Pseudo ECG-gating in fetal cardiac MRI

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Materials & Methods Quantification of LV function Using 4 chamber [horizontal long axis] and/or 2 chamber [vertical long axis] views of the LV, an area length ejection fraction measurement was performed on FCMR images and qualitative function was visually assessed and graded as decreased, normal or increased Echo – LV and RV ejection fraction was visually assessed and graded as decreased, normal or increased END SYSTOLE END DIASTOLE Normal fetal heart Tetralogy of Fallot TOF & esophageal atresia AO RV LV Posteriorly positioned twin. Fetal echo shows a VSD (↑) & overriding aorta (AO). Sagittal oblique SST2 view shows PA atresia ( ) and branch pulmonary arteries (↑) arising from the ductus arteriosus. TOF & esophageal atresia END SYSTOLE END DIASTOLE Fetal echo shows RV hypertrophy in this patient with TOF (↑). FCMR shows MPA stenosis (↑), uplifted cardiac apex ( ) & aorta overriding a VSD (↑). Inset image – dilated proximal esophagus due to atresia & TEF. Fetal echo shows RV hypertrophy in this patient with TOF (↑). FCMR shows MPA stenosis (↑), uplifted cardiac apex ( ) & aorta overriding a VSD (↑). Inset image – dilated proximal esophagus due to atresia & TEF. TAPVC FCMR shows a bridging liver and markedly hypoplastic pulmonary veins & (black↑) & AVSD (white ↑). Pulmonary venous drainage suspected to be abnormal, below the diaphragm, on echo was confirmed on MR (white ↑). 11/1/2012 2
TAPVC FCMR shows a bridging liver and markedly hypoplastic pulmonary veins & (black↑) & AVSD (white ↑). Pulmonary venous drainage suspected to be abnormal, below the diaphragm, on echo was confirmed on MR (white ↑). Double outlet right ventricle P A RA RV A P Fetal echo shows the main pulmonary artery (P) and the aorta (A) arising from the right ventricle (RV). Findings of normally related great vessels and double outlet right ventricle are confirmed on axial FCMR (A) and (P). Ductal arch (black ↑). TAPVC Materials & Methods Results A P LV & RV end diastolic (EDV) & systolic volumes (ESV) and ejection fraction (EF) 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. Fetal cardiac mass FCMR shows a bridging liver and markedly hypoplastic pulmonary veins & (black↑) & AVSD (white ↑). Pulmonary venous drainage suspected to be abnormal, below the diaphragm, on echo was confirmed on MR (white ↑). Fetal echo showed a hyperechoic LV mass (↑), confirmed on FCMR as hyperintensity (↑), consistent with rhabdomyoma, but renal and neuro findings of tuberous sclerosis were not found on fetal MR. FETAL CMR PATIENTS WITH KNOWN CONGENITAL HEART DISEASE HISTORY & MR INDICATION CARDIAC MASS QUERY ASSOCIATED ABNORMALITIES SUSPECTED TOF ADVANCED MATERNAL AGE & OBESITY POOR VISUALIZATION OF HEART ON ECHO HETEROTAXY POOR VISUALIZATION OF HEART ON ECHO POSTERIORLY POSITIONED TWIN B POOR VISUALIZATION OF HEART ON ECHO TOF POSSIBLE NEUROLOGICAL ANOMALY FETAL ECHOCARDIOGRAPHY 30 gestational weeks NORMAL LV & RV FUNCTION; HR - 119 bpm 27 gestational weeks NORMAL LV & RV FUNCTION; HR - 136 bpm 23 gestational weeks NORMAL LV & RV FUNCTION; HR - 126 bpm 31 gestational weeks NORMAL LV & RV FUNCTION; HR - 141 bpm 32 gestational weeks NORMAL LV & RV FUNCTION; HR - 131 bpm ANATOMY echogenic mass in LV DORV with normally related great vessels heterotaxy – R cardiac apex, bridging liver, probably abnormal pulmonary veins, possible TOF absent main pulmonary artery absent pulmonary artery FETAL CARDIAC MR 31 gestational weeks NORMAL LV & RV FUNCTION; HR – 130 bpm 28 gestational weeks NORMAL LV & RV FUNCTION; HR – 140 bpm 30 gestational weeks NORMAL LV & RV FUNCTION; HR – 130 bpm 32 gestational weeks NORMAL LV & RV FUNCTION; HR – 140 bpm 34 gestational weeks NORMAL LV & RV FUNCTION; HR – 130 bpm ANATOMY T2 hyperintense mass on lateral wall of LV normal brain & renal findings normal cardiac function DORV normally related aorta & pulmonary artery normal cardiac function heterotaxy – R cardiac apex, bridging liver, probably abnormal pulmonary veins, possible TOF normal cardiac function PA atresia RPA & LPA arise from ductus arteriosus normal cardiac function – agenesis of the CC pulmonary artery stenosis dilated proximal esophagus - esophageal atresia normal cardiac function 11/1/2012 3
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Pseudo ECG-gating in fetal cardiac MRI

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