Fetal iGRASP cine CMR assisting in prenatal diagnosis of complicated cardiac malformation with impact on delivery planning

Abstract

SummaryLimited 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.

Quantification of blood flow in the fetus with cardiovascular magnetic resonance imaging using Doppler ultrasound gating: validation against metric optimized gating

“…Fetal cardiovascular imaging using cardiovascular magnetic resonance (CMR) imaging is increasingly applied for fetal cardiovascular research [1][2][3] and as a clinical aid for improved diagnosis of congenital cardiovascular malformation [4,5]. Accurate quantification of fetal blood flow may lead to new insights in fetal cardiovascular physiology.…”

Fetal Cardiac MRI

“…6) and have proved useful for evaluating specific abnormalities as evidenced by case studies of a cardiac mass 42,52 and an unbalanced common atrioventricular canal. 53 In an evaluation of the utility of 4D volumetric reconstruction, 42 readers had high confidence in their comprehensive assessment of fetal cardiovascular anatomy using reconstructed 4D cine MRI (Fig. 5) and there was good agreement between ventricular dimensions at systole and diastole on 2D M-mode ultrasound and 4D MRI.…”

Understanding Fetal Hemodynamics Using Cardiovascular Magnetic Resonance Imaging

“…The development of fetal CMR has provided a new research tool for studying fetal cardiovascular physiology and the impact of abnormal circulatory hemodynamics on fetal development [30,32,[43][44][45][46]. Some centers have suggested there may be a clinical role for fetal CMR in the diagnosis of congenital malformations affecting the arterial and venous anatomy [22,23]. Potential future clinical indications for fetal CMR also include improved diagnosis of fetal cardiac malformations, the monitoring of fetal therapy, and the assessment of placental function.…”

“…Recently, a combination of metric-optimized gating, motion correction algorithms, and accelerated imaging acquisitions has shown promise in overcoming these challenges, resulting in high-resolution fetal cardiac imaging [13,14]. This kind of approach has been particularly effective for imaging the late-gestation fetus, which is larger and relatively restricted in terms of fetal motion, while the inherent trade-off between achieving adequate signal-to-noise ratio and spatial resolution while limiting artifact arising from more vigorous fetal motion remains a challenge in early pregnancy [12][13][14][15][16][17][18][19][20][21][22][23].…”