Assessment of Echocardiographically Detected Congenital Cardiac Malformations: Is there a Role for Fetal Magnetic Resonance Imaging?

Purpose

To report our preliminary experience with fetal MRI in evaluation of fetal congenital cardiac malformations

Materials and methods

15 fetuses with US-diagnosed congenital cardiac malformations performed 15 obstetric MRI examinations. Multiplanar T2w HASTE, trueFISP and CineMR sequences of the fetal heart oriented like standard echocardiographic projections were acquired.

Results

In all cases MRI imaged the pathologic fetal heart. Fetal MRI confirmed an increased heart size in all the cardiomegalies (9); an abnormal ventricular septum angulations to the midline in all apex malpositions (4) and assessed the absence of the ventricular septum at midcavity in 4/5 interventricular defects (IVD); the hypertrophy of the right ventricle in 9 cases with an associated increase of the thickness of the ventricular wall in 5; the hypertrophy of the right atrium size (8) with an associated increase of IVC (3) or ductus arteriosus size (1) and pericardial effusion (1); a persistent left SVC (1); lung hypoplasia (3). A trilocular biventricular heart with an associated left ventricle hypoplasia was detected in 1, while in 2 US-detected interatrial defects the oval foramina were missed. In 3 tetralogies of Fallot (1 with a balanced atrioventricular canal) the subaortic ventricular septal defect, the aortic origin positioned to override both the ventricles and the right ventricular hypertrophy were detected. In one fetus a truncus arteriosus was confirmed and in another fetus with tuberous sclerosis 3 hypointense intraventricular and valvular masses were demonstrated and some analogous subependimal brain lesions were revealed.

Conclusion

Our experience demonstrates that MRI is a potential second-level tool to add to fetal echocardiography in the prenatal diagnosis of complex congenital cardiac malformations.

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Pathological Fetal heart - congenital heart disease - fetal MRI - fetal echocardiography