Fetal whole heart blood flow imaging using 4D cine MRI

• Published in: Nature communications Vol. 11; no. 1; pp. 4992 - 13
• Main Authors: Roberts, Thomas A., van Amerom, Joshua F. P., Uus, Alena, Lloyd, David F. A., van Poppel, Milou P. M., Price, Anthony N., Tournier, Jacques-Donald, Mohanadass, Chloe A., Jackson, Laurence H., Malik, Shaihan J., Pushparajah, Kuberan, Rutherford, Mary A., Razavi, Reza, Deprez, Maria, Hajnal, Joseph V.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 05.10.2020; Nature Publishing Group; Nature Portfolio
• Subjects: 59; 59/57; 639/166/985; 639/766/930/2735; 692/308/3187; 692/4019/592/2726; Blood circulation; Blood flow; Blood Flow Velocity; Blood vessels; Blood Vessels - diagnostic imaging; Blood Vessels - physiology; Cardiovascular diseases; Cardiovascular system; Coronary artery disease; Echocardiography; Female; Fetal Heart - diagnostic imaging; Fetal Heart - physiology; Fetuses; Flow velocity; Four-Dimensional Computed Tomography - methods; Gestational Age; Heart; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - physiopathology; Heart diseases; Humanities and Social Sciences; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine - methods; Medical imaging; multidisciplinary; Phantoms, Imaging; Pregnancy; Prenatal Diagnosis; Science; Science (multidisciplinary); Uterus; Visualization
• ISSN: 2041-1723; 2041-1723
• DOI: 10.1038/s41467-020-18790-1

Prenatal detection of congenital heart disease facilitates the opportunity for potentially life-saving care immediately after the baby is born. Echocardiography is routinely used for screening of morphological malformations, but functional measurements of blood flow are scarcely used in fetal echocardiography due to technical assumptions and issues of reliability. Magnetic resonance imaging (MRI) is readily used for quantification of abnormal blood flow in adult hearts, however, existing in utero approaches are compromised by spontaneous fetal motion. Here, we present and validate a novel method of MRI velocity-encoding combined with a motion-robust reconstruction framework for four-dimensional visualization and quantification of blood flow in the human fetal heart and major vessels. We demonstrate simultaneous 4D visualization of the anatomy and circulation, which we use to quantify flow rates through various major vessels. The framework introduced here could enable new clinical opportunities for assessment of the fetal cardiovascular system in both health and disease. Three-dimensional imaging of the fetal heart and quantification of blood flow in the surrounding vessels is very challenging because the heart is small and the fetus is free to move in the womb. Here, the authors demonstrate motion-corrected 4D flow MRI of the whole fetal heart and major vessels.