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 three‐plane localiser, fetal movement was assessed with a balanced steady‐state free precession (bSSFP) cine. Single‐shot fast spin echo and bSSFP sequences were used for diagnostic imaging. Results: Twenty‐two fetal cardiac MRIs were performed over 12 months, at mean gestation of 32 weeks (26–38 weeks). The majority of referrals were for suspected vascular abnormalities (17/22), particularly involving the aortic arch (n = 10) and pulmonary vessels (n = 4). Single‐shot fast spin echo sequences produced ‘black‐blood’ images, useful for examining the extracardiac vasculature in these cases. BSSFP sequences were more useful for intracardiac structures. Real‐time 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

Why do women seek ultrasound scans from commercial providers during pregnancy?

The commercial availability of ultrasound scans for pregnant women has been controversial yet little is known about why women make use of such services. This article reports on semi-structured interviews with women in the UK who have booked a commercial scan, focusing on the reasons women gave for booking commercially provided ultrasound during a low-risk pregnancy. Participants’ reasons for booking a scan are presented in five categories: finding out the sex of the foetus; reassurance; seeing the baby; acquiring keepsakes and facilitating bonding. Our analysis demonstrates that women's reasons for booking commercial scans are often multiple and are shaped by experiences of antenatal care as well as powerful cultural discourses related to ‘good’ parenting and the use of technology in pregnancy. Sociological and public debate about the availability of commercial ultrasound and its social and personal impacts should consider the wider sociocultural context that structures women's choices to make use of such services

Can we improve outcome of congenital diaphragmatic hernia?

This review gives an overview of the disease spectrum of congenital diaphragmatic hernia (CDH). Etiological factors, prenatal predictors of survival, new treatment strategies and long-term morbidity are described. Early recognition of problems and improvement of treatment strategies in CDH patients may increase survival and prevent secondary morbidity. Multidisciplinary healthcare is necessary to improve healthcare for CDH patients. Absence of international therapy guidelines, lack of evidence of many therapeutic modalities and the relative low number of CDH patients calls for cooperation between centers with an expertise in the treatment of CDH patients. The international CDH Euro-Consortium is an example of such a collaborative network, which enhances exchange of knowledge, future research and development of treatment protocols

Intérêt pronostic [sic] de la mesure du volume pulmonaire foetal par IRM [Imagerie par Résonance Magnétique] dans la hernie diaphragmatique congénitale

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Site internet dédié à l'enseignement de l'imagerie en coupes des cardiopathies congénitales

Les cardiopathies congénitales sont des anomalies rares. Les données épidémiologiques actuelles retrouvent une prévalence de 8/1000 naissances toutes cardiopathies confondues. La détection de malformations cardiaques en période anténatale a un impact primordial sur la prise en charge néonatale de ces enfants. Parallèlement, les progrès de la chirurgie cardiaque, l amélioration des techniques de circulation extra-corporelle ainsi que de réanimation pédiatrique, ont permis de traiter des pathologies jusque là létales à plus ou moins court terme. Aujourd hui, beaucoup d enfants nés avec une malformation cardiaque atteignent l âge adulte et ce dans des conditions de vie satisfaisante. Dans les années 80, on a assisté à une révolution radiologique , avec l apparition de scanner multi-barrettes, permettant des acquisitions hélicoïdales et de l IRM. Rapidement, ces techniques sont devenues un moyen robuste d exploration des cardiopathies congénitales. Le radiologue non interventionnel, qui initialement n'était pas directement impliqué dans la prise en charge et le suivi de ces patients, prend alors une place importante au sein de l équipe médico-chirurgicale. Il convient pour cela d être formé, non seulement aux techniques d imagerie cardiaque en coupes mais également d avoir une connaissance précise de l anatomie, de la physiopathologie et des techniques chirurgicales de chaque cardiopathie. Il est admis de tous qu internet est un outil de partage et d enseignement exceptionnel de nos jours. Ce travail a donc consisté en la réalisation d un site internet axé sur l imagerie en coupes des cardiopathies congénitales. Il a pour but de permettre à toutes personnes du corps médical, confronté à ce type de pathologie, d avoir une vision d ensemble de la pathologie ainsi que des différentes modalités d examen utile pour chaque cardiopathie et ce qu ils peuvent en attendre.Congenital heart defects are rare. Current epidemiological data found a prevalence of 8/1000 births, all defects confused. Detection of cardiac malformations in the antenatal period has a crucial impact on neonatal care of these children. Meanwhile, advances in cardiac surgery and improved techniques for both cardiopulmonary bypass and pediatric reanimation, lead to better care for conditions that were letal in a more or less short interval. Today, many children born with heart defects grow to adulthood in satisfactory living conditions. In the 80's, there has been a "radiological revolution " with the advent of both multidetector-row CT-scanner, allowing helical acquisitions, and MRI. Quickly, these techniques have become a robust mean of exploration of congenital heart diseases. The non-interventionist radiologist, who initially was not directly involved in the management and monitoring of these patients, now plays an important role in the medico-surgical team. This requires to be trained, not only to cross sectional cardiac imaging but also to have a precise knowledge of the anatomy, physiology and surgical techniques of each congenital heart disease (CHD). It is admitted by all that the Internet is a fantastic tool for sharing and teaching nowadays. This work consisted in the creation of a website focused on cross sectional imaging of congenital heart diseases. It aims to enable all people in the medical profession, faced with this type of pathology, to have an overview of the disease and the different examination procedures useful for each CHD and what they can obtain from them.AMIENS-BU Santé (800212102) / SudocSudocFranceF