. A positive association between PC-MR mean flux and stroke volume with gestational age was obtained (r = 0.66, p = 0.02 and r = 0.63, p = 0.03). PC-MR and Doppler ultrasound peak velocities revealed a highly significant correlation (r = 0.8, p < 0.002). Peak velocities were lower for PC-MR with 69.1 cm/s (range 39-125) compared with 96.7 cm/s (range 60-142) for Doppler ultrasound (p < 0.001). Reproducibility of PC-MR was high (p > 0.05). CONCLUSION The MR-compatible DUS for fetal cardiac gating allows for PC-MR angiography in the fetal AoD. Comparison with Doppler ultrasound revealed a highly significant correlation of peak velocities with underestimation of PC-MR velocities. This new technique for direct fetal cardiac gating indicates the potential of PC-MR angiography for assessing fetal hemodynamics. KEY POINTS • The developed MR-compatible Doppler ultrasound sensor allows direct fetal cardiac gating and can be used for prenatal dynamic cardiovascular MRI. • The MR-compatible Doppler ultrasound sensor was successfully applied to perform intrauterine phase-contrast MR angiography of the fetal aorta, which revealed a highly significant correlation with Doppler ultrasound measurements. • As fetal flow hemodynamics is an important parameter in the diagnosis and management of fetal pathologies, fetal phase-contrast MR angiography may offer an alternative imaging method in addition to Doppler ultrasound and develop as a second line tool in the evaluation of fetal flow hemodynamics.
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Goolaub DS, Roy CW, Schrauben E, Sussman D, Marini D, Seed M, Macgowan CK. Multidimensional fetal flow imaging with cardiovascular magnetic resonance: a feasibility study. J Cardiovasc Magn Reson 2018; 20:77. [PMID: 30486832 PMCID: PMC6264058 DOI: 10.1186/s12968-018-0498-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/23/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To image multidimensional flow in fetuses using golden-angle radial phase contrast cardiovascular magnetic resonance (PC-CMR) with motion correction and retrospective gating. METHODS A novel PC-CMR method was developed using an ungated golden-angle radial acquisition with continuously incremented velocity encoding. Healthy subjects (n = 5, 27 ± 3 years, males) and pregnant females (n = 5, 34 ± 2 weeks gestation) were imaged at 3 T using the proposed sequence. Real-time reconstructions were first performed for retrospective motion correction and cardiac gating (using metric optimized gating, MOG). CINE reconstructions of multidimensional flow were then performed using the corrected and gated data. RESULTS In adults, flows obtained using the proposed method agreed strongly with those obtained using a conventionally gated Cartesian acquisition. Across the five adults, bias and limits of agreement were - 1.0 cm/s and [- 5.1, 3.2] cm/s for mean velocities and - 1.1 cm/s and [- 6.5, 4.3] cm/s for peak velocities. Temporal correlation between corresponding waveforms was also high (R~ 0.98). Calculated timing errors between MOG and pulse-gating RR intervals were low (~ 20 ms). First insights into multidimensional fetal blood flows were achieved. Inter-subject consistency in fetal descending aortic flows (n = 3) was strong with an average velocity of 27.1 ± 0.4 cm/s, peak systolic velocity of 70.0 ± 1.8 cm/s and an intra-class correlation coefficient of 0.95 between the velocity waveforms. In one fetal case, high flow waveform reproducibility was demonstrated in the ascending aorta (R = 0.97) and main pulmonary artery (R = 0.99). CONCLUSION Multidimensional PC-CMR of fetal flow was developed and validated, incorporating retrospective motion compensation and cardiac gating. Using this method, the first quantification and visualization of multidimensional fetal blood flow was achieved using CMR.
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Affiliation(s)
- Datta Singh Goolaub
- Medical Biophysics, University of Toronto, Toronto, ON Canada
- Translational Medicine, Hospital for Sick Children, Toronto, ON Canada
| | | | - Eric Schrauben
- Translational Medicine, Hospital for Sick Children, Toronto, ON Canada
| | - Dafna Sussman
- Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, ON Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST), Ryerson University and St. Michael’s Hospital, Toronto, ON Canada
| | - Davide Marini
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON Canada
| | - Mike Seed
- Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON Canada
- Paediatrics, University of Toronto, Toronto, ON Canada
| | - Christopher K. Macgowan
- Medical Biophysics, University of Toronto, Toronto, ON Canada
- Translational Medicine, Hospital for Sick Children, Toronto, ON Canada
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Dong SZ, Zhu M. MR imaging of subaortic and retroesophageal anomalous courses of the left brachiocephalic vein in the fetus. Sci Rep 2018; 8:14781. [PMID: 30283087 PMCID: PMC6170443 DOI: 10.1038/s41598-018-33033-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to report fetal cases of subaortic and retroesophageal anomalous courses of the left brachiocephalic vein (LBCV) evaluated by fetal cardiac magnetic resonance imaging (MRI). A retrospective review of 7282 fetal cardiac MRI from June 2006 to March 2017, nine cases of anomalous courses of the LBCV were correctly diagnosed by fetal cardiac MRI, one case of abnormal subaortic left brachiocephalic vein (ASLBV) missed by fetal MRI was identified postnatally during further imaging of the TOF. The diagnosis was confirmed postnatally by cardiac CT/MRI. An ASLBV was found in 8 cases, a retroesophageal LBCV was found in 2 additional cases with right aortic arch and aberrant left subclavian artery. 3 of 8 ASLBV cases were with a right aortic arch, 4 ASLBV cases had additional cardiovascular anomalies with one case isolated. 7 of 8 ASLBV and 2 retroesophageal LBCV were correctly diagnosed by fetal cardiac MRI; however fetal cardiac MRI missed 2 cases of associated pulmonary atresia (PA). Prenatal echocardiography (echo) correctly diagnosed five ASLBV and one retroesophageal LBCV as well as associated intracardiac anomalies. Fetal cardiac MRI can be a useful adjunct in the identification of subaortic and retroesophageal anomalous courses of the LBCV prenatally.
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Affiliation(s)
- Su-Zhen Dong
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Ming Zhu
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.
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