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Background <p>Fetal echocardiography (FE) is the primary modality for screening cardiac anomalies. Diagnostic limitations persist in complex lesions, thoracic vascular anomalies, late gestation, and cases with poor acoustic windows. Fetal cardiac magnetic resonance imaging (FCMRI) complements FE by providing additional anatomical details of cardiac and thoracic vascular anomalies, although its diagnostic test accuracy has not been systematically evaluated. This meta-analysis aimed to determine the diagnostic accuracy of FCMRI in detecting cardiac and thoracic vascular anomalies and to evaluate its potential role in prenatal decision-making.</p> Methods <p>Observational studies evaluating FCMRI for cardiac and thoracic vascular anomalies were analyzed at the lesion-description level. Summary statistics were estimated using a bivariate random-effects and hierarchical summary receiver operating characteristic models. Subgroup analyses were performed across anatomical lesion categories, image acquisition methods, and acquisition eras.</p> Results <p>Seven studies involving 449 cardiac and thoracic vascular anomalies were analyzed. FCMRI demonstrated a sensitivity of 0.80 (95% CI: 0.66–0.89) and specificity of 0.98 (95% CI: 0.92–0.99), indicating acceptable accuracy, with a 95% prediction ellipse area of 0.29, suggesting moderate between-study heterogeneity. Pooled sensitivity [0.88 (95%CI: 0.79–0.93)] was highest for complex heart defects, with a tightly clustered prediction ellipse (0.04). Thoracic vascular anomalies showed lower sensitivity [0.75 (95%CI: 0.56–0.88)] and greater heterogeneity (0.39), reflecting diagnostic challenges. Only two studies showed incremental clinical utility of FCMRI in decision-making that varied by specific cardiac and thoracic vascular anomaly. The analysis was limited by the small number of studies, methodological heterogeneity, and the underrepresentation of true-negative cases.</p> Conclusions <p>Fetal CMRI can provide clinically useful anatomical information complementary to FE, particularly in late gestation and selected high-risk pregnancies. Although it demonstrated high specificity and moderate sensitivity overall, diagnostic performance varied across lesion subtypes, with aortic and aberrant vascular anomalies remaining the most challenging to diagnose prenatally.</p> Meta analysis registration <p>PROSPERO: CRD420251133115.</p>

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Diagnostic accuracy of fetal cardiac magnetic resonance imaging in cardiac and thoracic vascular anomalies: a meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Chandana Bhargavi,
  • Rathika Damodara Shenoy,
  • Adrian Rassaf,
  • Daiki Jonouchi,
  • Elvis Anunwa,
  • Suchetha S. Rao,
  • Nutan Kamath,
  • Juan M. Acuna

摘要

Background

Fetal echocardiography (FE) is the primary modality for screening cardiac anomalies. Diagnostic limitations persist in complex lesions, thoracic vascular anomalies, late gestation, and cases with poor acoustic windows. Fetal cardiac magnetic resonance imaging (FCMRI) complements FE by providing additional anatomical details of cardiac and thoracic vascular anomalies, although its diagnostic test accuracy has not been systematically evaluated. This meta-analysis aimed to determine the diagnostic accuracy of FCMRI in detecting cardiac and thoracic vascular anomalies and to evaluate its potential role in prenatal decision-making.

Methods

Observational studies evaluating FCMRI for cardiac and thoracic vascular anomalies were analyzed at the lesion-description level. Summary statistics were estimated using a bivariate random-effects and hierarchical summary receiver operating characteristic models. Subgroup analyses were performed across anatomical lesion categories, image acquisition methods, and acquisition eras.

Results

Seven studies involving 449 cardiac and thoracic vascular anomalies were analyzed. FCMRI demonstrated a sensitivity of 0.80 (95% CI: 0.66–0.89) and specificity of 0.98 (95% CI: 0.92–0.99), indicating acceptable accuracy, with a 95% prediction ellipse area of 0.29, suggesting moderate between-study heterogeneity. Pooled sensitivity [0.88 (95%CI: 0.79–0.93)] was highest for complex heart defects, with a tightly clustered prediction ellipse (0.04). Thoracic vascular anomalies showed lower sensitivity [0.75 (95%CI: 0.56–0.88)] and greater heterogeneity (0.39), reflecting diagnostic challenges. Only two studies showed incremental clinical utility of FCMRI in decision-making that varied by specific cardiac and thoracic vascular anomaly. The analysis was limited by the small number of studies, methodological heterogeneity, and the underrepresentation of true-negative cases.

Conclusions

Fetal CMRI can provide clinically useful anatomical information complementary to FE, particularly in late gestation and selected high-risk pregnancies. Although it demonstrated high specificity and moderate sensitivity overall, diagnostic performance varied across lesion subtypes, with aortic and aberrant vascular anomalies remaining the most challenging to diagnose prenatally.

Meta analysis registration

PROSPERO: CRD420251133115.