Congenital heart disease (CHD) is the most common congenital defect affecting eight per thousand live births in North America. Prenatal diagnosis of CHD allows for improved and better informed decisions on patient management before and after birth. In current clinical practices, an ultrasound examination of the anatomy and function of the heart as well as the blood flow through the valves and great vessels is usually used for diagnosis of CHD. However, the use of ultrasound is limited in certain patients due to various reasons. In these cases, fetal cardiac MRI is a promising alternative imaging modality due to its excellent soft tissue contrast and lack of radiation exposure. Advances in cardiac MRI technology in the last two decades have enabled more widespread use of cardiac MRI in the clinical setting. However, the use of MRI for fetal cardiac imaging remains in its infancy due to various reasons. Aside from the more stringent requirement on spatial resolution for fetal imaging, a major impediment is lack of a robust cardiac motion gating technology. In cardiac MRI, the image acquisition is typically synchronized to the cardiac cycle using either an electrocardiogram (ECG) or peripheral pulse signal to minimize the artifacts and image blurring resulting from cardiac motion or to obtain a cardiac phase resolved image. However, these signals are simply not available for fetal MRI. Therefore, a robust cardiac gating strategy is needed for fetal cardiac MRI to be used clinically. The overall goal of this project is to develop techniques that can reliably provide a cardiac motion self- gating signal for use in fetal cardiac MRI. In this project, we propose several technical innovations that can be used routinely to obtain reliable fetal cardiac self-gating signal. The developed strategies will then be evaluated on a cohort of pregnant women who are referred to fetal ultrasound for suspected congenital heart disease.

Public Health Relevance

Congenital heart disease (CHD) is the most common congenital defect affecting eight per thousand live births in the U.S. However, fetal ultrasound, as the current clinical standard practice for diagnosis of CHD, is inadequate in certain patients. The proposed project aims at developing novel cardiac self-gating technologies to enable clinical fetal cardiac MRI as a valuable complimentary modality to ultrasound.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-SBIB-V (82))
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Evans, Frank
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University of California Los Angeles
Schools of Medicine
Los Angeles
United States
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Rapacchi, Stanislas; Han, Fei; Natsuaki, Yutaka et al. (2014) High spatial and temporal resolution dynamic contrast-enhanced magnetic resonance angiography using compressed sensing with magnitude image subtraction. Magn Reson Med 71:1771-83