Dianna M. Ehrhart Bardo MD, Presenter: Speakers Bureau, Koninklijke Philips Electronics NV

Erin Madriago MD, Abstract Co-Author: Nothing to Disclose

Claudine Monique Bohun MBBCh, BMedSc, Abstract Co-Author: Nothing to Disclose

Kathryn W. Holmes MD, MPH, Abstract Co-Author: Nothing to Disclose

Mary S. Minette MD, Abstract Co-Author: Nothing to Disclose

Roya Sohaey MD, Abstract Co-Author: Nothing to Disclose

Karen Yung-Ping Oh MD, Abstract Co-Author: Nothing to Disclose

Brendan Kelly MD, Abstract Co-Author: Nothing to Disclose

Don Baker PhD, Abstract Co-Author: Employee, Koninklijke Philips Electronics NV

Shannon Spruell RT, Abstract Co-Author: Nothing to Disclose

Stephanie Gibson RT, Abstract Co-Author: Nothing to Disclose

David J. Sahn MD, Abstract Co-Author: Nothing to Disclose

Accurate preoperative diagnosis of CHD is paramount for birth management, surgical decisions and survival. Fetal echo is the standard prenatal imaging modality but may be limited by acoustic window. The purpose of this study is to investigate feasibility of pseudo ECG-gating and real time MR fluoro to improve temporal resolution and allow qualitative & quantitative analysis of fetal cardiac MRI (fetal CMR).

Fetal CMR was performed on 10 fetuses (GA 28-36 weeks); 5 structurally normal hearts & 5 known/suspected CHD. The fetal heart rate (HR) was determined at the time of fetal echo. Fast T2 sequences were performed to localize the fetal heart and to establish short and long axis imaging planes. Steady-state free precession (SSFP) and real time MR fluoro cine sequences were performed in short and long axis views to evaluate cardiac function. Continuous ECG recording during SSFP MRI acquisition was achieved using a wireless ECG system (Philips, Best,The Netherlands) attached to an ECG simulator (Fluke Biomedical, Everette,WA) [pseudo ECG-gating], in order to replicate the fetal HR. Left (LV) & right ventricle (RV) end diastolic (EDV) & systolic volumes (ESV) and ejection fraction were estimated using cardiac analysis software available on an Extended Workspace (Philips, Best,The Netherlands) and/or by multiplying the thickness of the slice by the sum of all the areas in the data set. Qualitative, quantitative, & anatomic findings were compared to fetal echo; correlation was made by 2 experienced readers.  

Preliminary results show pseudo ECG-gating fetal CMR is feasible and qualitative functional analysis correlates well with fetal echo. Fetal CMR was essential for identifying or confirming normal & abnormal cardiothoracic anatomy, including definition of pulmonary atresia, anomalous pulmonary venous drainage, hypoplastic ventricles, tetralogy of Fallot, and normal cardiac structures.

Pseudo ECG-gated SSFP & real time MR fluoro cine for fetal CMR is feasible and functional analysis correlates with fetal echo. Fetal CMR can be used to identify or confirm normal and abnormal fetal cardiac anatomy and is especially helpful when acoustic window limit sonographic examination.  

Fetal CMR is a valuable tool in evaluation of CHD. Direct fetal HR monitoring is not feasible in MR. Pseudo ECG-gating is a user friendly method for improving temporal resolution of fetal CMR images.

Bardo, D, Madriago, E, Bohun, C, Holmes, K, Minette, M, Sohaey, R, Oh, K, Kelly, B, Baker, D, Spruell, S, Gibson, S, Sahn, D, Pseudo ECG-gating in Fetal Cardiac MRI: Preliminary Results of a New Method to Evaluate Congenital Heart Disease (CHD) in the Fetus, with Echocardiography Correlation.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12031618.html