Abstract Brain development follows a precisely regulated biological timetable, with defined periods of vulnerability increasingly recognized in congenital disorders affecting early brain development. This biological timing can be captured by the emerging concept of brain age, a measure of brain maturation, enabling the detection of deviation from normative developmental trajectories. Clinical conditions affect the degree of brain development during this critical period, including preterm birth and congenital heart disease (CHD). We developed a deep learning-based brain age estimation framework across the fetal–neonatal period (21-44 gestational weeks) to quantify neurodevelopment from structural MRI. Using 1056 scans from six datasets acquired at three centers, Zurich, Shanghai, and the Developing Human Connectome Project, we trained models on normative fetal and neonatal MRI data. Both structural MRI-based and segmentation-derived cortical morphology-based models were implemented to assess representation effects and cross-center generalisability. The framework was applied to two clinically relevant conditions, preterm birth and CHD, to estimate the brain age gap (BAG), defined as the difference between predicted brain age and chronological age. In preterm neonates scanned at term-equivalent age (n=90, 37-44 weeks), BAG was progressively more negative with lower gestational age at birth. Neonates born before 28 weeks showed delays of −0.7 to −0.8 weeks relative to term-born controls. In CHD (n=50, 22-34 weeks), fetal brain age did not differ from center-matched controls and no association with cardiac defect severity was observed. After birth, neonates with CHD (n=110, 37-44 weeks) showed significant (p<0.05) negative BAGs before surgery (-1.3 to -1.8 weeks) and BAGs increased significantly (p<0.05) after surgery (up to -3 weeks in center-specific analyses), indicating a delay in brain maturation from postnatal stage, but not in prenatal stage in CHD patients. These patterns were found across both structural MRI-based models and cortical morphology-based models, despite the need for cross-center calibration to minimize systematic bias. Voxel-based morphometry showed that a larger BAG was associated with regional contraction in deep frontal and peri-Rolandic white matter in preterm neonates, and perioperative spatial shifts in neonates with CHD. Saliency maps converged on deep white matter and periventricular regions, highlighting a potential link between BAG and delayed maturation of rapidly developing projection pathways. These findings may indicate neurodevelopmental delays in preterm birth and a postnatally emerging maturational gap in CHD that increases following cardiac intervention. Despite limited generalisability of our methods, these results support a continuous fetal-neonatal brain age metric as a sensitive marker of global neurological maturational timing.

The purpose of this study was to report our cases of umbilical-portal-systemic venous shunt (UPSVS) and to evaluate the utility of fetal magnetic resonance imaging (MRI) to diagnose this rare anomaly. This retrospective study included the fetuses with umbilical-portal venous system anomalies. All the cases were performed at 1.5 T magnetic resonance unit including the steady-state free precession (SSFP) and single-shot fast spin echo (SSFSE) sequences. We analyzed the abnormal anatomical findings by fetal MRI and compared them with the prenatal ultrasound (US). 15 cases with prenatally diagnosed UPSVS based on MRI or US were enrolled. Eight cases were identified by both MRI and US, including umbilical-systemic shunts (n = 3), ductus venosus-systemic shunt (n = 1), intrahepatic portal-systemic shunts (n = 3) and extrahepatic portal-systemic shunt (n = 1). Six cases were only identified by MRI including intrahepatic portal-systemic shunts (n = 5) and ductus venosus-systemic shunt (n = 1). In the remaining single case, prenatal ultrasound findings were suspicious for an intrahepatic portal-systemic shunt, without corresponding fetal MRI abnormalities. Follow-up data were obtained from thirteen patients. Two cases were lost to follow up. Of the thirteen patients undergoing follow-up, two cases of UPSVS were surgically confirmed. Postnatal imaging failed to identify any abnormalities of portal venous system in nine cases. The rest two cases demonstrated normal development and liver function after birth. Umbilical-portal-systemic venous shunt can be diagnosed prenatally via MRI. Fetal MRI can serve as a valuable adjunct to prenatal US and improve the diagnostic accuracy.

