Fetal Cardiac MRI

Roy, Christopher W.; Amerom, Joshua F.P. van; Marini, Davide; Seed, Mike; Macgowan, Christopher K.

doi:10.1097/rmr.0000000000000218

Cited by 46 publications

(37 citation statements)

References 65 publications

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“…Until recently, fetal cardiovascular magnetic resonance (CMR) imaging has been dependent on either real-time acquisition, which typically is of low spatial resolution, static acquisition, or in-house postprocessing techniques due to lack of methods for direct cardiac gating. 11 , 12 , 13 , 14 , 15 , 16 With the development of an MR-compatible Doppler ultrasound (DUS) device, 17 it is possible to acquire high-resolution fetal CMR images without postprocessing, making fetal CMR potentially more clinically applicable. 18 , 19 , 20 , 21 Since echocardiography requires less time and resources compared with CMR, fetal CMR would likely serve as a complement to fetal echocardiography in challenging cases.…”

Section: Introductionmentioning

confidence: 99%

Utility of Fetal Cardiovascular Magnetic Resonance for Prenatal Diagnosis of Complex Congenital Heart Defects

et al. 2021

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IMPORTANCE Prenatal diagnosis of complex congenital heart defects reduces mortality and morbidity in affected infants. However, fetal echocardiography can be limited by poor acoustic windows, and there is a need for improved diagnostic methods.OBJECTIVE To assess the clinical utility of fetal cardiovascular magnetic resonance imaging in cases in which fetal echocardiography could not visualize all relevant anatomy.

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Section: Introductionmentioning

confidence: 99%

Utility of Fetal Cardiovascular Magnetic Resonance for Prenatal Diagnosis of Complex Congenital Heart Defects

et al. 2021

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“…1 With this well-defined cohort and analysis, Salehi et al 1 It is important to note that the utility of fetal CMR is limited to late gestations because larger fetal size facilitates static MR imaging. 5 The mean gestation age at which fetal CMR was performed in the current study was 36 weeks (range, 31-39). 1 Fetal echocardiography is most challenging at these late gestations, when there are fewer fluid pockets for scanning and more calcified bone structures impeding sound waves, and fetal CMR is proving to be a useful adjunct for these cases.…”

mentioning

confidence: 89%

“…The visualization of the fetal heart by fetal CMR is challenging due to the small heart size, fast fetal heart rate, and fetal motion. Technical advances and improvements in gating and reconstruction methods have been previously described by Roy et al 5 Recognizing these strengths and limitations of both fetal echocardiography and fetal CMR, the current study by Salehi et al 1 focuses on those fetuses with unresolved, clinically important questions regarding the CHD diagnosis after fetal echocardiogram review by experienced fetal cardiologists and radiologists. They further delineate a fetal CMR method for improved visualization of specific cardiac structures and function, namely the aortic arch, pulmonary artery, arterial duct, and ventricles.…”

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confidence: 99%

Fetal Cardiac Imaging for Congenital Heart Disease—Is Cardiac Magnetic Resonance Imaging the Future?

