Journal Article

Quantification of blood flow in the fetus with cardiovascular magnetic resonance imaging using Doppler ultrasound gating: validation against metric optimized gating

Hedström, Erik, Ryd, Daniel, Macgowan, Christopher K., Ruprecht, Christian, Arheden, Håkan, Kording, Fabian, Seed, Michael, Sun, Liqun, Steding-Ehrenborg, Katarina, Aletras, Anthony H., Bidhult, Sebastian

2019

Overview

Introduction Fetal cardiovascular magnetic resonance (CMR) imaging is used clinically and for research, but has been previously limited due to lack of direct gating methods. A CMR-compatible Doppler ultrasound (DUS) gating device has resolved this. However, the DUS-gating method is not validated against the current reference method for fetal phase-contrast blood flow measurements, metric optimized gating (MOG). Further, we investigated how different methods for vessel delineation affect flow volumes and observer variability in fetal flow acquisitions. Aims To 1) validate DUS gating versus MOG for quantifying fetal blood flow; 2) assess repeatability of DUS gating; 3) assess impact of region of interest (ROI) size on flow volume; and 4) compare time-resolved and static delineations for flow volume and observer variability. Methods Phase-contrast CMR was acquired in the fetal descending aorta (DAo) and umbilical vein by DUS gating and MOG in 22 women with singleton pregnancy in gestational week 36 0 (26 5 –40 0 ) with repeated scans in six fetuses. Impact of ROI size on measured flow was assessed for ROI:s 50–150% of the vessel diameter. Four observers from two centers provided time-resolved and static delineations. Bland-Altman analysis was used to determine agreement between both observers and methods. Results DAo flow was 726 (348–1130) ml/min and umbilical vein flow 366 (150–782) ml/min by DUS gating. Bias±SD for DUS-gating versus MOG were − 45 ± 122 ml/min (−6 ± 15%) for DAo and 19 ± 136 ml/min (2 ± 24%) for umbilical vein flow. Repeated flow measurements in the same fetus showed similar volumes (median CoV = 11% (DAo) and 23% (umbilical vein)). Region of interest 50–150% of vessel diameter yielded flow 35–120%. Bias±SD for time-resolved versus static DUS-gated flow was 33 ± 39 ml/min (4 ± 6%) for DAo and 11 ± 84 ml/min (2 ± 15%) for umbilical vein flow. Conclusions Quantification of blood flow in the fetal DAo and umbilical vein using DUS-gated phase-contrast CMR is feasible and agrees with the current reference method. Repeatability was generally high for CMR fetal blood flow assessment. An ROI similar to the vessel area or slightly larger is recommended. A static ROI is sufficient for fetal flow quantification using currently available CMR sequences.

• Publisher: BioMed Central,BioMed Central Ltd,Elsevier
• Subject: Abdomen / Adult / Angiology / Aorta / Aorta, Thoracic - diagnostic imaging / Aorta, Thoracic - physiology / Bias / Blood flow / Blood Flow Velocity / Blood vessels / Cardiology / Cardiovascular magnetic resonance imaging / Clinical Medicine / Coronary vessels / Diagnostic imaging / Diameters / Doppler effect / Doppler ultrasound gating / Engineering and Technology / Female / Fetal blood flow / Fetuses / Gating / Gestational Age / Heart rate / Humans / Image processing / Imaging / Klinisk medicin / Magnetic Resonance Imaging / Medical and Health Sciences / Medical Engineering / Medical Laboratory Technologies / Medicin och hälsovetenskap / Medicine & Public Health / Medicinsk laboratorieteknik / Medicinteknik / Methods / Metric optimized gating / Observer Variation / Observers / Oligodendrocyte-myelin glycoprotein / Ontario / Physiology / Predictive Value of Tests / Pregnancy / Pregnant women / Radiologi och bildbehandling / Radiology / Radiology and Medical Imaging / Regional Blood Flow / Reproducibility / Reproducibility of Results / Scanners / Sweden / Teknik / Ultrasonic imaging / Ultrasonography, Doppler / Ultrasonography, Prenatal / Ultrasound / Umbilical vein / Umbilical Veins - diagnostic imaging / Umbilical Veins - physiology / Veins / Veins & arteries