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Feasibility of MRI of the Fetal Heart with Balanced Steady-State Free Precession Sequence Along Fetal Body and Cardiac Planes

¹ Department of Radiology, Cairo University, Kasr Al-Ainy Hospital, 4 49th St., Cairo 11571, Egypt.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —26-week-old fetus with family history of congenital heart disease. Sequential axial MR images were obtained in the inferior-to-superior direction. Sequential axial steady-state free precession (SSFP) MR image at level of four cardiac chambers. Interventricular septum (white arrowhead) is central, intact, and makes angle of approximately 45° with imaginary line bisecting spine and anterior chest wall. Right ventricle is behind sternum (short white arrow) and nearly equal in size to left ventricle (long white arrow). Atria (black arrowheads) are equal in size.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —26-week-old fetus with family history of congenital heart disease. Sequential axial MR images were obtained in the inferior-to-superior direction. Sequential axial SSFP MR image at level of left ventricular outflow tract shows left ventricle (long white arrow) and its outflow tract (arrowhead). Right ventricle (short white arrow) and left atrium (black arrow) also are evident.

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —26-week-old fetus with family history of congenital heart disease. Sequential axial MR images were obtained in the inferior-to-superior direction. Sequential axial SSFP MR image at level of right ventricular outflow tract shows bifurcation of main pulmonary artery (long white arrow) at its distal end. Right main bronchus (black arrowhead) is posterior to right pulmonary artery, documenting visceroatrial situs. Ascending aorta (short white arrow), descending aorta (white arrowhead), and superior vena cava (black arrow) also are evident.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —26-week-old fetus with family history of congenital heart disease. Sequential axial MR images were obtained in the inferior-to-superior direction. Sequential axial SSFP MR image in three-vessel view shows aorta (long arrow) winding around trachea (black arrowhead). Left brachiocephalic vein (short arrow) meets right brachiocephalic vein (white arrowhead) to form superior vena cava. Postnatal echocardiography revealed no abnormality.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —27-week-old fetus in woman with history of previous pregnancy with congenital heart disease. Sequential coronal MR images were obtained in anterior-to-posterior direction. Coronal balanced steady-state free precession (SSFP) MR image shows left ventricular outflow tract (black arrowhead). Inflow systemic veins and their tributaries drain to right atrium (long arrow). Brachiocephalic veins (white arrowheads) join to form superior vena cava, and hepatic veins drain to inferior vena cava (short arrow).

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —27-week-old fetus in woman with history of previous pregnancy with congenital heart disease. Sequential coronal MR images were obtained in anterior-to-posterior direction. Coronal balanced SSFP MR image posterior to A shows main pulmonary artery (short white arrow) bifurcation. Black arrowhead points to right pulmonary artery. Aortic arch (long white arrow) gives off three neck vessels (white arrowheads). Presence of stomach (black arrow) on same side of body as cardiac apex indicates normal visceroatrial situs. Postnatal echocardiography and clinical examination revealed no cardiac abnormality.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —23-week-old fetus with history of father with congenital heart disease. Sequential sagittal MR images obtained in right-to-left direction) show systemic inflow veins and connections between ventricles and great vessels. Sagittal steady-state free precession (SSFP) MR image shows superior (long arrow) and inferior (arrowhead) venae cavae draining to right atrium (short arrow).

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —23-week-old fetus with history of father with congenital heart disease. Sequential sagittal MR images obtained in right-to-left direction) show systemic inflow veins and connections between ventricles and great vessels. Sagittal SSFP MR image shows pulmonary artery (short arrow) originating from right ventricle (long arrow). Cusps of pulmonary valve appear faintly (arrowhead).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —23-week-old fetus with history of father with congenital heart disease. Sequential sagittal MR images obtained in right-to-left direction) show systemic inflow veins and connections between ventricles and great vessels. Sagittal SSFP MR image shows left ventricle (long arrow) giving origin to aorta. Ascending aorta (arrowhead), arch, and descending aorta (short arrow) are evident. Postnatal echocardiography and clinical examination revealed no cardiac abnormality.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —25-week-old fetus in with history of maternal rubella infection. Sagittal steady-state free precession image shows right ventricle (short arrow) and its outflow tract (large arrowhead). Low-signal-intensity interventricular septum separates right and left ventricles (long arrow). Origin of left ventricular outflow tract (small arrowhead) is perpendicular to that of right ventricular outflow tract. Postnatal echocardiography and clinical examination revealed no cardiac abnormality.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —26-week-old fetus with history of maternal exposure to possible teratogen (phenytoin). In utero MRI with steady-state free precession (SSFP) along different cardiac axes was feasible. Insets indicate orientation of image plane. SSFP MR image along long axis of cardiac plane shows morphologic features of cardiac chambers. Moderator band (arrow) appears as line of low signal intensity that connects right apical ventricular septum to right ventricular lateral wall. Right and left pulmonary veins (arrowheads) join left atrium.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —26-week-old fetus with history of maternal exposure to possible teratogen (phenytoin). In utero MRI with steady-state free precession (SSFP) along different cardiac axes was feasible. Insets indicate orientation of image plane. SSFP MR images along short-axis cardiac plane from anterior (B) to posterior (C) show connections between ventricles and great vessels. B shows right ventricle (long white arrow) and its outflow tract (arrowhead). Short white arrow (B) points to interventricular septum and black arrow (B) to left ventricle. C shows outflow tract (arrowhead) of left ventricle (arrow).

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —26-week-old fetus with history of maternal exposure to possible teratogen (phenytoin). In utero MRI with steady-state free precession (SSFP) along different cardiac axes was feasible. Insets indicate orientation of image plane. SSFP MR images along short-axis cardiac plane from anterior (B) to posterior (C) show connections between ventricles and great vessels. B shows right ventricle (long white arrow) and its outflow tract (arrowhead). Short white arrow (B) points to interventricular septum and black arrow (B) to left ventricle. C shows outflow tract (arrowhead) of left ventricle (arrow).

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —26-week-old fetus with history of maternal exposure to possible teratogen (phenytoin). In utero MRI with steady-state free precession (SSFP) along different cardiac axes was feasible. Insets indicate orientation of image plane. SSFP MR image in four-chamber view shows morphologic features of cardiac chambers: trabeculated septal wall of right ventricle (long arrow), atrial septal duct valve in left atrium (short arrow), and foramen ovale (arrowhead).

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5E —26-week-old fetus with history of maternal exposure to possible teratogen (phenytoin). In utero MRI with steady-state free precession (SSFP) along different cardiac axes was feasible. Insets indicate orientation of image plane. SSFP MR image in two-chamber view along left side of heart shows ventricle (long arrow), atrium (arrowhead), and location of atrioventricular ring (short arrow). Postnatal echocardiography and clinical examination revealed no cardiac abnormality.

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