Abstract
ObjectivesFetal cardiovascular magnetic resonance imaging (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.MethodsCases 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 and bSSFP sequences were used for diagnostic imaging.ResultsTwenty‐two fetal cardiac MRIs were performed over 12 months, at mean gestation of 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). Single‐shot fast spin echo 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.ConclusionsFetal vascular abnormalities such as coarctation can be difficult to diagnose by using ultrasound. Fetal MRI may have an adjunctive role in the evaluation of the extracardiac vascular anatomy and tissue characterisation. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.
Highlights
Following a three-plane localiser, fetal movement was assessed with a balanced steady-state free precession cine
Twenty-two fetal cardiac Magnetic resonance imaging (MRI) were performed over 12 months, at mean gestation of 32 weeks (26–38 weeks)
BSSFP sequences were more useful for intracardiac structures
Summary
Conventional fetal echocardiography is the mainstay for prenatal diagnosis of congenital cardiac lesions, based on its ease of use, availability and high diagnostic accuracy.[1,2,3] individual fetal and maternal factors can have a deleterious effect on the quality of ultrasound imaging,[4,5] and there remain inherent difficulties in diagnosing specific forms of congenital heart disease in the fetus.[3,6,7,8] Despite this, due to technical and safety considerations, alternatives to ultrasonographic techniques have traditionally been extremely limited.[9]Magnetic resonance imaging (MRI) has been an established adjunct for postnatal assessment of the cardiovascular system since the 1980s,10 with routine studies able to deliver three-dimensional angiography, detailed real-time imaging, cardiac volumes and vascular flow measurements.[11]. Conventional fetal echocardiography is the mainstay for prenatal diagnosis of congenital cardiac lesions, based on its ease of use, availability and high diagnostic accuracy.[1,2,3] individual fetal and maternal factors can have a deleterious effect on the quality of ultrasound imaging,[4,5] and there remain inherent difficulties in diagnosing specific forms of congenital heart disease in the fetus.[3,6,7,8] Despite this, due to technical and safety considerations, alternatives to ultrasonographic techniques have traditionally been extremely limited.[9]. Electrocardiographic ‘gating’, a means of improving spatiotemporal resolution, is not yet practicable in the fetus, several non-invasive methods are under investigation.[14,15] Unpredictable threedimensional fetal motion, maternal bulk motion and fetal and maternal breathing movements present additional difficulties,[16] with no additional benefit from attempted fetal sedation.[5]
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