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An exploration of the potential utility of fetal cardiovascular MRI as an adjunct to fetal echocardiography
Objectives: Fetal cardiovascular magnetic resonance imaging (MRI) offers a potential alternative to echocardiography, although in practice, its use has been limited. We sought to explore the need for additional imaging in a tertiary fetal cardiology unit and the usefulness of standard MRI sequences.
Methods: Cases where the diagnosis was not fully resolved using echocardiography were referred for MRI. Following a threeâplane localiser, fetal movement was assessed with a balanced steadyâstate free precession (bSSFP) cine. Singleâshot fast spin echo and bSSFP sequences were used for diagnostic imaging.
Results: Twentyâtwo fetal cardiac MRIs were performed over 12âmonths, at mean gestation of 32âweeks (26â38âweeks). The majority of referrals were for suspected vascular abnormalities (17/22), particularly involving the aortic arch (nâ=â10) and pulmonary vessels (nâ=â4). Singleâshot fast spin echo sequences produced âblackâbloodâ images, useful for examining the extracardiac vasculature in these cases. BSSFP sequences were more useful for intracardiac structures. Realâtime SSFP allowed for dynamic assessment of structures such as cardiac masses, with enhancement patterns also allowing for tissue characterisation in these cases.
Conclusions: Fetal vascular abnormalities such as coarctation can be difficult to diagnose by using ultrasound. Fetal MRI may have an adjunctive role in the evaluation of the extracardiac vascular anatomy and tissue characterisation. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd
Fetal functional imaging portrays heterogeneous development of emerging human brain networks
The functional connectivity architecture of the adult human brain enables complex cognitive processes, and exhibits a remarkably complex structure shared across individuals. We are only beginning to understand its heterogeneous structure, ranging from a strongly hierarchical organization in sensorimotor areas to widely distributed networks in areas such as the parieto-frontal cortex. Our study relied on the functional magnetic resonance imaging (fMRI) data of 32 fetuses with no detectable morphological abnormalities. After adapting functional magnetic resonance acquisition, motion correction, and nuisance signal reduction procedures of resting-state functional data analysis to fetuses, we extracted neural activity information for major cortical and subcortical structures. Resting fMRI networks were observed for increasing regional functional connectivity from 21st to 38th gestational weeks (GWs) with a network-based statistical inference approach. The overall connectivity network, short range, and interhemispheric connections showed sigmoid expansion curve peaking at the 26â29 GW. In contrast, long-range connections exhibited linear increase with no periods of peaking development. Region-specific increase of functional signal synchrony followed a sequence of occipital (peak: 24.8 GW), temporal (peak: 26 GW), frontal (peak: 26.4 GW), and parietal expansion (peak: 27.5 GW). We successfully adapted functional neuroimaging and image post-processing approaches to correlate macroscopical scale activations in the fetal brain with gestational age. This in vivo study reflects the fact that the mid-fetal period hosts events that cause the architecture of the brain circuitry to mature, which presumably manifests in increasing strength of intra- and interhemispheric functional macro connectivity.Seventh Framework Programme (European Commission) (KHRESMOI Project
Combined Diffusion-Relaxometry MRI to Identify Dysfunction in the Human Placenta
Purpose: A combined diffusion-relaxometry MR acquisition and analysis
pipeline for in-vivo human placenta, which allows for exploration of coupling
between T2* and apparent diffusion coefficient (ADC) measurements in a sub 10
minute scan time.
Methods: We present a novel acquisition combining a diffusion prepared
spin-echo with subsequent gradient echoes. The placentas of 17 pregnant women
were scanned in-vivo, including both healthy controls and participants with
various pregnancy complications. We estimate the joint T2*-ADC spectra using an
inverse Laplace transform.
Results: T2*-ADC spectra demonstrate clear quantitative separation between
normal and dysfunctional placentas.
