Reference Values for Fetal Cardiac Dimensions, Volumes, Ventricular Function and Left Ventricular Longitudinal Strain Using Doppler Ultrasound Gated Cardiac Magnetic Resonance Imaging in Healthy Third Trimester Fetuses

Abstract

BackgroundRecent advances in hardware and software permit the use of cardiac MRI of late gestation fetuses, however there is a paucity of MRI‐based reference values.PurposeTo provide initial data on fetal cardiac MRI‐derived cardiac dimensions, volumes, ventricular function, and left ventricular longitudinal strain in healthy developing fetuses >30 weeks gestational age.Study TypeProspective.PopulationTwenty‐five third trimester (34 ± 1 weeks, range of 32–37 weeks gestation) women with healthy developing fetuses.Field Strength/SequenceStudies were performed at 1.5 T and 3 T. Cardiac synchronization was achieved with a Doppler ultrasound device. The protocol included T2 single shot turbo spin echo stacks for fetal weight and ultrasound probe positioning, and multiplanar multi‐slice cine balanced steady state free precession gradient echo sequences.AssessmentPrimary analyses were performed by a single observer. Weight indexed right ventricular (RV) and left ventricular (LV) volumes and function were calculated from short axis (SAX) stacks. Cardiac dimensions were calculated from the four‐chamber and SAX stacks. Single plane LV longitudinal strain was calculated from the four‐chamber stack. Interobserver variability was assessed in 10 participants. Cardiac MRI values were compared against available published normative fetal echocardiogram data using z‐scores.Statistical TestsMean and SDs were calculated for baseline maternal/fetal demographics, cardiac dimensions, volumes, ventricular function, and left ventricular longitudinal strain. Bland–Altman and intraclass correlation coefficient analysis was performed to test interobserver variability.ResultsThe mean gestational age was 34 ± 1.4 weeks. The mean RV and LV end diastolic volumes were 3.1 ± 0.6 mL/kg and 2.4 ± 0.5 mL/kg respectively. The mean RV cardiac output was 198 ± 49 mL/min/kg while the mean LV cardiac output was 173 ± 43 mL/min/kg.Data ConclusionThis paper reports initial reference values obtained by cardiac MRI in healthy developing third trimester fetuses. MRI generally resulted in slightly larger indexed values (by z‐score) compared to reports in literature using fetal echocardiography.Evidence level1Technical EfficacyStage 2

Editorial for “Reference Values for Fetal Cardiac Dimensions, Volumes, Ventricular Function and Left Ventricular Longitudinal Strain Using Doppler Ultrasound Gated Cardiac Magnetic Resonance Imaging in Healthy Third Trimester Fetuses”

“…In normal fetuses, the use of MRI is allowed following ethical standards as defined elsewhere (declaration of Helsinki) 5 . A recent publication by Barker et al in the Journal of Magnetic Resonance Imaging (JMRI) is one of the first publications to present normative cardiac MRI data for a healthy fetal population, eg, cardiac dimensions, volumes, and function 6 . This is an important advance, as establishing a range of normal structural and functional values allows more for effective diagnosis.…”