Quick Fire Cases
Priyanka Devaguptapu, BSc
Medical Student
University of Florida
Jennifer Co-Vu, MD
Associate Professor, Director, Fetal Cardiac Program, Single Ventricle Program
University of Florida
In this series, we present three cases in which fetal cardiac MRI (CMR) was used with the goal of providing a more accurate diagnosis to patients with complex congenital anomalies including concerns for congenital disease.
Patient 1 was a 38-year-old with monozygotic twins, with possible fetal coarctation of the aorta and duodenal atresia in twin A.
Patient 2 was a 23-year-old with fetal Trisomy 21, with concern for Dandy-Walker malformation and AV canal.
Patient 3 was a 33-year-old with concerns for agenesis of the corpus callosum and suggestive of a possible perimembranous ventricular septal defect in the fetus.
Diagnostic Techniques and Their Most Important Findings:
Fetal MRI and CMR was done using Siemens 1.5T Magnetom (Erlangen, Germany) involved integrating Northh Smart-Sync software (Hamburg, Germany), which utilizes Doppler ultrasound to detect the patient's heartbeat. This works as a gating signal, improving image quality by compensating for motion.
Patient 1 underwent fetal MRI at 33 weeks gestation. Twin A on fetal CMR has coarctation of the aorta and severe distention of the stomach and proximal duodenum. Twin B has normal intracardiac anatomy.
Patient 2 underwent fetal MRI at 32 weeks gestation. Fetal CMR showed balanced AV canal defect with mild right atrial dilatation and neurological findings as follows: mild vermian hypoplasia with mega cisterna magna and no vermian rotation.
Patient 3 underwent fetal MRI at 30 weeks gestation which demonstrated agenesis of the corpus callosum, with symmetric prominence of the lateral ventricular atria and occipital horns compatible with colpocephaly. Fetal CMR noted normal intracardiac anatomy.
Learning Points from this Case:
The cases discussed demonstrate the feasibility of utilizing fetal CMR as an adjunct to more traditionally utilized imaging modalities such as fetal echocardiography especially in fetuses with complex congenital anomalies requiring fetal MRI. Our current process involves referring patients with multiple congenital lesions, already requiring fetal MRI, to also include a dedicated cardiac sequence with good images. This potentially expands the use of fetal CMR for patients with poor acoustic windows on ultrasound in the future.
