Fetal MRI of the heart and brain in congenital heart disease

Moerdijk, Anouk S; Claessens, Nathalie H.P.; Ooijen, Inge M van; Ooij, Pim van; Alderliesten, Thomas; Grotenhuis, Heynric B.; Bekker, M. N.; Benders, Mjnl; Bohte, AE; Breur, JMPJ; Charisopoulou, D; Clur, S. A.; Cornette, JMJ; Fejzic, Z; Franssen, MTM; Frerich, S; Geerdink, LM; Go, ATJI; Gommers, S; Helbing, Wim A.; Hirsch, A; Holtackers, Robert J.; Klein, WM; Krings, GJ; Lamb, HJ; Nijman, Maaike; Pajkrt, Eva; Planken, R. Nils; Schrauben, EM; Steenhuis, T. J.; Heide, Henriëtte ter; Vanagt, WYR; Beynum, IM van; Gaalen, MD van; Iperen, GG van; Schuppen, J van; Willems, TP; Witters, I

doi:10.1016/s2352-4642(22)00249-8

Cited by 6 publications

(4 citation statements)

References 82 publications

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“…The ARCH pathway is designed to be exible and subject to systematic review and modi cation over time, allowing for newer evidence-based research and technological advancements to inform risk strati cation and suggested management. For example, fetal cardiac MRI is a modality that has rapidly evolved in recent years to evaluate congenital heart defects [22,23]. Further research may support use of fetal cardiac MRI in conjunction with echocardiography to inform risk strati cation of fetuses with suspicion for coarctation of the aorta.…”

Section: Discussionmentioning

confidence: 99%

Antenatal Risk of Coarctation for newborns at Hartford Hospital (ARCH) Pathway: A Predictor of Postnatal Management Strategy

Wang,

Cummins,

Flerlage

et al. 2024

Preprint

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Background: The diagnosis of coarctation of the aorta (CoA) prior to birth can be challenging due to the physiologic changes during postnatal transition. Prenatal risk stratification can standarize postnatal management and improve outcome. CT Children’s Fetal Cardiology created the Antenatal Risk of CoA in Hartford (ARCH) clinical pathway defining four distinct postnatal order sets based on degree of suspicion for ductal dependency on fetal evaluation: low, low-moderate, moderate-high, and high risk. This study aims to evaluate safety and efficacy of the ARCH pathway in neonates with suspected CoA. Study Design: This study was a single-center, retrospective chart review evaluating maternal-infant dyads with findings concerning for CoA between July 2004 and July 2021, before and after ARCH pathway implementation. Neonates were evaluated for the presence or absence of critical CoA and postnatal clinical data were collected. Statistical analysis was performed using chi square and Fisher’s exact test. Results: There were 108 maternal-infant dyads studied, comprising 53 non-pathway patients and 55 ARCH-pathway participants. Thirty-three neonates had critical CoA, comprising 23 non-pathway and 10 ARCH-pathway subjects. Patients categorized in the high-risk group were highly associated with critical CoA (P= 0.003). Non-pathway neonates with CoA demonstrated higher likelihood of hospital transfer compared to ARCH-pathway neonates (56.5% vs 10.0%, P = 0.021). NICU admission, prostaglandin administration, and intubation were not significantly different between before and after ARCH implementation (P <0.05). More echocardiograms were performed in ARCH-pathway neonates without CoA than their non-pathway counterparts (1.586 vs 2.133, P = 0.049). Conclusion: The ARCH pathway is a safe, reliable prenatal risk stratification system to help guide management of patients with critical CoA. These results identify effective targets of modification to the pathway to reduce resource utilization without compromising safety.

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Section: Discussionmentioning

confidence: 99%

Antenatal Risk of Coarctation for newborns at Hartford Hospital (ARCH) Pathway: A Predictor of Postnatal Management Strategy

Wang,

Cummins,

Flerlage

et al. 2024

Preprint

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“…However, researchers and clinicians have increasingly appreciated that ND perturbations may also be due to abnormal hemodynamics in utero 5 . The original studies of the fetal central nervous system employed ultrasound to assess structure and function, identifying abnormal cerebral size and vascular flow among certain fetuses with CHD; more recently, fetal magnetic resonance imaging has increasingly provided insights into altered fetal ND 6 …”

Section: Figurementioning

confidence: 99%

“…5 The original studies of the fetal central nervous system employed ultrasound to assess structure and function, identifying abnormal cerebral size and vascular flow among certain fetuses with CHD; more recently, fetal magnetic resonance imaging has increasingly provided insights into altered fetal ND. 6 Fetal magnetoencephalography (MEG) is a complementary but less widely adopted modality for the study of the fetal brain. MEG employs super conducting quantum interference device (SQUID) technology to passively record the faint magnetic fields created by the movement of charged particles (principally in the heart and cerebrum); at our institution, fetal MEG is performed in the SQUID Array for Reproductive Assessment (SARA; CTF Systems Inc).…”

mentioning

confidence: 99%

Feasibility of magnetoencephalography in fetuses with cyanotic congenital heart disease

Bolin,

Escalona‐Vargas,

Siegel

et al. 2024

Prenatal Diagnosis

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Key pointsWhat's already known about this topic? A disproportionate number of children with cyanotic heart disease suffer from neurodevelopmental (ND) impairment, which is believed to be due in part to abnormal cerebral development in utero. Magnetoencephelography (MEG) is a non‐invasive method for assessing neurodevelopment, but has not been studied in fetuses with congenital heart disease (CHD). What does this study add? In this preliminary study, we showed the feasibility of performing MEG in fetuses with CHD. Fetuses with CHD had different magnetoencephalographic characteristics when compared with matched controls.

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“…Ultrasonography (US) is the first‐line imaging modality used to screen, identify, describe, and follow fetal abnormalities [1]. Fetal magnetic resonance imaging (MRI) should be performed as a complementary modality if a fetal brain abnormality is suspected based on US [2]. MRI provides better contrast and higher resolution and has multiplanar capability, which improves diagnostic accuracy and confidence [3].…”

Section: Introductionmentioning

confidence: 99%

Advanced neuroimaging in the fetal brain: An update on technical advances and clinical findings

Ren

Dong

2023

iRADIOLOGY

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Magnetic resonance imaging (MRI) is widely used to provide detailed information regarding fetal brain development in utero. Conventional T1-and T2weighted sequences provide anatomical details of the normal brain and demonstrate brain lesions. In addition to providing highly detailed qualitative assessments of fetal brain development, advanced MRI methods such as threedimensional high-resolution MRI, diffusion MRI, magnetic resonance spectroscopy, and functional MRI can provide quantitative morphologic assessments of tissue microstructure and functional activity. This review aims to describe normal fetal brain development and highlight current state-of-the-art MRI sequences for fetal neuroimaging. We focus on current clinical applications which can provide a better understanding of in utero impairments in fetal brain development.

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Fetal MRI of the heart and brain in congenital heart disease

Cited by 6 publications

References 82 publications

Antenatal Risk of Coarctation for newborns at Hartford Hospital (ARCH) Pathway: A Predictor of Postnatal Management Strategy

Antenatal Risk of Coarctation for newborns at Hartford Hospital (ARCH) Pathway: A Predictor of Postnatal Management Strategy

Feasibility of magnetoencephalography in fetuses with cyanotic congenital heart disease

Advanced neuroimaging in the fetal brain: An update on technical advances and clinical findings

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