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Four-dimensional fetal cardiac imaging in a cohort of fetuses with suspected congenital heart disease

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Abstract

Background

Fetal cardiac magnetic resonance imaging (MRI) requires high spatial and temporal resolution and robustness to random fetal motion to capture the dynamics of the beating fetal heart. Slice-to-volume reconstruction techniques can produce high-resolution isotropic images while compensating for random fetal motion.

Objective

The objective of this study was to evaluate image quality for slice-to-volume reconstruction of four-dimensional balanced steady-state free precession (bSSFP) imaging of the fetal heart.

Materials and methods

A cohort of 13 women carrying fetuses with congenital heart disease were imaged with real-time bSSFP sequences. Real-time bSSFP sequences were post-processed using a slice-to-volume reconstruction algorithm to produce retrospectively gated 4-D sequences with isotropic spatial resolution. Two radiologists evaluated slice-to-volume reconstruction image quality on a scale from 0 to 4 using 11 categories based on a segmental approach to defining cardiac anatomy and pathology. A score of 0 corresponded to cardiac structures not visualized at all and four corresponded to high quality and distinct appearance of structures.

Results

In 11 out of 13 cases, the average radiologist score of image quality across all categories was 3.0 or greater. In the remaining two cases, slice-to-volume reconstruction was not possible due to insufficient image quality in the acquisition.

Conclusion

Slice-to-volume reconstruction has the potential to produce isotropic images with high spatial and temporal resolution that can display the anatomy of the fetal heart in arbitrary imaging planes retrospectively. More rapid, motion-robust acquisitions may be necessary to successfully reconstruct the fetal heart in all patients.

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Acknowledgments

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Phoenix Children’s Hospital.

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Authors and Affiliations

  1. Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85257, USA

    Nicholas C. Rubert, Gaurav Jategaonkar, Jonathan D. Plasencia, Christopher L. Lindblade, Dianna M. E. Bardo & Luis F. Goncalves

  2. Mayo Clinic, Scottsdale, AZ, USA

    Dianna M. E. Bardo

  3. University of Arizona, Phoenix, AZ, USA

    Dianna M. E. Bardo & Luis F. Goncalves

  4. School of Medicine, Creighton University, Phoenix, AZ, USA

    Dianna M. E. Bardo

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  1. Nicholas C. Rubert
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  2. Gaurav Jategaonkar
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Correspondence to Nicholas C. Rubert.

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Supplementary Information

Sagittal 2-D real-time acquisitions for subject 6 at 29 weeks’ gestational age. Minimal motion occurs during the acquisition. (MP4 867 kb)

Sagittal 2-D real-time acquisition for subject 5 at 25 weeks’ gestational age. Large fetal movement results in artifacts within individual frames. (MP4 1156 kb)

Multiplanar reformat simultaneously shows left-to-right: short-axis, four-chamber and 2-chamber views for subject 7 at 36 weeks’ gestational age. (MP4 525 kb)

Multiplanar reformat simultaneously shows three-vessel and trachea and other orthogonal views for subject 7 at 36 weeks’ gestational age. (MP4 422 kb)

A rendering of thresholded segmentation of blood pool for four-dimensional segmentation is oriented to demonstrate the aortic arch for subject 7 at 36 weeks’ gestational age. (MP4 2245 kb)

A rendering of thresholded segmentation of blood pool four-dimensional segmentation is oriented to demonstrate the left superior vena cava to coronary sinus for subject 7 at 36 weeks’ gestational age. (MP4 704 kb)

A 4-D multiplanar display of the heart at 34 weeks in a fetus with tetralogy of Fallot and pulmonary atresia. Subject 11 at 34 weeks’ gestational age. Left panel: coronal reformat. Middle panel: axial reformat. Right panel: sagittal reformat. (MP4 6588 kb)

A 4-D rendered view of threshold-based segmentation of the blood pool for the heart at 34 weeks in a fetus with tetralogy of Fallot and pulmonary atresia, frontal projection. Subject 11 at 34 weeks’ gestational age. (MP4 7615 kb)

A four-chamber view in subject 12 at 30 weeks’ gestational age. (MP4 291 kb)

A left ventricular outflow tract view of subject 12 at 30 weeks’ gestational age. (MP4 268 kb)

A three-vessel view of subject 12 at 30 weeks’ gestational age. (MP4 307 kb)

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Rubert, N.C., Jategaonkar, G., Plasencia, J.D. et al. Four-dimensional fetal cardiac imaging in a cohort of fetuses with suspected congenital heart disease. Pediatr Radiol 53, 198–209 (2023). https://doi.org/10.1007/s00247-022-05500-w

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  • DOI: https://doi.org/10.1007/s00247-022-05500-w

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