Feasibility study in assessment of congenital cardiovascular malformation by recent technique of fetal cardiac MR imaging

Abstract

BackgroundAbnormalities of the cardiovascular system are the most common congenital diseases in the fetus and the first cause of infant mortality. Echocardiography is still the method of choice to visualize the fetal cardiac cardiovascular abnormalities, yet cardiovascular magnetic resonance (CMR) is relatively unaffected by maternal and fetal conditions such as maternal obesity, uterine myoma, twins, oligohydramnios, fetal position and rib calcification, which particularly impair sonographic visualization of the fetal heart. Fetal cardiac MR imaging is a novel MRI technique which can provide valuable information that could add to the prenatal diagnosis and evaluation of cardiac and most of extra-cardiac anomalies. In this work, we aimed to highlight the advantage of FCMRI over fetal echocardiography in assessment of fetal congenital cardiac anomalies.ResultsFifty-Two fetuses with suspected or diagnosed congenital cardiac anomalies. All cases underwent detailed history taking, underwent fetal echocardiography using suitable curvilinear probe and performed according to standard protocol, then fetal cardiac MR was done with Balanced fast field echo, Black blood single shot, white blood Cine, Real-time 3D dynamic sequences, images were acquired in the transverse, four-chamber, short-axis, coronal and oblique sagittal views. Findings of fetal echocardiography were compared with that of cardiac MRI and with standard post-natal echocardiography. Prenatal Echo and fetal cardiac MRI showed significant moderate agreement between the two modalities in the detection of different congenital cardiac anomalies, Kappa test: 0.500; p value 0.021. Fetal MRI had a significant role in detection of extra cardiac anomalies in most cases. Comparing to gold standard post-natal echo. Accuracy of fetal CMRI is 95.5% and of fetal Echo is 86.4% regarding overall cardiac anomalies:ConclusionFetal cardiac MR imaging as an adjunct to fetal echocardiography may provide valuable information that could add to the prenatal diagnosis and evaluation of cardiac and most of extra cardiac anomalies.