MRI reveals hemodynamic changes with acute maternal hyperoxygenation in human fetuses with and without congenital heart disease

Porayette, Prashob; Madathil, Sujana; Sun, Liqun; Jaeggi, Edgar; Grosse-Wortmann, Lars; Yoo, Shi Joon; Hickey, Edward; Miller, Steven P.; Macgowan, Christopher K.; Seed, Mike

doi:10.1002/pd.4762

Cited by 42 publications

(16 citation statements)

References 55 publications

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“…Further into the future, as we begin to understand the complex fetoplacental interactions in fetuses with CHD, manipulation of the fetal circulation via experimental interventions such as maternal hyperoxygenation may provide a non-invasive means of improving cerebral oxygen and substrate delivery in selected patients 61 . Finally, the use of direct fetal cardiac intervention, currently being explored by a small number of centres for a limited set of indications, 62 may develop a role as our understanding and expertise develop in this area.…”

Section: Opportunities For the Futurementioning

confidence: 99%

The neurodevelopmental implications of hypoplastic left heart syndrome in the fetus

et al. 2016

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As survival after cardiac surgery continues to improve, an increasing number of patients with hypoplastic left heart syndrome are reaching school age and beyond, with growing recognition of the wide range of neurodevelopmental challenges many survivors face. Improvements in fetal detection rates, coupled with advances in fetal ultrasound and MRI imaging, are contributing to a growing body of evidence that abnormal brain architecture is in fact present before birth in hypoplastic left heart syndrome patients, rather than being solely attributable to postnatal factors. We present an overview of the contemporary data on neurodevelopmental outcomes in hypoplastic left heart syndrome, focussing on imaging techniques that are providing greater insight into the nature of disruptions to the fetal circulation, alterations in cerebral blood flow and substrate delivery, disordered brain development, and an increased potential for neurological injury. These susceptibilities are present before any intervention, and are almost certainly substantial contributors to adverse neurodevelopmental outcomes in later childhood. The task now is to determine which subgroups of patients with hypoplastic left heart syndrome are at particular risk of poor neurodevelopmental outcomes and how that risk might be modified. This will allow for more comprehensive counselling for carers, better-informed decision making before birth, and earlier, more tailored provision of neuroprotective strategies and developmental support in the postnatal period.

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Section: Opportunities For the Futurementioning

confidence: 99%

The neurodevelopmental implications of hypoplastic left heart syndrome in the fetus

et al. 2016

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“…Previous studies of through‐plane single‐vessel fetal phase contrast MRI have relied on Cartesian measurements in target vessels 1,2,10,24 . Using such techniques, flows in the major fetal vessels have been quantified in healthy pregnancies and those affected by growth restriction or CHD 1,24–28 . Further studies have also compared Doppler ultrasound gating and MOG for fetal phase contrast MRI 29 .…”

Section: Discussionmentioning

confidence: 99%

Fetal Flow Quantification in Great Vessels Using Motion‐Corrected Radial Phase Contrast MRI: Comparison With Cartesian

Goolaub

Schrauben

et al. 2020

Magnetic Resonance Imaging

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BackgroundPhase 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.PurposeTo 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 TypeMethod comparison.Phantom/SubjectsComputer simulation. Seventeen pregnant volunteers.Field Strength/Sequence1.5T and 3T. Cartesian and golden‐angle radial phase contrast MRI.AssessmentThrough 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 TestsWilcoxon signed‐rank test. Linear regression. Bland–Altman plots. Student's t‐test.ResultsSimulations 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 ConclusionSimulations 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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“…At present, MRI is widely used to diagnose human diseases and has become more effective than CT and X-rays for the early diagnosis of human tumors, heart diseases and cerebrovascular diseases [11]. Cheng et al [30] reported that comprehensive motion-compensated highly accelerated 4D flow MRI with ferumoxytol enhancement may be used to improve diagnoses of pediatric congenital heart disease.…”

Section: Discussionmentioning

confidence: 99%

“…The safety and imaging quality of MRI has been confirmed in pediatric and adult patients with congenital heart disease and pacemakers [10]. Porayette et al [11] reported that MRI effectively identified hemodynamic changes with acute maternal hyperoxygenation in human fetuses with and without congenital heart disease. In clinics, left ventricular eccentricity index measured by cardiac MRI has been used to assess right ventricular hemodynamics and myocardial fibrosis in congenital heart disease, suggesting that MRI is a more effective diagnostic method for congenital heart disease compared to computed tomography (CT) and ultrasonography [12].…”

Section: Introductionmentioning

confidence: 99%

Use of magnetic resonance imaging combined with gene analysis for the diagnosis of fetal congenital heart disease

Wang¹,

Nie

Wang³

et al. 2019

BMC Med Imaging

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BackgroundFetal deformity is a disease caused by abnormal chromosome structure, which may be influenced by genetic factors as well as the maternal and external environment. Magnetic resonance imaging (MRI) may be used to effectively diagnose fetus deformities. However it has been reported that gene analysis is a more accurate diagnostic method. The aim of the present study was to investigate the effectiveness of MRI in combination with gene analysis for the diagnosis of fetal congenital heart disease, a form of fetus deformity.MethodsMRI, array comparative genome hybridization analysis and fluorescence in situ hybridization were used to analyze the effectiveness of the two methods in a total of 78 pregnant women with suspected fetal congenital heart disease.ResultsOur findings demonstrated that the combination of MRI and gene analysis resulted in significantly improved diagnostic accuracy, sensitivity and specificity for fetal congenital heart disease compared with either method alone. MRI combined with gene analysis confirmed 42 fetuses with pulmonary stenosis, 24 with aortic stenosis and 12 healthy fetuses, which was significantly improved compared with MRI or gene analysis alone. It was also observed that gene analysis was a more efficient method of diagnosis compared with MRI; however, the combination of the two methods was the most effective.ConclusionIn conclusion, the results of the present study suggest that MRI combined with gene analysis may be a more effective diagnostic method for fetal congenital heart disease compared with the current protocol.

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MRI reveals hemodynamic changes with acute maternal hyperoxygenation in human fetuses with and without congenital heart disease

Cited by 42 publications

References 55 publications

The neurodevelopmental implications of hypoplastic left heart syndrome in the fetus

The neurodevelopmental implications of hypoplastic left heart syndrome in the fetus

Fetal Flow Quantification in Great Vessels Using Motion‐Corrected Radial Phase Contrast MRI: Comparison With Cartesian

Use of magnetic resonance imaging combined with gene analysis for the diagnosis of fetal congenital heart disease

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