Fetal whole-heart 4D flow cine MRI using multiple non-coplanar balanced SSFP stacks

PurposeTo develop an MRI framework for reconstruction of 4D velocity vector blood flow volumes for visualisation and quantification of circulation in the fetal heart and major vessels.\n\nMethodsA novel method of velocity-encoding using multiple non-coplanar stacks of bSSFP phase images was combined with a previous framework for reconstruction of motion-corrected 4D magnitude cine volumes to generate spatiotemporally-paired 4D flow cine volumes of the fetal circulatory system. The multiple stack velocity-encoding scheme was validated in a simulated flow phantom and compared with a gold-standard method for velocity-encoding in a physical flow phantom. The 4D flow cine framework was evaluated in seven fetal subjects. Reconstructed 4D flow volumes were evaluated by an expert fetal cardiologist and preliminary flow measurements were taken in various major vessels of the heart.\n\nResultsPhantom experiments showed that the multiple non-coplanar stack velocity-encoding scheme was accurate. The 4D flow cine reconstruction framework was robust in fetal subjects and generated multi-dimensional velocity vector maps of blood flow through the cardiac cycle. Directionality of blood flow was consistent with expected fetal circulatory hemodynamics. Relative blood flow rates in the major vessels were in line with previous observations, although absolute values were underestimated by a factor of approximately two due to limitations of spatial and temporal resolution.\n\nConclusion4D flow cine volumes can be reconstructed from multiple non-coplanar stacks of slices. The proposed framework was used to visualise and quantify flow through the whole fetal heart and great vessels, but is applicable to any imaging scenario where motion is a major challenge.