In vivo Intrauterine Sound Pressure and Temperature Measurements during Magnetic Resonance Imaging (1.5 T) in Pregnant Ewes

Ruckhäberle, Eugen; Nekolla, Stephan G.; Ganter, Carl; Schneider, K. T. M.; Peter, Augustine T.; Raidt, A.; Kovâcs, László; Brockmeier, Steffi Johanna; Schwaiger, Markus; Oberhoffer, Renate; Papadopulos, Nikolaos Α.

doi:10.1159/000151339

Cited by 9 publications

(8 citation statements)

References 60 publications

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“…CMR has also emerged as a powerful approach to imaging congenital heart disease in neonates and infants. CMR avoids exposure to ionizing radiation, and at present, there is no evidence that short-term exposure to electromagnetic fields of 1.5 T or less harms the fetus [2,16,17]. CMR has the potential to expand its ability to image the fetal congenital cardiovascular abnormalities [9,18].…”

Section: Discussionmentioning

confidence: 99%

“…Unlike ultrasound imaging, however, CMR is relatively unaffected by maternal and fetal conditions such as obesity, oligohydramnios and fetal complex malformations of various organ systems which particularly impair sonographic visualization of the fetal heart and great vessels. CMR avoids exposure to ionizing radiation and to the best of our knowledge, no clinical or experimental evidence has indicated that CMR has any adverse effects on the human fetus [2]. Recently, the successful development of new sequences during free breathing without cardiac triggering has established the beginning of a potential role for CMR in the study of the fetal cardiovascular system [3-5].…”

Section: Introductionmentioning

confidence: 99%

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Preliminary experience with cardiovascular magnetic resonance in evaluation of fetal cardiovascular anomalies

Dong

Zhu

2013

Journal of Cardiovascular Magnetic Resonance

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BackgroundThe cardiovascular system is the part of the fetal anatomy that most frequently suffers from congenital pathology. This study shows our preliminary experience with fetal cardiovascular magnetic resonance (CMR) to evaluate congenital cardiovascular abnormalities.MethodsBetween January 2006 and June 2011, Prenatal routine obstetric ultrasound (US), echocardiography and CMR data from 68 pregnant women carrying fetuses with congenital cardiovascular anomalies were compared with postnatal diagnoses (postnatal imagings, surgery and autopsy). All prenatal CMR was performed at 1.5 T. Imaging sequences included steady-state free-precession (SSFP) sequences, real-time SSFP and single-shot turbo spin echo (SSTSE) sequences. The images were analyzed with an anatomic segmental approach by two radiologists.ResultsFetal CMR yielded the same diagnosis as postnatal findings in 79% (54/68) of patients. The diagnostic sensitivity of routine obstetric US for cardiac anomalies was 46% (31/68). The diagnostic sensitivity of fetal echocardiographic examination by a fetal cardiac specialist was 82% (56/68). In 2 (3%) of 68 cases, diagnoses with both echocardiography and CMR were incorrect when compared with postnatal diagnosis. In ten (15%) cases, diagnosis at echocardiography was incorrect and that at CMR was correct. In twelve (18%) cases, diagnosis at echocardiography was correct and that at CMR was incorrect. Ten cases missed or misdiagnosed by echocardiography but correctly diagnosed by fetal CMR included asplenia syndrome (n = 2), interrupted inferior vena cava of polysplenia syndrome (n = 1), tricuspid incompetence (n = 1), double outlet right ventricle (n = 2), double aortic arch (n = 1), right pulmonary artery hypoplasia (n = 1), right-sided aortic arch of tetralogy of Fallot (n = 1) and hypoplastic left heart syndrome of a twin fetus (n = 1).ConclusionFetal CMR is a promising diagnostic tool for assessment of congenital cardiovascular abnormalities, especially in situations that limit echocardiography.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preliminary experience with cardiovascular magnetic resonance in evaluation of fetal cardiovascular anomalies

Dong

Zhu

2013

Journal of Cardiovascular Magnetic Resonance

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“…The background maternal source intrauterine noise is in the range of 100 dB, and increases only minimally during MRI. 67 The attenuation of external noise by maternal tissue, fluid, and fetal skull in the setting of high intrauterine background noise pressures makes injury to fetal hearing from MRI noise very unlikely, although not entirely impossible. While further investigation is indicated, available studies of MRI exposed infants have shown no evidence of increased risk of hearing loss relative to controls.…”

Section: Risks Of Mri Biological Effects Of Mrimentioning

confidence: 99%

“…74 Simulation studies have shown that the average SAR in the fetus is generally much lower than the SAR in the mother and that fetal temperature increase during clinical MRI is not expected to exceed the 0.5°C limit. 75,76 Reassuringly, investigations of fetal MRI in gravid sheep, pigs, and rabbits have also revealed minimal or no heating of amniotic fluid or fetus during standard fetal MRI protocols up to 30 minutes, 65,67,69,77 and to date no evidence of fetal harm has been detected despite increasingly widespread use of MRI for prenatal diagnosis over the past 2 decades. 68 Importantly, brain and cervical spine MRI should produce much lower SAR and heat deposition in the uterus and fetus than fetal MRI in most cases.…”