Fetal echocardiography is the preferred imaging method for prenatal diagnosis of congenital cardiovascular anomalies. With the development of rapid magnetic resonance imaging (MRI) and electrocardiographic gating techniques, fetal cardiac MRI has become an adjunct to ultrasound, which can not only detect congenital cardiovascular anomalies, but also quantify fetal cardiovascular structures, cardiac function, and hemodynamics. This article summarizes fetal cardiac MRI sequences, describes normal imaging features, and presents a systematic approach to looking for MRI appearances of various congenital heart diseases in fetuses based on our experience.

Fetal intracranial tumors are rare, accounting for approximately 0.5%–1.9% of all pediatric tumors, though the true incidence may be underestimated. These tumors often present with distinct histopathological features, imaging characteristics, and clinical behavior compared to their postnatal counterparts. This review summarizes the current understanding of the prenatal diagnosis and characterization of fetal brain tumors, with a particular focus on the role of fetal magnetic resonance imaging (MRI). We discuss the advantages of advanced MR sequences in enhancing lesion detection and anatomical delineation following suspicious findings on obstetric ultrasound. Common tumor types encountered in utero—including teratomas, astrocytomas, medulloblastomas, choroid plexus papillomas, and craniopharyngiomas—are reviewed in terms of imaging features, differential diagnosis, and clinical implications. Furthermore, the review addresses the diagnostic challenges, prognostic considerations, and the potential role of fetal MRI in guiding perinatal management and parental counseling.

Purpose To assess the predictive effect of measuring fetal brain volume based on voxel-based morphometric analysis on fetal brain development in fetuses with mild to moderate isolated lateral ventriculomegaly. Methods This retrospective study included fetuses that underwent magnetic resonance imaging at our institution between January 2020 and December 2024. The subjects include a case group consisting of fetuses with isolated mild-to-moderate ventriculomegaly and a control group consisting of healthy fetuses matched for gestational age. Statistical analysis was performed to compare quantitative volumes of fetal gray matter, white matter, and cerebrospinal fluid between a cohort of fetuses with isolated lateral ventriculomegaly and a normal control cohort, using an independent-samples t-test. The voxel-based morphometric analysis was applied to assess gray matter differences between the two groups. Result Compared to the control group, the fetuses with mild to moderate isolated lateral ventriculomegaly exhibited a significantly increased cerebrospinal fluid volume and a significantly decreased white matter volume. voxel-based morphometric analysis revealed that compared with the normal control group, fetuses with ventriculomegaly exhibited significant gray matter volume reductions in widespread cortical regions, including the frontal, parietal, temporal, and occipital lobes, and the insula. Conclusion The voxel-based morphometry is useful in assessing local regional differences in the brain parenchyma of fetuses with isolated mild to moderate lateral ventriculomegaly.

Objective·To analyze the neurodevelopmental outcomes of children after end-to-side anastomosis for coarctation of the aorta (CoA).Methods·The surgical and neurological follow-up data were collected from children who underwent end-to-side anastomosis for CoA at Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 1, 2017 to December 31, 2021. Neurological assessments included magnetic resonance imaging (MRI) and Griffiths Mental Development Scale assessments. Neurodevelopmental outcomes were evaluated using Griffiths Mental Development Scale. Clinical characteristics were compared between patients with normal and abnormal MRI and Griffiths Mental Development Scale results to assess the correlation between the two assessments and their association with cardiopulmonary bypass (CPB) use and CPB modality.Results·Twenty-seven children with isolated CoA or CoA combined with simple intracardiac anomalies were included. MRI results were available for 25 cases, with 5 showing abnormalities (20.0%). Griffiths Mental Development Scale results were available for 26 cases, with 21 (80.77%) showing abnormal scores, including 18 in hearing and language, and 12 in performance. No significant correlation was found between abnormal MRI or Griffiths Mental Development Scale results and the use of CPB (P=0.341, P=1.000). Among patients who underwent CPB, those in the moderate hypothermia group accounted for the majority of cases without neurological abnormalities, with proportions of 80.00% (MRI) and 100.00% (Griffiths Mental Development Scale).Conclusion·Children undergone end-to-side anastomosis for CoA are at relatively high risk for neurodevelopmental abnormalities, particularly in hearing-language and performance domains. CPB may not be a direct risk factor for poor neurodevelopmental outcome, and moderate hypothermia during CPB may be neuroprotective.

