Functional cardiac MRI in preterm and term newborns

Alan M Groves, Gaia Chiesa, Giuliana Durighel, Stephen T Goldring, Julie A Fitzpatrick, Sergio Uribe, Reza Razavi, Jo V Hajnal, A David Edwards, Alan M Groves, Gaia Chiesa, Giuliana Durighel, Stephen T Goldring, Julie A Fitzpatrick, Sergio Uribe, Reza Razavi, Jo V Hajnal, A David Edwards

Abstract

Objective: To use cardiac MRI techniques to assess ventricular function and systemic perfusion in preterm and term newborns, to compare techniques to echocardiographic methods, and to obtain initial reference data.

Design: Observational magnetic resonance and echocardiographic imaging study.

Setting: Neonatal Unit, Queen Charlotte's and Chelsea Hospital, London, UK. Patients 108 newborn infants with median birth weight 1627 (580-4140) g, gestation 32 (25-42) weeks.

Results: Mean (SD) flow volumes assessed by phase contrast (PC) imaging in 28 stable infants were left ventricular output (LVO) 222 (46), right ventricular output (RVO) 219 (47), superior vena cava (SVC) 95 (27) and descending aorta (DAo) 126 (32) ml/kg/min, with flow being higher at lower gestational age. Limits of agreement for repeated PC assessment of flow were LVO ±50.2, RVO ±55.5, SVC ±20.9 and DAo ±26.2 ml/kg/min. Mean (SD) LVO in 75 stable infants from three-dimensional models were 245 (47) ml/kg/min, with limits of agreement ±58.3 ml/kg/min. Limits of agreement for repeated echocardiographic assessment of LVO were ±108.9 ml/kg/min.

Conclusions: Detailed magnetic resonance assessments of cardiac function and systemic perfusion are feasible in newborn infants, and provide more complete data with greater reproducibility than existing echocardiographic methods. Functional cardiac MRI could prove to be a useful research technique to study small numbers of newborn infants in specialist centres; providing insights into the pathophysiology of circulatory failure; acting as an outcome measure in clinical trials of inotropic intervention and so guiding clinical practice in the wider neonatal community.

Conflict of interest statement

Competing interests RR, JVH and ADE receive investigator-led research support from Philips.

Figures

Figure 1
Figure 1
Four chamber (A) and short axis (B) views obtained with balanced fast field echo sequences in a newborn infant (view also video links at http://adc.bmj.com).
Figure 2
Figure 2
Regression plot of external validation of phase contrast flow quantification versus flow phantom. Line of unity shown.
Figure 3
Figure 3
Normal ranges by corrected gestational age at scan for phase contrast assessment of left ventricular output (A), right ventricular output (B), superior vena caval flow (C) and descending aortic flow (D).
Figure 4
Figure 4
Bland-Altman plots of scan-rescan repeatability of assessment of left ventricular output performed by phase contrast (A) and cine (B) imaging, and of comparison of phase contrast and echo measures of left ventricular output (C).
Figure 5
Figure 5
Normal ranges by corrected gestational age at scan for bFFE assessment of left ventricular output (A), end-diastolic volume (B), end-systolic volume (C) and ejection fraction (D).

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