Advanced Fetal MRI techniques: assessment of fetal cardiovascular anatomy disturbances in children with congenital heart disease

Congenital heart disease (CHD) is the most common of all major congenital
anomalies and affects around 9 out of 1000 live births. Mortality rates have
been reduced, but CHD is still the second most frequent cause of neonatal
death2. Fetal echocardiography has significantly improved antenatal diagnosis
of CHD, but limitations remain. Discordance between pre- and postnatal
diagnosis of CHD has been described, with impact on neonatal management.
Especially vascular anomalies such as coarctation of the aorta, have proven to
be difficult to detect and predict by fetal echocardiography. Therefore, there
is a clinical need for a complementary imaging modality to further improve the
current fetal diagnostic work-up of CHD, for which recently developed fetal
cardiovascular magnetic resonance imaging (CMR) may be suited.

Hypothesis: Fetal CMR may improve the diagnostic accuracy of prenatal diagnosis
of CHD when compared to fetal echocardiography in The Netherlands.

The primary research objective is to assess the feasibility of fetal CMR in all
academic centers in The Netherlands.
The second research objective of the study is to investigate the diagnostic
capacity of fetal CMR for aortic and pulmonary CHD and the additive value to
fetal echocardiography (at gestational age 20-24 weeks and 30-34 weeks) for
correct antenatal diagnosis of CHD.

Prospective cohort study of expectant mothers of fetuses with significant
aortic and/or pulmonary CHD undergoing fetal CMR and fetal echocardiographic
evaluation.

The burden for both the mother and the fetus is the experience of undergoing
fetal CMR,. Fetal CMR can be performed within 30/45 minutes of scan time, which
can be difficult for a mother in her third trimester of pregnancy. Therefore,
specific attention will be paid to the mother*s condition, as she will be
positioned in a comfortable position and with left lateral tilt, to prevent
vena cava inferior syndrome, and hearing protection will be offered. Fetal MRI
for other purposes such as fetal brain imaging is performed in most
participating institutions, which facilitates the introduction of fetal CMR.
Current experimental and clinical evidence indicates that there are no adverse
biological effects for pregnant women, fetuses and neonates from the use of
CMR14,15. MRI vendor differences between the participating institutions
(Philips, Siemens and General Electric) will be overcome by support of our two
study MRI physicists and by an international scientific advisory committee with
ample experience in fetal CMR. The post-processing techniques are considered to
be generic and applicable/compatible to all available MRI systems in the
participating centers.