Diagnostic accuracy of fetal cardiac magnetic resonance imaging in cardiac and thoracic vascular anomalies: a meta-analysis
- 1Department of Anatomy and Medical Imaging, American University of Antigua College of Medicine
- 2Department of Pediatrics, Kasturba Medical College Mangalore, Manipal Academy of Higher Education
- 3Department of Clinical Medicine, American University of Antigua College of Medicine
Abstract
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.
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BibTeX
@article{bhargavi2026diagnostic,
title = {{Diagnostic accuracy of fetal cardiac magnetic resonance imaging in cardiac and thoracic vascular anomalies: a meta-analysis}},
author = {Chandana Bhargavi and Rathika Damodara Shenoy and Adrian Rassaf and Daiki Jonouchi and Elvis Anunwa and Suchetha S. Rao and Nutan Kamath and Juan M. Acuna},
journal = {BMC Medical Imaging},
year = {2026},
month = jun,
doi = {10.1186/s12880-026-02521-x},
url = {https://doi.org/10.1186/s12880-026-02521-x},
note = {CC BY},
}
RIS
TY - JOUR
TI - Diagnostic accuracy of fetal cardiac magnetic resonance imaging in cardiac and thoracic vascular anomalies: a meta-analysis
AU - Chandana Bhargavi
AU - Rathika Damodara Shenoy
AU - Adrian Rassaf
AU - Daiki Jonouchi
AU - Elvis Anunwa
AU - Suchetha S. Rao
AU - Nutan Kamath
AU - Juan M. Acuna
PY - 2026
DA - 2026/06/01
JO - BMC Medical Imaging
DO - 10.1186/s12880-026-02521-x
UR - https://doi.org/10.1186/s12880-026-02521-x
AB - 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.
SN - 1471-2342
ER -