The use of image fusion in prenatal medicine

Abstract

Fusion imaging (FI), the simultaneous display of the same anatomical region using two imaging modalities, has been used in other areas of medicine for both diagnosis and guiding interventions. Examples include positron emission tomography‐computed tomography (PET‐CT) imaging in oncology and ultrasound‐magnetic resonance imaging (US‐MRI) fusion in biopsies of the prostate gland. The underlying principle is to take advantage of the complementary information in each modality to improve accuracy, be it diagnostic accuracy or targeting accuracy in biopsies. For example, PET‐CT overlays the metabolic activity of lesions on the superb spatial and anatomical detail of CT. While the historical mainstay of fetal imaging has been ultrasound, advances in ultrafast MR imaging together with advances in fetal MRI over the past two decades, have resulted in the opportunity to explore fusion imaging in fetal medicine. We present an overview of the principles of US‐MRI fusion imaging in prenatal medicine, report our local experience, and review the literature in this emerging area. We share our perspective on how FI can improve diagnostic confidence, be used as an educational tool, and potentially enhance guidance in certain fetal procedures.

Assessment of the fetal lungs in utero

“…27 Multimodal fusion imaging, which allows superimposition of real-time ultrasound images and multiplanar reconstruction images of MRI, is another promising technique, which has been assessed to date in multiple conditions including CDH and pulmonary sequestration. 28 Abnormal lung development and associated lung pathologies Normal fetal lung development can be disrupted at any stage of development (Table 1). Prognosis is dependent on the underlying condition and gestation of the insult.…”

“… 27 Multimodal fusion imaging, which allows superimposition of real-time ultrasound images and multiplanar reconstruction images of MRI, is another promising technique, which has been assessed to date in multiple conditions including CDH and pulmonary sequestration. 28 …”

Experience in utilizing a novel 3D digital model with CT and MRI fusion data in sarcoma evaluation and surgical planning

“…However, it is not possible to reconstruct a 3D model based only on MRI data. The image fusion technique could possibly combine the merits of CT and MRI and get a better model of the tumor in assisting clinical decisions 18,19 . Pilot attempts have been utilized in other organs using CT and MRI fusion techniques in guiding clinical practice 20–22 .…”

“…The image fusion technique could possibly combine the merits of CT and MRI and get a better model of the tumor in assisting clinical decisions. 18,19 Pilot attempts have been utilized in other organs using CT and MRI fusion techniques in guiding clinical practice. [20][21][22] We previously reported a successful case using the CT/MRI fusion 3D model to evaluate and plan the surgery of a pelvic osteosarcoma patient.…”

The use of MRI in fetal conditions amenable for antenatal management

“…Fusion of US and MR images is possible today. Millischer et al demonstrate how combining both imaging modalities adds information and improves diagnostic confidence . Another more generic contribution is on postmortem imaging.…”