Feasibility of fetal cardiac magnetic resonance imaging: preliminary experience

Gorincour, Guillaume; Bourlière-Najean, B.; Bonello, Béatrice; Fraisse, Alain; Philip, Nicole; Potier, A.; Kreitmann, B.; Petit, Philippe

doi:10.1002/uog.3924

Cited by 60 publications

(43 citation statements)

References 13 publications

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“…286,287 Some investigators, by combining these sequences and balanced steady-state free-precession sequences, have achieved better images. 288,289 The development of these more sophisticated sequences, with improved temporal resolution, has enhanced the ability of MRI to evaluate fetal cardiac structure despite fetal motion and rapid fetal heart rates. 290,292 However, although these advanced sequences can generate highly useful information without true gating, this singleshot imaging approach has limited spatial resolution.…”

Section: Acquisitionmentioning

confidence: 99%

“…In summary, with increasingly sophisticated MRI technology, faster imaging sequences, improvements in resolution, and innovative gating algorithms, fetal cardiac MRI has the potential to complement ultrasound imaging in the evaluation of fetal visceroatrial situs, 288,290,294 cardiac structure, 286,[288][289][290][291][292] and cardiac function. 287,292 Although the clinical utility of the technology has not been well established and although it currently is used mostly as a research tool, fetal cardiac MRI is reasonable to perform in the evaluation of certain forms of fetal cardiovascular disease, including heterotaxy and systemic venous anomalies, and in the assessment of associated extracardiac malformations.…”

Section: Acquisitionmentioning

confidence: 99%

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Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,016

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Acquisitionmentioning

confidence: 99%

Section: Acquisitionmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,016

543

View full text Add to dashboard Cite

show abstract

“…Due to its noninvasive nature, this present study is far more practicable, particularly in relation to human subjects. Compared with images of prior studies (17)(18)(19), the visualization in this study of the aforementioned anatomical structures demonstrated considerable improvements in the adequacy of the visualization. Prior studies described difficulties with the imaging of main cardiac outflow vessels, such as the aorta with its valve (19).…”

Section: Discussionmentioning

confidence: 86%

Cardiac MRI of the fetal heart using a novel triggering method: Initial results in an animal model

Yamamura

Kopp

Frisch

et al. 2012

Magnetic Resonance Imaging

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Purpose: To investigate MRI of the fetal heart by way of a novel triggering method with the use of an MR-compatible cardiotocography (CTG) in an animal model. Materials and Methods:Fetal cardiac MRI was performed on four pregnant ewes on a 1.5 Tesla (T) MR system. A CTG was rendered MR compatible and its signal was used for the triggering of the fetal heart to perform cardiac cine MRI of the fetal heart with maternal freebreathing with cine steady-state free precession. The left ventricular volume and function were measured from the short-axis (view). The image quality of anatomical structures was assessed.Results: All cardiac valves and the foramen ovale could be visualized. Myocardial contraction was depicted in cine sequences. The average blood volume at the end systole was 1.7 mL (SD 6 0.12). The average volume at the end diastole was 4.6 mL (6 0.4); thus the average stroke volumes of the left ventricle were 2.87 mL (6 0.31) with ejection fractions of 60.53% (6 4.17). Conclusion:The newly developed MR compatible CTG could be used as a tool for cardiac triggering method of the fetal heart. This novel device might help fetal cardiac MRI technology in the future. THE RAPID DEVELOPMENT of cardiac MR imaging in the past few years has enabled many different investigations, for example investigations into coronary arteries and myocardial infarctions. In practice, twodimensional (2D) CINE steady-state free precession (SSFP) imaging is the most reliable and frequently used technique for left ventricular (LV) function assessment. To assess the LV function correctly, speed as well as synchronization of data acquisition with the cardiac cycle are required, so that artifacts due to cardiac motion and flow constraints that dictate the viable window for data acquisition are avoided. To avoid the artifacts caused by cardiac motion, it is customary that either finger pulse oximetry or electrocardiography (ECG) triggering/gating techniques are used so that data acquisition can be synchronized with the cardiac cycle.Although the use of MR imaging during pregnancy is limited to the second and third trimester, its diagnostic value has been increasing in recent years. In the field of fetal MR imaging, the evaluation of the fetal heart is one of the greatest challenges. Nowadays, the gold standard in fetal cardiac imaging is the use of ultrasound (US), because it can be obtained during the entire pregnancy; it is easy to use and thus more practicable. Both the measurement of the cardiac volume and the evaluation of volumetric changes with US are possible, and the technology has been improving. Because cardiac chambers do not lend themselves to geometric assumptions, it has always been difficult to calculate their dimensions, even though studies have shown that 3D US has a better reproducibility than 2D (1-4). To be able to do so, it is necessary to trace the volume of the cardiac chambers manually, due to the appearance of various US specific artifacts, such as speckles and acoustic shadowing, which appear when traced automaticall...

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“…In-utero MR imaging of the fetal heart 2.2.1 Feasibility and patients' selection MRI of the fetal heart is feasible (Saleem, 2008); however, it has not been thoroughly investigated with only few reports in literature most of them in the form of case reports or preliminary experiences (Gorincour et al, 2007;Kivelitz et al, 2004;Manganaro et al, 2008). We will depend in discussion of MRI of fetal heart in this chapter on findings from our study of 298 pregnancies at high risk for CHD that were enrolled sequentially from September 2003 to August 2010 in our institutional review board-approved study.…”

Section: 2mentioning

confidence: 99%

“…Role of CMR includes anatomic and functional assessment of the cardiovascular system (Finn et al, 2006). Fetal MRI proved valuable in defining the details of fetal anatomy especially the central nervous system (Frates et al, 2004;Levine, 2006;Saleem et al, 2009) and potentially the heart (Gorincour et al, 2007;Saleem, 2008). However, CMR has not been thoroughly investigated in-utero.…”

Section: Introductionmentioning

confidence: 99%