Objective: To enable fast and stable neonatal brain MR imaging by integrating learned neonate-specific subspace model and model-driven deep learning. Methods: Fast data acquisition is critical for neonatal brain MRI, and deep learning has emerged as an effective tool to accelerate existing fast MRI methods by leveraging prior image information. However, deep learning often requires large amounts of training data to ensure stable image reconstruction, which is not currently available for neonatal MRI applications. In this work, we addressed this problem by utilizing a subspace model-assisted deep learning approach. Specifically, we used a subspace model to capture the spatial features of neonatal brain images. The learned neonate-specific subspace was then integrated with a deep network to reconstruct high-quality neonatal brain images from very sparse k-space data. Results: The effectiveness and robustness of the proposed method were validated using both the dHCP dataset and testing data from four independent medical centers, yielding very encouraging results. The stability of the proposed method has been confirmed with different perturbations, all showing remarkably stable reconstruction performance. The flexibility of the learned subspace was also shown when combined with other deep neural networks, yielding improved image reconstruction performance. Conclusion: Fast and stable neonatal brain MR imaging can be achieved using subspace-assisted deep learning with sparse sampling. With further development, the proposed method may improve the practical utility of MRI in neonatal imaging applications.

Background: Different degrees of 'II-weighted (TIW) signal intensities in certain locations on brain magnetic resonance imaging (MRI) are characteristic features of neurological involvement in congenital portosystemic shunt (CPSS). Long-term accumulation of manganese (Mn) as a biomarker can lead to irreversible brain damage. Objectives: The aim of this study was to utilize quantitative brain MRI indicators to characterize brain signal differences in various regions in children with congenital portosystemic shunt. This may contribute to diagnosis, prognosis, and treatment decisions. Patients and Methods: This was a case-control study. Thirty-two patients diagnosed with CPSS based on at least one of the following imaging studies-abdominal ultrasound, Digital Subtraction Angiography (DSA), and Computed Tomography (CT)-and who underwent brain MRI prior to interventional treatment or surgery were included as the Case Group in this study. The age of these patients varied from 22 months to 15 years. Brain MRI of thirty children aged 2 to 15 years, identified without liver or structural diseases, were selected as the Control Group. The brain imaging protocol included an axial spin-echo T1-weighted image (T1WI), an axial T2-weighted image (T2WI), an axial diffusion-weighted imaging (DWI), an axial T2-fluid attenuated inversion recovery (FLAIR) sequence, and a sagittal gradient-echo 3D T1W thin-slice sequence, which can be reconstructed into axial and coronal planes. We utilized quantitative MRI assessment based on the 3D T1-weighted sequence to evaluate intracranial signal differences. The quantitative index was categorized into two types: Globus pallidus-to-frontal subcortical white matter Index (GFI) and anterior pituitary-to-pons Index (API). GFI and API were measured and statistically analyzed on the 3D T1W sequence between the Case Group and the Control Group. GFI of the Case Group was also measured and analyzed between the 3D T1W sequence and the standard T1W sequence. Correlation analysis was applied between the GFI ratios and ammonia levels, as well as between the API ratios and ammonia levels in the Case Group. The duration of the study was more than three months. Results: Significant differences in GFI and API were observed in the Case Group compared with the Control Group (P < 0.01). There was also a statistical difference in GFI between the 3D T1W sequence and the standard T1W sequence (P < 0.01). However, the GFI and API ratios were not correlated with ammonia levels (P > 0.05). The Pearson correlation values were 0.147 and 0.190, respectively. Conclusion: There was a correlation between different brain signals and congenital portosystemic shunt. Quantitative MRI assessment based on the 3D T1-weighted sequence could be used to evaluate these brain signal differences. A longitudinal study with multiple measurements would be beneficial for more accurately assessing such differences, enabling timely interventions, reducing complications, and avoiding lifelong drug therapy.

