MR imaging of fetal cardiac malposition and congenital cardiovascular anomalies on the four-chamber view
© The Author(s) 2016
Received: 13 June 2016
Accepted: 14 July 2016
Published: 29 July 2016
Fetal echocardiography is the method of choice to visualize the fetal congenital cardiovascular anomalies. However, there are some disadvantages. Fetal cardiac magnetic resonance imaging (MRI) has the potential to complement ultrasound in detecting congenital cardiovascular anomalies. This pictorial review draws on our experience about fetal cardiac MRI; it describes the four-chamber view on fetal cardiac MRI and important clues on an abnormal four-chamber view to the diagnosis of fetal congenital cardiovascular anomalies.
Abnormalities of the cardiovascular system are the most common congenital diseases in the fetus and the first cause of infant mortality (Johnson et al. 2014). Without a doubt, Echocardiography is the method of choice to visualize the fetal cardiac cardiovascular abnormalities.
Unlike fetal echocardiography imaging, cardiovascular magnetic resonance (CMR) is relatively unaffected by maternal and fetal conditions such as maternal obesity, uterine myoma, twins, oligohydramnios, fetal position and rib calcification, which particularly impair sonographic visualization of the fetal heart (Donofrio et al. 2014; Wielandner et al. 2013). Fetal CMR imaging has the potential to complement ultrasound in detecting cardiovascular malformations and extracardiac anomalies (Donofrio et al. 2014; Wielandner et al. 2013; Manganaro et al. 2014; Dong et al. 2013).
Cardiac positional anomalies
Cardiac and ventricle size anomalies
Fetal cardiac size anomalies also are very important and should be secondly assessed. The cardiac size relative to the thorax may be evaluated from four-chamber view CMR images. Cardiac malformations associated with cardiomegaly and/or different sizes of the cardiac chambers are also easily recognized on four-chamber view of fetal CMR.
Cardiac septum defects
Cardiac tumor and other malformations
The four-chamber view images on fetal CMR can identify cardiac malposition, cardiac malformations associated with cardiomegaly, different sizes of the cardiac chambers, large cardiac septum defects, cardiac tumors and others. Although certain fetal heart abnormalities will not be consistently identified such as small ventricular septum defect and valvular stenosis, the four-chamber view on fetal CMR still can provide some diagnostic information for fetal heart anomalies.
SZD acquired the fetal MR and echocardiography data and drafted the manuscript. MZ provided guidance and was involved with editing the final manuscript. Both authors read and approved the final manuscript.
This work was supported by three funds from National Natural Science Foundation of China (30970795, 81101032 and 81571628).
The authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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