Section: Risks Of Mri Biological Effects Of Mrimentioning

confidence: 99%

Neuroimaging in Pregnant Women

Chansakul

Young

2017

Semin Neurol

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Choosing the most appropriate diagnostic neuroimaging study for a pregnant woman involves assessing the pretest likelihood of serious treatable neurologic disease, the diagnostic utility of various available computed tomography (CT) and magnetic resonance (MR) modalities, and the risks of each. Of these three elements-pretest differential diagnosis, utility of MRI and CT, and risks of MR and CT-the risk component is perhaps the least well understood by most physicians. We provide a basic review of the intrinsic risks of MRI and CT, particularly radiation biology and radiation safety, as well as the risks pertaining to the use of contrast agents, to reduce provider confusion and anxiety and improve quality, safety, and efficiency of neuroimaging diagnosis in pregnant patients. We believe that a better understanding of the associated very low risks with mother and fetus will reassure the reader that CT remains the most appropriate tool for initial rapid diagnosis of acute neurological conditions in pregnancy and that in urgent situations CT should not be withheld or delayed due to exaggerated concern about radiation. Noncontrast MRI, while not without risk, is generally considered safe in pregnancy, as no evidence of fetal adverse effects has been demonstrated to date. Iodinated CT contrast agents are likely safer than gadolinium-based MRI contrast agents because of gadolinium accumulation in the amniotic fluid and fetal tissue, although no harmful effects of tissue gadolinium accumulation are known. In most but not all pregnant patients presenting with a new or worsening neurological abnormality, the risks intrinsic to the disease will outweigh the risks of imaging. In an individual patient, the pretest probability of serious treatable disease and acuity of presentation will usually suggest an optimal imaging strategy and choice of test. This optimal strategy will also depend on the immediate availability and level of sophistication of the scanners, software, technologists, and radiologists. As such, the standard of care for imaging in pregnancy requires direct consultation between the referring clinician and radiologist to determine the most appropriate strategy and brief documentation of the resulting consensus risk-benefit assessment.

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“…Not all CHD is obvious during the second trimester; some defects, such as valve obstruction, necessitate targeted examination at an advanced gestational age. However, fetal echocardiography during the third trimester may be limited by several factors including fetal position, calcification of the fetal bones, maternal obesity and reduction of amniotic fluid volume. To overcome these limitations, an additional imaging modality may help to improve parental counseling and planning of postnatal care.…”

Section: Introductionmentioning

confidence: 99%

Dynamic fetal cardiac magnetic resonance imaging in four‐chamber view using Doppler ultrasound gating in normal fetal heart and in congenital heart disease: comparison with fetal echocardiography

Sousa

Hecher

Yamamura

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives To investigate the diagnostic performance of dynamic fetal cardiac magnetic resonance imaging (MRI), using a MR‐compatible Doppler ultrasound (DUS) device for fetal cardiac gating, in differentiating fetuses with congenital heart disease from those with a normal heart, and to compare the technique with fetal echocardiography. Methods This was a prospective study of eight fetuses with a normal heart and four with congenital heart disease (CHD), at a median of 34 (range, 28–36) weeks' gestation. Dynamic fetal cardiac MRI was performed using a DUS device for direct cardiac gating. The four‐chamber view was evaluated according to qualitative findings. Measurements of the length of the left and right ventricles, diameter of the tricuspid and mitral valves, myocardial wall thickness, transverse cardiac diameter and left ventricular planimetry were performed. Fetal echocardiography and postnatal diagnoses were considered the reference standards. Results Direct cardiac gating allowed continuous triggering of the fetal heart, showing high temporal and spatial resolution. Both fetal cardiac MRI and echocardiography in the four‐chamber view detected pathological findings in three of the 12 fetuses. Qualitative evaluation revealed overall consistency between echocardiography and MRI. On both echocardiography and MRI, quantitative measurements revealed significant differences between fetuses with a normal heart and those with CHD with respect to the length of the right (P < 0.01 for both) and left (P < 0.01 for both) ventricles and transverse cardiac diameter (P < 0.05 and P < 0.01, respectively). Tricuspid valve diameter on cardiac MRI was found to be significantly different in healthy fetuses from in those with CHD (P < 0.05). Conclusions For the first time, this study has shown that dynamic fetal cardiac MRI in the four‐chamber view, using external cardiac gating, allows evaluation of cardiac anatomy and diagnosis of congenital heart disease in agreement with fetal echocardiography. Dynamic fetal cardiac MRI may be useful as a second‐line investigation if conditions for fetal echocardiography are unfavorable. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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In vivo Intrauterine Sound Pressure and Temperature Measurements during Magnetic Resonance Imaging (1.5 T) in Pregnant Ewes

Cited by 9 publications

References 60 publications

Preliminary experience with cardiovascular magnetic resonance in evaluation of fetal cardiovascular anomalies

Preliminary experience with cardiovascular magnetic resonance in evaluation of fetal cardiovascular anomalies

Neuroimaging in Pregnant Women

Dynamic fetal cardiac magnetic resonance imaging in four‐chamber view using Doppler ultrasound gating in normal fetal heart and in congenital heart disease: comparison with fetal echocardiography

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