Luis F. Goncalves, MD.
Thanks to the sophisticated technology and skilled fetal imaging specialists at Phoenix Children’s, more high-risk infants have a chance to live long, healthy lives.
The fetal imaging team’s advanced expertise – and its close integration with subspecialists throughout the hospital – ensures congenital anomalies are diagnosed accurately and early, so parents can promptly begin treatment planning with the physicians who will care for their children after birth.
The Right Combination of Talent and Technology
At Phoenix Children’s, the six-provider fetal imaging team’s combined experience is second to none in the Southwestern U.S. Luis Goncalves, MD, director of the Division of Fetal Imaging, is the most senior member of the team, with 30 years of experience in fetal imaging and unique dual training in obstetrics and pediatric radiology.
“Our goal is to provide support to referring maternal-fetal medicine specialists and obstetricians to diagnose complex or rare congenital anomalies – particularly those that may benefit from fetal MRI,” says Dr. Goncalves. “We double-read exams within our core team to ensure accuracy and, when needed, also tap into the additional expertise of more than a dozen pediatric radiologists who each specialize in different areas of the body. These collaborations are important because not every fetal anomaly occurs in isolation; many of these babies have multiple problems.”
Expectant families are frequently referred to the Fetal Imaging Center at Phoenix Children’s after a routine blood test or screening ultrasound flags a potential problem. Team members perform state-of-the-art imaging procedures to confirm a full range of congenital conditions, including:
- Abdominal wall defects
- Anorectal anomalies
- Central nervous system anomalies
- Congenital heart defects
- Diaphragmatic hernia
- Facial anomalies
- Gastrointestinal anomalies
- Genital anomalies
- Lung or airway problems
- Multiple malformations
- Neural tube defects
The team uses the latest in fetal imaging technology to help identify these challenging anomalies. These advanced procedures include:
- Fetal MRI, including super-resolution imaging with motion correction and diffusion tensor imaging (DTI) with exams performed in 1.5T and 3T magnets
- 3D and 4D fetal ultrasound with high-resolution transducers
- Low-dose fetal CT scans, which are reserved for babies with complex skeletal problems that can’t be diagnosed confidently with ultrasound or MRI alone
And to help the hundreds of families referred annually for confirmation of congenital heart disease, the fetal imaging team works closely with certified fetal cardiac sonographers in the Phoenix Children’s Fetal Cardiology Program.
Revolutionary Processes and Procedures Refine Prenatal Diagnoses
The state-of-the-art imaging technology available at Phoenix Children’s makes it possible to detect subtle malformations that may not be apparent during screening ultrasounds or other traditional exams.
“Using a combination of high-resolution ultrasound and fetal MRI on babies who are high risk for retinoblastoma, we were recently able to diagnose a tumor the size of a pinhead,” says Dr. Goncalves, who was the lead author of a recent article about this case (Clinical Imaging, March 2021). “Because tumor doubling time for retinoblastoma is extremely short, early detection provides an opportunity for early delivery and prompt initiation of treatment.”
Phoenix Children’s is also home to a dedicated, 3D pediatric imaging lab that helps create and refine novel techniques to enhance diagnosis – even before children are born.
“Because babies are constantly moving in the womb, it can be hard to capture high-quality images,” says Dr. Goncalves. “We’ve implemented a super-resolution technology that allows us to correct motion after the images are acquired. Then we combine all the images in a data set that’s used to create 3D reconstructions for better anatomy assessment, anomaly identification and measurements.”
This technology is particularly useful in fetal brain imaging, when measurements of brain volume may predict problems earlier than with 2D measurements. The team is also in the process of applying this motion-correction technology to fetal cardiac MRI.
Connecting Families to Comprehensive Care
For most families, an unexpected fetal diagnosis is a pivotal moment that marks the beginning of a journey that can feel daunting. When at Phoenix Children’s, families have comprehensive, meaningful support throughout their journey.
The fetal imaging team is part of the Center for Fetal and Neonatal Care, which provides care coordination and navigation to parents who learn their baby has a congenital condition. Together, they guide families to the right medical or surgical experts who will help them understand their child’s diagnosis, prognosis and treatment options. The Center for Fetal and Neonatal Care team also connects these families to any counseling or other support services they may need.
“We can link parents to the right specialists, right away, so their baby’s care plans are already in place at the time of birth,” says Dr. Goncalves. “This integrative approach is what sets us apart. Each family has an entire team of experts to support them, and each team member shares the same goal: to ensure every baby has the best possible care and the best chance of going on to achieve their highest potential.”