Arya

2021

JAMA Netw Open

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Salehi et al 1 present a single-center cohort study to determine the diagnostic utility of fetal cardiac magnetic resonance (CMR) imaging for improving the prenatal diagnosis of congenital heart defects (CHDs) when fetal echocardiogram fails to visualize the cardiac anatomy. The study included 31 fetuses with suspected CHD in whom fetal CMR was performed between gestational ages of 31 and 39 weeks due to inadequacy of fetal echocardiogram imaging. Fetal CMR affected clinical management in 26 cases (84%). Salehi et al 1 concluded that fetal CMR improved prenatal diagnosis of CHD and thus affected clinical decision-making and counseling when fetal echocardiogram imaging was technically limited. The field of fetal cardiology emerged in 1980 when 3 pioneers in cardiac imaging-Kleinman, Allen, and Sahn-first described 2-dimensional fetal echocardiography imaging in fetuses between 14 and 41 weeks gestational age. 2-4 They demonstrated fetal cardiac anatomy in more than 350 fetuses, and Kleinman et al 2 even identified univentricular CHD and fetal cardiac dysrhythmia. During the past 40 years, fetal echocardiography has made significant technological advances, including improved color Doppler assessment, 3-dimensional imaging, and 4-dimensional imaging. These innovations have led to high diagnostic accuracy of fetal echocardiogram imaging, allowing for identification of complex and critical CHDs as early as 12 weeks gestation as well as appropriate delivery planning and counseling. Nevertheless, fetal echocardiography can be technically limited by factors such as maternal body habitus, oligohydramnios, uterine masses, gestational age, multiple gestation, and fetal position, which result in incomplete imaging of the fetal cardiac structures. In these cases, fetal CMR may prove to be an important adjunct to a fetal echocardiogram because it is not limited by these factors. Fetal CMR can image the fetal heart from any plane, allowing for a large field of view. There are no reported risks of fetal CMR to the pregnant mother or fetus; however, fetal CMR is significantly more expensive, requires more resources, and is time-consuming compared with fetal echocardiography. The visualization of the fetal heart by fetal CMR is challenging due to the small heart size, fast fetal heart rate, and fetal motion. Technical advances and improvements in gating and reconstruction methods have been previously described by Roy et al. 5 Recognizing these strengths and limitations of both fetal echocardiography and fetal CMR, the current study by Salehi et al 1 focuses on those fetuses with unresolved, clinically important questions regarding the CHD diagnosis after fetal echocardiogram review by experienced fetal cardiologists and radiologists. They further delineate a fetal CMR method for improved visualization of specific cardiac structures and function, namely the aortic arch, pulmonary artery, arterial duct, and ventricles. 1 With this well-defined cohort and analysis, Salehi et al 1 optimized the utility of fetal CMR in certain CHDs for...

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“…More recently, automated outlier rejection methods for the detection of through-plane motion have been implemented 31 69 . For each voxel and real-time frame, they estimate the probability of being classified as either an inlier or outlier, and based on these probabilities, outlier voxels are then downweighted or completely rejected from the reconstruction 1 . In 2019 Lloyd et al 70 performed three-dimensional (3 D) MRI of the fetal heart in 85 fetuses.…”

Section: Motion Compensationmentioning

confidence: 99%

Fetal Cardiovascular MRI – A Systemic Review of the Literature: Challenges, New Technical Developments, and Perspectives

Knapp

Sousa

Schönnagel

2022

Rofo

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Background Fetal magnetic resonance imaging (MRI) has become a valuable adjunct to ultrasound in the prenatal diagnosis of congenital pathologies of the central nervous system, thorax, and abdomen. Fetal cardiovascular magnetic resonance (CMR) was limited, mainly by the lack of cardiac gating, and has only recently evolved due to technical developments. Method A literature search was performed on PubMed, focusing on technical advancements to perform fetal CMR. In total, 20 publications on cardiac gating techniques in the human fetus were analyzed. Results Fetal MRI is a safe imaging method with no developmental impairments found to be associated with in utero exposure to MRI. Fetal CMR is challenging due to general drawbacks (e. g., fetal motion) and specific limitations such as the difficulty to generate a cardiac gating signal to achieve high spatiotemporal resolution. Promising technical advancements include new methods for fetal cardiac gating, based on novel post-processing approaches and an external hardware device, as well as motion compensation and acceleration techniques. Conclusion Newly developed direct and indirect gating approaches were successfully applied to achieve high-quality morphologic and functional imaging as well as quantitative assessment of fetal hemodynamics in research settings. In cases when prenatal echocardiography is limited, e. g., by an unfavorable fetal position in utero, or when its results are inconclusive, fetal CMR could potentially serve as a valuable adjunct in the prenatal assessment of congenital cardiovascular malformations. However, sufficient data on the diagnostic performance and clinical benefit of new fetal CMR techniques is still lacking. Key Points: Citation Format

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Fetal Cardiac MRI

Cited by 46 publications

References 65 publications

Utility of Fetal Cardiovascular Magnetic Resonance for Prenatal Diagnosis of Complex Congenital Heart Defects

Utility of Fetal Cardiovascular Magnetic Resonance for Prenatal Diagnosis of Complex Congenital Heart Defects

Fetal Cardiac Imaging for Congenital Heart Disease—Is Cardiac Magnetic Resonance Imaging the Future?

Fetal Cardiovascular MRI – A Systemic Review of the Literature: Challenges, New Technical Developments, and Perspectives

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