Fetal whole heart blood flow imaging using 4D cine MRI

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.

Cardiac magnetic resonance imaging: insights into developmental programming and its consequences for aging

“…85 The development of 4D cine methods, using highly accelerated dynamic MRI with slice-to-volume reconstruction, can capture fetal cardiac motions in real-time. 86 The use of 4D flow CMR has been validated for directly measuring flow through fetal vessels of the central circulation and their shunts in an in utero sheep model. 87 Also, T2 relaxometry measurements have been used in fetal sheep models to quantitate blood oxygenation with CMR and validate these against blood gas analyzer measurements.…”

Open or closed: Changes in ductus arteriosus flow patterns at birth using 4D flow MRI in newborn piglets

“…These include logistical constraints (e.g., transfer to MRI suite, high image resolution, scan time, physiological challenges of maintaining body temperature and vital signs monitoring, and control of movement artifact) involved in scanning extremely preterm infants who are the patient group most likely to need DA treatment yet are the most clinically compromised. Work is ongoing to address these challenges in both human fetal and neonatal MRI (Goolaub et al, 2018 ; Roberts et al, 2020 ; Schrauben, Lim, et al, 2019 ).…”

3D Approaches in Complex CHD: Where Are We? Funny Printing and Beautiful Images, or a Useful Tool?

“…Standard 2D foetal (cardiac) MRI is susceptible to foetal and maternal motion [ 37 ]. Novel techniques using motion-corrected slice-volume registration software now allow for successful 3D whole heart imaging, including an assessment of extra-cardiac vasculature and blood [ 38 , 39 ]. Motion-corrected black-blood 3D volumes exhibited good spatial agreement when compared with paired ultrasound data, and in 10 of 85 foetuses reported, new anatomical features were described that had previously been undetected, all of which were confirmed postnatally [ 37 ].…”