1. Three-dimensional visualisation of the fetal heart using prenatal MRI with motion-corrected slice-volume registration: a prospective, single-centre cohort study
- Author
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Lloyd, DFA, Pushparajah, K, Simpson, JM, Van Amerom, JFP, Van Poppel, MPM, Schulz, A, Kainz, B, Deprez, M, Lohezic, M, Allsop, J, Mathur, S, Bellsham-Revell, H, Vigneswaran, T, Charakida, M, Miller, O, Zidere, V, Sharland, G, Rutherford, M, Hajnal, JV, Razavi, R, Engineering & Physical Science Research Council (E, Wellcome Trust, and Wellcome Trust/EPSRC
- Subjects
Heart Defects, Congenital ,Science & Technology ,Cardiotocography ,IMPACT ,Gestational Age ,DIAGNOSIS ,Magnetic Resonance Imaging ,Article ,Ultrasonography, Prenatal ,RIGHT AORTIC-ARCH ,COARCTATION ,Medicine, General & Internal ,Fetal Heart ,Imaging, Three-Dimensional ,FETUSES ,Pregnancy ,General & Internal Medicine ,Image Processing, Computer-Assisted ,Humans ,Female ,Prospective Studies ,Life Sciences & Biomedicine ,ULTRASOUND ,11 Medical and Health Sciences - Abstract
BACKGROUND: Two-dimensional (2D) ultrasound echocardiography is the primary technique used to diagnose congenital heart disease before birth. There is, however, a longstanding need for a reliable form of secondary imaging, particularly in cases when more detailed three-dimensional (3D) vascular imaging is required, or when ultrasound windows are of poor diagnostic quality. Fetal MRI, which is well established for other organ systems, is highly susceptible to fetal movement, particularly for 3D imaging. The objective of this study was to investigate the combination of prenatal MRI with novel, motion-corrected 3D image registration software, as an adjunct to fetal echocardiography in the diagnosis of congenital heart disease. METHODS: Pregnant women carrying a fetus with known or suspected congenital heart disease were recruited via a tertiary fetal cardiology unit. After initial validation experiments to assess the general reliability of the approach, MRI data were acquired in 85 consecutive fetuses, as overlapping stacks of 2D images. These images were then processed with a bespoke open-source reconstruction algorithm to produce a super-resolution 3D volume of the fetal thorax. These datasets were assessed with measurement comparison with paired 2D ultrasound, structured anatomical assessment of the 2D and 3D data, and contemporaneous, archived clinical fetal MRI reports, which were compared with postnatal findings after delivery. FINDINGS: Between Oct 8, 2015, and June 30, 2017, 101 patients were referred for MRI, of whom 85 were eligible and had fetal MRI. The mean gestational age at the time of MRI was 32 weeks (range 24–36). High-resolution (0·50–0·75 mm isotropic) 3D datasets of the fetal thorax were generated in all 85 cases. Vascular measurements showed good overall agreement with 2D echocardiography in 51 cases with paired data (intra-class correlation coefficient 0·78, 95% CI 0·68–0·84), with fetal vascular structures more effectively visualised with 3D MRI than with uncorrected 2D MRI (657 [97%] of 680 anatomical areas identified vs 358 [53%] of 680 areas; p
- Published
- 2018