To investigate the feasibility of fetal phase-contrast (PC)-MR angiography of the descending aorta (AoD) using an MR-compatible Doppler ultrasound sensor (DUS) for fetal cardiac gating and to compare velocimetry with Doppler ultrasound measurements.
In this prospective study, 2D PC-MR angiography was performed in 12 human fetuses (mean gestational age 32.8 weeks) using an MR-compatible DUS for gating of the fetal heart at 1.5 T. Peak flow velocities in the fetal AoD were compared with Doppler ultrasound measurements performed on the same day. Reproducibility of PC-MR measurements was tested by repeated PC-MR in five fetuses.
Dynamic PC-MR angiography in the AoD was successfully performed in all fetuses using the DUS, with an average fetal heart rate of 140 bpm (range 129–163). Time-velocity curves revealed typical arterial blood flow patterns. PC-MR mean flow velocity and mean flux were 21.2 cm/s (range 8.6–36.8) and 8.4 ml/s (range 3.2–14.6), respectively. A positive association between PC-MR mean flux and stroke volume with gestational age was obtained (r = 0.66, p = 0.02 and r = 0.63, p = 0.03). PC-MR and Doppler ultrasound peak velocities revealed a highly significant correlation (r = 0.8, p < 0.002). Peak velocities were lower for PC-MR with 69.1 cm/s (range 39–125) compared with 96.7 cm/s (range 60–142) for Doppler ultrasound (p < 0.001). Reproducibility of PC-MR was high (p > 0.05).
The MR-compatible DUS for fetal cardiac gating allows for PC-MR angiography in the fetal AoD. Comparison with Doppler ultrasound revealed a highly significant correlation of peak velocities with underestimation of PC-MR velocities. This new technique for direct fetal cardiac gating indicates the potential of PC-MR angiography for assessing fetal hemodynamics.
• The developed MR-compatible Doppler ultrasound sensor allows direct fetal cardiac gating and can be used for prenatal dynamic cardiovascular MRI.
• The MR-compatible Doppler ultrasound sensor was successfully applied to perform intrauterine phase-contrast MR angiography of the fetal aorta, which revealed a highly significant correlation with Doppler ultrasound measurements.
• As fetal flow hemodynamics is an important parameter in the diagnosis and management of fetal pathologies, fetal phase-contrast MR angiography may offer an alternative imaging method in addition to Doppler ultrasound and develop as a second line tool in the evaluation of fetal flow hemodynamics.
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Doppler ultrasound sensor
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This study has received funding from the German Research Foundation (DFG).
The scientific guarantor of this publication is Prof. Dr. Gerhard Adam.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: The authors BS, JY, FK, KF, CR, and MTS are co-founders and stakeholders of northh medical GmbH, the developing company of the Doppler ultrasound gating device.
Statistics and biometry
Dr. Roland Fischer, who is a co-author of this manuscript, kindly provided statistical advice for this manuscript.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Singular subjects of this study have been part of a previous publication performing fetal cardiac MRI, therefore investigating a different issue of fetal MR imaging than PC-MR angiography.
• performed at one institution
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Schoennagel, B.P., Yamamura, J., Kording, F. et al. Fetal dynamic phase-contrast MR angiography using ultrasound gating and comparison with Doppler ultrasound measurements. Eur Radiol 29, 4169–4176 (2019). https://doi.org/10.1007/s00330-018-5940-y
- Fetal research
- Magnetic resonance angiography
- Ultrasonography, Doppler
- Blood flow velocity