Background: Different degrees of T1-weighted (T1W) signal intensities in certain locations on brain magnetic resonance imaging (MRI) are characteristic features of neurological involvement in congenital portosystemic shunt (CPSS). Long-term accumulation of manganese (Mn) as a biomarker can lead to irreversible brain damage. Objectives: The aim of this study was to utilize quantitative brain MRI indicators to characterize brain signal differences in various regions in children with congenital portosystemic shunt. This may contribute to diagnosis, prognosis, and treatment decisions. Patients and Methods: This was a case-control study. Thirty-two patients diagnosed with CPSS based on at least one of the following imaging studies—abdominal ultrasound, Digital Subtraction Angiography (DSA), and Computed Tomography (CT)—and who underwent brain MRI prior to interventional treatment or surgery were included as the Case Group in this study. The age of these patients varied from 22 months to 15 years. Brain MRI of thirty children aged 2 to 15 years, identified without liver or structural diseases, were selected as the Control Group. The brain imaging protocol included an axial spin-echo T1-weighted image (T1WI), an axial T2-weighted image (T2WI), an axial diffusion-weighted imaging (DWI), an axial T2-fluid attenuated inversion recovery (FLAIR) sequence, and a sagittal gradient-echo 3D T1W thin-slice sequence, which can be reconstructed into axial and coronal planes. We utilized quantitative MRI assessment based on the 3D T1-weighted sequence to evaluate intracranial signal differences. The quantitative index was categorized into two types: Globus pallidus-to-frontal subcortical white matter Index (GFI) and anterior pituitary-to-pons Index (API). GFI and API were measured and statistically analyzed on the 3D T1W sequence between the Case Group and the Control Group. GFI of the Case Group was also measured and analyzed between the 3D T1W sequence and the standard T1W sequence. Correlation analysis was applied between the GFI ratios and ammonia levels, as well as between the API ratios and ammonia levels in the Case Group. The duration of the study was more than three months. Results: Significant differences in GFI and API were observed in the Case Group compared with the Control Group (P < 0.01). There was also a statistical difference in GFI between the 3D T1W sequence and the standard T1W sequence (P < 0.01). However, the GFI and API ratios were not correlated with ammonia levels (P > 0.05). The Pearson correlation values were 0.147 and 0.190, respectively. Conclusion: There was a correlation between different brain signals and congenital portosystemic shunt. Quantitative MRI assessment based on the 3D T1-weighted sequence could be used to evaluate these brain signal differences. A longitudinal study with multiple measurements would be beneficial for more accurately assessing such differences, enabling timely interventions, reducing complications, and avoiding lifelong drug therapy.

BACKGROUND:Prenatal diagnosis of total anomalous pulmonary venous connection (TAPVC) is challenging, and little is known about how it affects brain development. PURPOSE:To evaluate the utility of fetal MRI to diagnose TAPVC and related brain growth changes. STUDY TYPE:Retrospective case-control study. POPULATION:Twenty-one fetuses (23.0 to 30.8 weeks, mean 26.4 weeks) with pre-natal MRI diagnosis of TAPVC. Post-natal images and surgery were available in 18 fetuses. Brain volumes in TAPVC fetuses were compared with age and sex matched 100 cases of normal controls and 38 fetuses with tetralogy of Fallot (TOF). SEQUENCE:Single shot turbo spin echo sequence for evaluating fetal brain, and steady-state free precession (SSFP) sequence for evaluating fetal cardiovascular structures at 1.5 T. ASSESSMENT:TAPVC type was determined by visualizing the drainage of the common pulmonary vein and dilated coronary sinus: supracardiac, intracardiac and infracardiac. The fetal pulmonary edema was evaluated, and fetal brain volumes were measured using automatic segmentation. STATISTICAL TESTS:One-way analysis of variance and post hoc least square difference tests to evaluate differences in variables between TAPVC, TOF and control groups. A P value <0.05 was considered significant. RESULTS:Of the 21 cases of TAPVC, 10 (47.6%) were identified as supracardiac, 8 (38.1%) as intracardiac, and 3 (14.3%) as infracardiac. Eighteen cases were confirmed by postnatal imaging and surgery; the remaining three cases had no confirmation. Six cases were associated with other cardiovascular abnormalities. Key MRI features of fetal TAPVC included a dilated coronary sinus and vertical vein. Fetal pulmonary edema was seen in six cases. Compared to controls, TAPVC fetuses had lower cerebellum and brainstem volumes and higher e-CSF, while had larger subcortical brain tissue, cerebellum, brainstem, e-CSF, and intracranial cavity volumes than those of TOF cases. DATA CONCLUSION:Fetal MRI may be a useful modality for evaluating fetal TAPVC and altered brain development. EVIDENCE LEVEL:3 TECHNICAL EFFICACY: Stage 3.