Conclusions: Combined T2*-diffusivity MRI is promising for assessing fetal
and maternal health during pregnancy. The T2*-ADC spectrum potentially provides
additional information on tissue microstructure, compared to measuring these
two contrasts separately. The presented method is immediately applicable to the
study of other organs
Using an Internal Auditory Stimulus to Activate the Developing Primary Auditory Cortex: A Fetal fMRI Study
Insight into the rapidly developing brain in utero is scarce. Fetal functional magnetic resonance imaging (fMRI) is a technique used to gain awareness into the developmental process. Previous auditory task-based fMRI studies employed an external sound stimulus directly on the maternal abdomen. However, there has since been recommendation to cease doing so. We sought to investigate a reliable paradigm to study the development of fetal brain networks and postulate that by using an internal stimulus, such as the mother singing, it would result in activation of the fetal primary auditory cortex. Volunteers carrying singleton fetuses with a gestational age of 33-38 weeks underwent two stimulus-based block design BOLD fMRI series. All of the nine fetal subjects analyzed had activation in the right Heschlâs gyrus, and seven out of the nine fetal subjects had activation in the left Heschlâs gyrus when exposed to the internal acoustic stimulus. Ultimately, this internal auditory stimulus can be used to analyze the developing fetal brain
Magnetic Resonance Imaging of the Brain in Moving Subjects. Application of Fetal, Neonatal and Adult Brain Studies
Imaging in the presence of subject motion has been an ongoing challenge for
magnetic resonance imaging (MRI). Motion makes MRI data inconsistent, causing
artifacts in conventional anatomical imaging as well as invalidating diffusion
tensor imaging (DTI) reconstruction. In this thesis some of the important issues
regarding the acquisition and reconstruction of anatomical and DTI imaging of
moving subjects are addressed; methods to achieve high resolution and high signalto-
noise ratio (SNR) volume data are proposed.
An approach has been developed that uses multiple overlapped dynamic single shot
slice by slice imaging combined with retrospective alignment and data fusion to
produce self consistent 3D volume images under subject motion. We term this
method as snapshot MRI with volume reconstruction or SVR. The SVR method
has been performed successfully for brain studies on subjects that cannot stay still,
and in some cases were moving substantially during scanning. For example, awake
neonates, deliberately moved adults and, especially, on fetuses, for which no
conventional high resolution 3D method is currently available. Fine structure of the
in-utero fetal brain is clearly revealed for the first time with substantially improved
SNR. The SVR method has been extended to correct motion artifacts from
conventional multi-slice sequences when the subject drifts in position during data
acquisition.
Besides anatomical imaging, the SVR method has also been further extended to
DTI reconstruction when there is subject motion. This has been validated
successfully from an adult who was deliberately moving and then applied to inutero
fetal brain imaging, which no conventional high resolution 3D method is
currently available. Excellent fetal brain 3D apparent diffusion coefficient (ADC)
maps in high resolution have been achieved for the first time as well as promising
fractional Anisotropy (FA) maps.
Pilot clinical studies using SVR reconstructed data to study fetal brain development
in-utero have been performed. Growth curves for the normally developing fetal
brain have been devised by the quantification of cerebral and cerebellar volumes as
well as some one dimensional measurements. A Verhulst model is proposed to
describe these growth curves, and this approach has achieved a correlation over
0.99 between the fitted model and actual data
Real-Time Magnetic Resonance Imaging
Realâtime magnetic resonance imaging (RTâMRI) allows for imaging dynamic processes as they occur, without relying on any repetition or synchronization. This is made possible by modern MRI technology such as fastâswitching gradients and parallel imaging. It is compatible with many (but not all) MRI sequences, including spoiled gradient echo, balanced steadyâstate free precession, and singleâshot rapid acquisition with relaxation enhancement. RTâMRI has earned an important role in both diagnostic imaging and image guidance of invasive procedures. Its unique diagnostic value is prominent in areas of the body that undergo substantial and often irregular motion, such as the heart, gastrointestinal system, upper airway vocal tract, and joints. Its value in interventional procedure guidance is prominent for procedures that require multiple forms of softâtissue contrast, as well as flow information. In this review, we discuss the history of RTâMRI, fundamental tradeoffs, enabling technology, established applications, and current trends
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