Integration of Prenatal Cardiovascular Magnetic Resonance Imaging in Congenital Heart Disease

Abstract

Standard of care echocardiography can have limited diagnostic accuracy in certain cases of fetal congenital heart disease. Prenatal cardiovascular magnetic resonance (CMR) imaging has potential to provide additional anatomic imaging information, including excellent soft tissue images in multiple planes, improving prenatal diagnostics and in utero hemodynamic assessment. We conducted a literature review of fetal CMR, including its development and implementation into clinical practice, and compiled and analyzed the results. Our findings included the fact that technological and innovative approaches are required to overcome some of the challenges in fetal CMR, in part due to the dynamic nature of the fetal heart. A number of reconstruction algorithms and cardiac gating strategies have been developed over time to improve fetal CMR image quality, allowing unique investigations into fetal hemodynamics, oxygenation, and growth. Studies demonstrate that incorporating CMR in the prenatal arena influences postnatal clinical management. With further refinement and experience, fetal CMR in congenital heart disease continues to evolve and demonstrate ongoing potential as a complementary imaging modality to fetal echocardiography in the care of these patients.

Keywords: cardiac magnetic resonance imaging; congenital heart disease; fetal cardiac gating; pregnancy.

Figure 1. Fetal versus postnatal circulation.

AAo indicates ascending aorta; CVO, combined ventricular output; DA, ductus arteriosus; DAo, descending aorta; DV, ductus venosus; HLHS, hypoplastic left heart syndrome; IVC, inferior vena cava; LA, left atrium; LV, left ventricle; MPA, main pulmonary artery; PFO, patent foramen ovale; RA, right atrium; RV, right ventricle; SVC, superior vena cava; UA, umbilical artery; and UV, umbilical vein.

Figure 2. Proposed clinical pathway and indications for prenatal imaging in congenital heart disease.

Figure created with biorender.com. CHD indicates congenital heart disease; MRI, magnetic resonance imaging; and NICU, neonatal intensive care unit.