ObjectiveThere are differences in the vulnerability of male and female fetal brains to adverse intrauterine exposure, preterm birth, and associated perinatal brain injury. The main objective of this study was to identify any statistically significant difference in the change of apparent diffusion coefficient (ADC) in the intracranial regions of male and female fetuses in the second and third trimesters.MethodsDiffusion-weighted imaging (DWI) was performed in 200 fetuses between 20 and 37 gestational ages (GA) with normal results or suspicious results on sonography followed by structural MRI. Pairwise ADC values of the regions of interest (ROIs) were manually delineated on either side of the cerebral white matter: frontal white matter (FWM), parietal white matter (PWM), occipital white matter (OWM), temporal white matter (TWM), basal ganglia (BG), thalamus (THA), cerebellar hemisphere (CBM), and a single measurement in the pons. The changes in these values were studied over the gestational range, along with potential sex differences and asymmetries of the cerebral hemispheres.ResultsDuring the third trimester, ADC values in OWM, TWM, and CBM were significantly higher in male fetuses than those in female fetuses (p < 0.05). After the correction of false-discovery rates (FDR), the difference in CBM was the only statistically significant (p = 0.0032). However, the decreased rate of ADC values in male fetuses in CWM (except for FWM), BG, THA, CBM, and pons was higher than that in female fetuses during the second and third trimesters.ConclusionsWe have shown some differences in the intracranial regional ADC changes between male and female fetuses using in utero DWI during the second and third trimesters.

Magnetic resonance imaging (MRI) is widely used to provide detailed information regarding fetal brain development in utero. Conventional T1‐and T2‐weighted sequences provide anatomical details of the normal brain and demonstrate brain lesions. In addition to providing highly detailed qualitative assessments of fetal brain development, advanced MRI methods such as three‐dimensional high‐resolution MRI, diffusion MRI, magnetic resonance spectroscopy, and functional MRI can provide quantitative morphologic assessments of tissue microstructure and functional activity. This review aims to describe normal fetal brain development and highlight current state‐of‐the‐art MRI sequences for fetal neuroimaging. We focus on current clinical applications which can provide a better understanding of in utero impairments in fetal brain development.

目的:探讨MRI在胎儿腹壁缺损的产前诊断价值.方法:收集上海儿童医学中心2008-2019年产前MRI确诊并经出生后随访的胎儿腹壁缺损24例,对其MRI表现及特点进行回顾性分析.结果:脐膨出膨出物表面由包膜覆盖,腹裂为全层腹壁缺损,疝出物表面无包膜覆盖.(1)脐膨出13例:膨出物位于脐带下方5例、上方3例、右侧2例,脐带位于膨出物顶部3例;膨出物含肝脏和/或胆囊12例,肠管4例,胃泡5例;合并其他畸形8例.(2)腹裂11例:裂口位于脐带右侧5例,左侧2例,上方3例,下方1例;疝出物含肝脏和/或胆囊4例,肠管10例;合并其他畸形5例.结论:MRI可以诊断胎儿腹壁缺损,提供全面和详细的解剖信息,评估缺陷的程度,帮助临床医师评估预后,并有助于确诊可疑病例.

