An exploration of the potential utility of fetal cardiovascular MRI as an adjunct to fetal echocardiography.
Research paper by
David F A DF Lloyd, Joshua F P JF van Amerom, Kuberan K Pushparajah, John M JM Simpson, Vita V Zidere, Owen O Miller, Gurleen G Sharland, Joanna J Allsop, Matthew M Fox, Maelene M Lohezic, Maria M Murgasova, Christina C Malamateniou, Jo V JV Hajnal, Mary M Rutherford, Reza R Razavi
Fetal cardiovascular MRI offers a potential alternative to echocardiography, although in practice its use has been limited. We sought to explore the need for additional imaging in a tertiary fetal cardiology unit, and the usefulness of standard MRI sequences.Cases where the diagnosis was not fully resolved using echocardiography were referred for MRI. Following a three-plane localiser, fetal movement was assessed with a balanced steady-state free precession (bSSFP) cine. Single-shot fast spin echo (SSFSE) and bSSFP sequences were used for diagnostic imaging.22 fetal cardiac MRIs were performed over 12 months, at mean gestation 32 weeks (26 - 38 weeks). The majority of referrals were for suspected vascular abnormalities (17/22), particularly involving the aortic arch (n = 10) and pulmonary vessels (n = 4). SSFSE sequences produced "black-blood" images, useful for examining the extracardiac vasculature in these cases. BSSFP sequences were more useful for intracardiac structures. Real-time SSFP allowed for dynamic assessment of structures such as cardiac masses, with enhancement patterns also allowing for tissue characterisation in these cases.Fetal vascular abnormalities such as coarctation can be difficult to diagnose using ultrasound. Fetal MRI may have an adjunctive role in the evaluation of the extracardiac vascular anatomy and tissue characterisation.