Abstract
PurposeTo image multidimensional flow in fetuses using golden-angle radial phase contrast cardiovascular magnetic resonance (PC-CMR) with motion correction and retrospective gating.MethodsA novel PC-CMR method was developed using an ungated golden-angle radial acquisition with continuously incremented velocity encoding. Healthy subjects (n = 5, 27 ± 3 years, males) and pregnant females (n = 5, 34 ± 2 weeks gestation) were imaged at 3 T using the proposed sequence. Real-time reconstructions were first performed for retrospective motion correction and cardiac gating (using metric optimized gating, MOG). CINE reconstructions of multidimensional flow were then performed using the corrected and gated data.ResultsIn adults, flows obtained using the proposed method agreed strongly with those obtained using a conventionally gated Cartesian acquisition. Across the five adults, bias and limits of agreement were − 1.0 cm/s and [− 5.1, 3.2] cm/s for mean velocities and − 1.1 cm/s and [− 6.5, 4.3] cm/s for peak velocities. Temporal correlation between corresponding waveforms was also high (R~ 0.98). Calculated timing errors between MOG and pulse-gating RR intervals were low (~ 20 ms). First insights into multidimensional fetal blood flows were achieved. Inter-subject consistency in fetal descending aortic flows (n = 3) was strong with an average velocity of 27.1 ± 0.4 cm/s, peak systolic velocity of 70.0 ± 1.8 cm/s and an intra-class correlation coefficient of 0.95 between the velocity waveforms. In one fetal case, high flow waveform reproducibility was demonstrated in the ascending aorta (R = 0.97) and main pulmonary artery (R = 0.99).ConclusionMultidimensional PC-CMR of fetal flow was developed and validated, incorporating retrospective motion compensation and cardiac gating. Using this method, the first quantification and visualization of multidimensional fetal blood flow was achieved using CMR.
Highlights
Disruption of the fetal circulation by congenital heart disease (CHD) can result in injury to critical organs and possible fetal death [1]
Validation of the proposed sequence was performed in a flow phantom and validation of the retrospective gating and CINE reconstruction was performed in healthy adult subjects
Validation of the pipeline was performed in a flow phantom and healthy adult subjects, and its feasibility was tested in healthy pregnancies
Summary
Disruption of the fetal circulation by congenital heart disease (CHD) can result in injury to critical organs and possible fetal death [1]. In such cases, premature delivery with subsequent intervention may be recommended, but this option must be weighed against the risks of prematurity such as infection, impaired organ development and cognitive delay. Using these methods, fetal blood flow and oxygen delivery have been measured in a variety of fetal CHD including left-heart disease and transposition of the great arteries [5, 6]. To quantify flow accurately in the heart and major vessels, a high spatial resolution (≤ 1 × 1 mm2) is beneficial
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