ObjectiveThis study aimed to report our experience in qualitative and quantitative evaluation of fetal complete vascular ring (CVR) using fetal cardiovascular magnetic resonance imaging (MRI) to improve prenatal diagnosis and make early postnatal management possible.MethodsA retrospective case-control study was performed on cases of CVR diagnosed using fetal cardiovascular MRI, and confirmed by postnatal imaging diagnosis. Associated abnormalities were recorded. The diameters of aortic arch isthmus (AoI) and ductus arteriosus (DA), and tracheal diameters in fetuses with tracheal compression were measured and compared with those of the control group.ResultsAll fetal CVR cases in this study included right aortic arch (RAA) with aberrant left subclavian artery (ALSA) and left DA (n = 93), double aortic arch (DAA) (n = 29), RAA with mirror-image branching and retroesophageal left ductus arteriosus (RLDA) (n = 8). Compared with the control group, the diameters of AoI in fetuses with DAA were decreased (p < 0.001), and the diameters of DA in fetuses with RAA with ALSA and left DA were increased (p < 0.001). The diameters of AoI and DA were positively correlated with gestational age (GA) in the normal control group (both p < 0.001); The diameters of AoI and DA were also positively correlated with GA in RAA with ALSA and left DA subgroup (both p < 0.001) and RAA with mirror-image branching and RLDA subgroup (AoI: p = 0.003; DA: p = 0.002); The diameters of DA were positively associated with GA in DAA subgroup (p < 0.001), however, there was no linear tendency between the diameters of AoI and GA in the DAA subgroup (p = 0.074). There were CVR fetuses with associated intracardiac malformation (n = 13), especially ventricular septal defect rather than complex heart disease, and extracardiac malformation (n = 14). Sixteen fetuses were shown the airway compression whose tracheal diameters were smaller than the normal (p < 0.001).ConclusionsThe altered diameters of AoI and DA can be detected and measured in CVR fetuses using fetal cardiovascular MRI. Fetal CVR can occur alone or with intracardiac and extracardiac malformation. Fetal CVR can be associated with prenatal airway compression.

性早熟指女童8岁、男童9岁之前出现应于青春期发育的第二性征[1],可分为中枢性性早熟和外周性性早熟(peripheral precocious puberty,PPP).PPP 无完整发育程序性过程,为非促性腺激素释放激素依赖性性早熟[2],常见病因包括肾上腺疾病、性腺肿瘤和麦丘恩-奥尔布赖特综合征(McCune-Albright syndrome,MAS)等[3].以PPP为首发症状的儿童卵巢/睾丸肿瘤临床少见,本研究观察影像学诊断此类肿瘤的价值.

BackgroundFetal dedicated echocardiography is the standard to measure the fetal cardiac axis. However, fetal screening ultrasound (US) or fetal dedicated echocardiography may be technically limited.ObjectiveThe purpose of this study was to explore the accuracy of fetal cardiac magnetic resonance imaging (MRI) to measure the cardiac axis in fetuses with congenital heart disease as an adjunct to fetal dedicated echocardiography and to assess the predictive value of fetal cardiac MRI measurements in distinguishing healthy fetuses from fetuses with congenital heart disease.Materials and methodsThis is a retrospective study of fetuses referred to our hospital for a fetal cardiac MRI from November 2019 to December 2021. Cardiac axes were measured in the 4-chamber view of the fetal heart using fetal cardiac MRI and dedicated echocardiography, or only using fetal cardiac MRI when screening US was technically limited. The fetuses were divided into a congenital heart disease group and a healthy control group. We used Bland-Altman analysis and the intraclass correlation coefficient (ICC) to assess the agreement of cardiac axis measurements in fetuses with congenital heart disease obtained by cardiac MRI and by fetal dedicated echocardiography. Receiver operating characteristic (ROC) curve analysis of the fetal cardiac axes in the congenital heart disease and healthy fetus groups assessed the predictive value of the cardiac axis measurements.ResultsThis retrospective study included 431 women (162 carrying fetuses with congenital heart disease, 269 carrying healthy fetuses). Cardiac axes were measured in the 162 fetuses with congenital heart disease using fetal cardiac MRI and dedicated echocardiography. Cardiac axes were measured in the 269 healthy control fetuses using fetal cardiac MRI when fetal screening US was technically limited. The interobserver analysis and intraobserver analysis showed that the cardiac axis measured by fetal cardiac MRI and fetal dedicated echocardiography was repeatable (ICC > 0.90). In 162 fetuses with congenital heart disease, Bland-Altman analysis showed a strong agreement between cardiac MRI and fetal dedicated echocardiography measurements for the cardiac axis. The ICC for the cardiac axis values between cardiac MRI and fetal dedicated echocardiography measurements was 0.99. In fetuses with congenital heart disease, 64.2% (104/162) had an abnormal cardiac axis. For the fetal cardiac axis in both the 162 fetuses with congenital heart disease and the 269 healthy fetuses, the area under the ROC curve reached 0.85 (95% confidence interval: 0.80-0.89; P < 0.0001).ConclusionThe cardiac axis can be accurately measured using fetal cardiac MRI when fetal dedicated echocardiography/fetal screening US is technically limited. The cardiac axis measurements by fetal cardiac MRI are consistent with known cardiac axis measurements by fetal dedicated echocardiography. The frequency of abnormal cardiac axis depends on the type of congenital heart disease.

