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Contribution of fetal magnetic resonance imaging in fetuses with congenital heart disease

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Abstract

Background

Increasing evidence supports an association among congenital heart disease (CHD), structural brain lesions on neuroimaging, and increased risk of neurodevelopmental delay and other structural anomalies. Fetal MRI has been found to be effective in demonstrating fetal structural and developmental abnormalities.

Objective

To determine the contribution of fetal MRI to identifying cardiovascular and non-cardiovascular anomalies in fetuses with CHD compared to prenatal US and fetal echocardiography.

Materials and methods

We performed a retrospective study of fetuses with CHD identified by fetal echocardiography. Exams were performed on 1.5-tesla (T) or 3-T magnets using a balanced turbo field echo sequence triggered by an external electrocardiogram simulator with a fixed heart rate of 140 beats per minute (bpm). Fetal echocardiography was performed by pediatric cardiologists and detailed obstetrical US by maternal–fetal medicine specialists prior to referral to MRI. We compared the sensitivity of fetal MRI and fetal echocardiography for the diagnosis of cardiovascular anomalies, as well as the sensitivity of fetal MRI and referral US for the diagnosis of non-cardiac anomalies. We performed statistical analysis using the McNemar test.

Results

We identified 121 anomalies in 31 fetuses. Of these, 73 (60.3%) were cardiovascular and 48 (39.7%) involved other organ systems. Fetal echocardiography was more sensitive for diagnosing cardiovascular anomalies compared to fetal MRI, but the difference was not statistically significant (85.9%, 95% confidence interval [CI] 77.8–94.0% vs. 77.5%, 95% CI 67.7–87.2%, respectively; McNemar test 2.29; P=0.13). The sensitivity of fetal MRI was higher for diagnosing extracardiac anomalies when compared to referral US (84.1%, 95% CI 73.3–94.9% vs. 31.8%, 95% CI 18.1–45.6%, respectively; McNemar test 12.9; P<0.001). The additional information provided by fetal MRI changed prognosis, counseling or management for 10/31 fetuses (32.2%), all in the group of 19 fetuses with anomalies in other organs and systems besides CHD.

Conclusion

Fetal MRI performed in a population of fetuses with CHD provided additional information that altered prognosis, counseling or management in approximately one-third of the fetuses, mainly by identifying previously unknown anomalies in other organs and systems.

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Authors and Affiliations

  1. Department of Radiology, Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA

    Luis F. Goncalves, Patricia Cornejo, Mittun C. Patel & Dianna M. E. Bardo

  2. University of Arizona College of Medicine, Phoenix, AZ, USA

    Luis F. Goncalves, Christopher L. Lindblade, Patricia Cornejo, Mittun C. Patel, Ericka Scheller McLaughlin & Dianna M. E. Bardo

  3. Department of Radiology, Creighton University, Phoenix, AZ, USA

    Luis F. Goncalves, Christopher L. Lindblade, Patricia Cornejo, Mittun C. Patel, Ericka Scheller McLaughlin & Dianna M. E. Bardo

  4. Department of Radiology, Mayo Clinic, Phoenix, AZ, USA

    Luis F. Goncalves, Christopher L. Lindblade, Patricia Cornejo, Mittun C. Patel, Ericka Scheller McLaughlin & Dianna M. E. Bardo

  5. Department of Cardiology, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Christopher L. Lindblade & Ericka Scheller McLaughlin

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  1. Luis F. Goncalves
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Correspondence to Luis F. Goncalves.

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Goncalves, L.F., Lindblade, C.L., Cornejo, P. et al. Contribution of fetal magnetic resonance imaging in fetuses with congenital heart disease. Pediatr Radiol 52, 513–526 (2022). https://doi.org/10.1007/s00247-021-05234-1

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  • DOI: https://doi.org/10.1007/s00247-021-05234-1

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