Bhat Misha, Haris Kostas, Bidhult Sebastian, Liuba Petru, Aletras Anthony H, Hedström Erik
Pediatric Cardiac Center, Skåne University Hospital and Lund University, Lund, Sweden.
Laboratory of Computing, Medical Informatics and Biomedical - Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Clin Physiol Funct Imaging. 2019 Jul;39(4):231-235. doi: 10.1111/cpf.12566. Epub 2019 Mar 8.
Limited visualization of the fetal heart and vessels by fetal ultrasound due to suboptimal fetal position, patient habitus and skeletal calcification may lead to missed diagnosis, overdiagnosis and parental uncertainty. Counselling and delivery planning may in those cases also be tentative. The recent fetal cardiac magnetic resonance (CMR) reconstruction method utilizing tiny golden-angle iGRASP (iterative Golden-angle RAdial Sparse Parallel MRI) allows for cine imaging of the fetal heart for use in clinical practice. This case describes an unbalanced common atrioventricular canal where limited ultrasound image quality and visibility of the aortic arch precluded confirming or ruling out presence of a ventricular septal defect. Need of prostaglandins or neonatal intervention was thus uncertain. Cardiovascular magnetic resonance imaging confirmed ultrasound findings and added value by ruling out a significant ventricular septal defect and diagnosing arch hypoplasia. This confirmed the need of patient relocation for delivery at a paediatric cardiothoracic surgery centre and prostaglandins could be initiated before the standard postnatal ultrasound. The applied CMR method can thus improve diagnosis of complicated fetal cardiac malformation and has direct clinical impact.
由于胎儿位置欠佳、孕妇体型及骨骼钙化等原因，胎儿超声对胎儿心脏和血管的可视化有限，这可能导致漏诊、过度诊断以及准父母的疑虑。在这些情况下，咨询和分娩计划也可能具有试探性。最近利用微小黄金角iGRASP（迭代黄金角径向稀疏并行磁共振成像）的胎儿心脏磁共振（CMR）重建方法，可用于临床实践中对胎儿心脏进行电影成像。本病例描述了一例不平衡型完全性房室通道，超声图像质量有限且主动脉弓可视性不佳，无法确定或排除室间隔缺损的存在。因此，是否需要使用前列腺素或进行新生儿干预尚不确定。心血管磁共振成像证实了超声检查结果，并通过排除显著的室间隔缺损和诊断主动脉弓发育不全增加了诊断价值。这确定了需要将患者转运至小儿心胸外科中心进行分娩，并且可以在产后标准超声检查之前开始使用前列腺素。因此，所应用的CMR方法可改善对复杂胎儿心脏畸形的诊断，并具有直接的临床影响。
