Application of a new method: Fetal cardiac MRI in fetuses with congenital heart disease
Final Report Abstract
This project intended to apply the new method of retrospective cardiac gating via an Doppler-Ultrasound (US) device for magnetic resonance imaging (MRI) in fetuses with and without congenital heart disease (CHD) in utero to test feasibility, set up a protocol and evaluate clinical value. Site was the Lumiere Foundation at Université Paris Cité, Hôpital Necker, a designated center for pre- and neonatal medicine. Fetal MRI in general holds the potential to provide prognosis-relevant diagnostic information. The extension of fetal MRI by Doppler-US gated cardiac sequences enables the additional evaluation of CHD as well as cardiac compassion in other malformations within the same scanning session and may inform clinical decision making and perinatal management in case of inconclusive US assessment of the fetal heart. A standardized protocol is therefore necessarily required to provide comparability between the imaging modalities as well as between centers, to obtain high image quality and to properly evaluate morphology and function of the fetal heart. For this purpose, an article providing an overview and the path to standardization of planning fetal cardiac in late gestation in comparison to standardized orientations during an ultrasound examination of the fetal heart with corresponding schematic, US and MRI image examples and annotated anatomical structures was prepared. An evaluation of feasibility yielded fetal cardiac MRI to be feasible in 95% of patients with image quality rated medium or high in > 85% of cases according to our image quality evaluation. We were able to reproduce a substantial agreement between MRI and US (κ-value 0.70 with an accuracy of 0.85). Besides, CHD also impacts on brain development with biometric and neurocognitive consequences from the neonatal period onwards, why we also investigated brain perfusion by arterial spin labeling in CHD as well as healthy control (HC) fetuses in relation to cardiac anatomy and function. Although very preliminary, our results suggest differences in cerebral perfusion between HC fetuses and those affected by CHD. More precisely, modified cardiac function related to CHD may particularly affect perfusion of the basal ganglia, reflecting on potential roots of altered fetal gyration patterns and neonatal brain biometrics, that have been reported in individuals affected by CHD.
Publications
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L’IRM cardiaque: où en sommes-nous? Presented at the Journée Lumiere for professional and academic education, Paris, France, December 2023.
Biechele G.
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Feasibility of fetal cardiac MRI in the prenatal evaluation of congenital heart defects in comparison to US Presented as a Poster at the World Congress of the International Society of Ultrasound in Obstetrics and Gynecology, Budapest, Hungary, September 2024.
Biechele G., Midavaine M., Stos B., Laux D., Stoecklein S., Grevent D. & Salomon L.J.
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Performance of fetal cardiac MRI: an approach to practice (ISUOG Abstract Presentation Award) Presented as an Oral Presentation at the World Congress of the International Society of Ultrasound in Obstetrics and Gynecology, Budapest, Hungary, September 2024.
Biechele G., De Vries F., Stos B., Stoecklein .S, Grevent D. & Salomon L.J.
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Prenatal link between cerebral blood flow and cardiac function in CHD assessed by fetal MRI Accepted for Oral Presentation at the Annual Meeting of the Radiological Society of North America, Chicago, USA, December 2024.
Biechele G., Midavaine M., Stos B., Laux D., Stoecklein S., Grevent D. & Salomon L.J.