先天性心脏病目前是全球范围内最前见的出生缺陷,在胎儿期和新生儿期的发病率和死亡率非常高,因此,产前准确诊断非常重要.超声心动图是产前评价心脏解剖和诊断心脏畸形的主要影像学手段.近年来,随着胎儿磁共振成像(MRI)技术的快速发展,胎儿MRI已逐渐应用于产前评价先天性心脏病.对于产科和儿童心血管医生来说,了解近年来胎儿MRI的发展及其在诊断先天性心脏畸形中的作用是非常重要的.本文将详细介绍胎儿心脏磁共振成像目前所面临的挑战、成像新技术、成像标准切面以及其在产前先心病诊断中的应用价值.

Objective The purpose of this study is to establish a reference of intracranial structure volumes in normal fetuses ranging from 19 to 37 weeks' gestation (mean 27 weeks). Materials and Methods A retrospective analysis of 188 MRI examinations (1.5 T) of fetuses with a normal brain appearance (19–37 gestational weeks) from January 2018 to December 2021 was included in this study. Three dimensional (3-D) volumetric parameters from slice-to-volume reconstructed (SVR) images, such as total brain volume (TBV), cortical gray matter volume (GMV), subcortical brain tissue volume (SBV), intracranial cavity volume (ICV), lateral ventricles volume (VV), cerebellum volume (CBV), brainstem volume (BM), and extra-cerebrospinal fluid volume (e-CSFV), were quantified by manual segmentation from two experts. The mean, SD, minimum, maximum, median, and 25th and 75th quartiles for intracranial structures volume were calculated per gestational week. A linear regression analysis was used to determine the gestational weekly age-related change adjusted for sex. A t-test was used to compare the mean TBV and ICV values to previously reported values at each gestational week. The formulas to calculate intracranial structures volume derived from our data were created using a regression model. In addition, we compared the predicted mean TBV values derived by our formula with the expected mean TBV predicted by the previously reported Jarvis' formula at each time point. For intracranial volumes, the intraclass correlation coefficient (ICC) was calculated to convey association within and between observers. Results The intracranial volume data are shown in graphs and tabular summaries. The male fetuses had significantly larger VV compared with female fetuses (p = 0.01). Measured mean ICV values at 19 weeks are significantly different from those published in the literature (p < 0.05). Means were compared with the expected TBV generated by the previously reported formula, showing statistically differences at 22, 26, 29, and 30 weeks' gestational age (GA) (all p < 0.05). A comparison between our data-derived formula and the previously reported formula for TBV showed very similar values at every GA. The predicted TBV means derived from the previously reported formula were all within the 95% confidence interval (CI) of the predicted means of this study. Intra- and inter-observer agreement was high, with an intraclass correlation coefficient larger than 0.98. Conclusion We have shown that the intracranial structural volume of the fetal brain can be reliably quantified using 3-D volumetric MRI with a high degree of reproducibility and reinforces the existing data with more robust data in the earlier second and third stages of pregnancy.

Objective The purpose of this retrospective study was to report our cases of fetal ectopia cordis (EC) and to evaluate the utility of fetal cardiovascular magnetic resonance imaging (MRI) for the diagnosis of this rare anomaly. Method This retrospective study included 11 fetuses with EC. The multiplane steady-state free precession (SSFP) sequence, single-shot turbo spin-echo sequence and non-gated SSFP cine cardiovascular magnetic resonance were used to evaluate the fetal heart and abdomen. Results The 11 fetal cases with EC were examined by fetal cardiovascular MRI and confirmed by postnatal or post-mortem findings. Of these 11 cases, two were isolated thoracic EC, six had pentalogy of Cantrell, and three had an omphalocele and EC. Among all 11 fetuses, nine were associated with congenital heart defects. In four cases, fetal MRI added additional information compared to fetal ultrasound, however, in two cases, fetal MRI missed the diagnosis of a ventricular septal defect noted by echocardiography. Conclusion Fetal MRI combined with prenatal echocardiography can improve the accuracy of the prenatal diagnosis of EC.