Learning the Hidden Signature of Fetal Arch Anatomy: a Three-Dimensional Shape Analysis in Suspected Coarctation of the Aorta

Abstract

Neonatal coarctation of the aorta (CoA) is a common congenital heart defect. Its antenatal diagnosis remains challenging, and its pathophysiology is poorly understood. We present a novel statistical shape modeling (SSM) pipeline to study the role and predictive value of arch shape in CoA in utero. Cardiac magnetic resonance imaging (CMR) data of 112 fetuses with suspected CoA was acquired and motion-corrected to three-dimensional volumes. Centerlines from fetal arches were extracted and used to build a statistical shape model capturing relevant anatomical variations. A linear discriminant analysis was used to find the optimal axis between CoA and false positive cases. The CoA shape risk score classified cases with an area under the curve of 0.907. We demonstrate the feasibility of applying a SSM pipeline to three-dimensional fetal CMR data while providing novel insights into the anatomical determinants of CoA and the relevance of in utero arch anatomy for antenatal diagnosis of CoA. Graphical abstract

Role of artificial‐intelligence‐assisted automated cardiac biometrics in prenatal screening for coarctation of aorta

“…Prior research has shown results consistent with our findings, in which ROC curves were displayed with AUCs ranging from 0.82 to 0.98 16 , the best of which involved technically challenging ultrasound planes, including the sagittal plane of the aortic arch, and were conducted by experts 3,16,23 . Previous studies have centered on constructing diagnostic prediction models based on CoA cases already suspected of having ventricular imbalance and, consequently, undergoing fetal echocardiography in the third trimester 2,3,12,14–18,23,26 . In contrast, the primary objective of this study was to refine the CoA screening procedure to ensure that at‐risk fetuses do indeed undergo the supplementary examinations.…”

“…Indeed, a gap exists in the literature concerning AI-assisted screening of less-apparent CHDs, such as CoA, that have lower detection rates. Several previous studies have evaluated manual methods for cardiac biometric measurements to predict CoA, however, they have mainly included third-trimester fetal echocardiography performed owing to a prior suspicion of ventricular disproportion 3,[12][13][14][15][16][17][18] . Furthermore, third-trimester fetal echocardiography, which is often performed at specialized centers, differs from the 18-22-week scan by including additional cardiac planes.…”

Using computed tomography angiography and computational fluid dynamics to study aortic coarctation in different arch morphologies

“…Many studies have pointed out that clinical consequences such as hypertension are related to abnormal aortic arch morphology ( 14 ). According to the shape of the aortic arch, it can be defined as gothic, crenel, or romanesque arch, which comes from the corresponding architectural style.…”

Editorial: Case reports in general cardiovascular medicine: 2022

“…Coarctation of the aorta (CoA) and hypertrophic cardiomyopathy (HCM) are two irrelevant cardiovascular diseases ( 1 ). This report describes a diagnosis, management, and 8-year follow-up in a patient with the co-existence of CoA and HCM.…”

“…Coarctation of the aorta (CoA) and hypertrophic cardiomyopathy (HCM) are two irrelevant cardiovascular diseases (1). This report describes a diagnosis, management, and Takayasu arteritis (TA) is a chronic granulomatous vasculitis of unknown pathophysiological mechanisms.…”