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Avena-Zampieri CL, Hutter J, Deprez M, Payette K, Hall M, Uus A, Nanda S, Milan A, Seed PT, Rutherford M, Greenough A, Story L. Assessment of normal pulmonary development using functional magnetic resonance imaging techniques. Am J Obstet Gynecol MFM 2023; 5:100935. [PMID: 36933803 PMCID: PMC10711505 DOI: 10.1016/j.ajogmf.2023.100935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The mainstay of assessment of the fetal lungs in clinical practice is via evaluation of pulmonary size, primarily using 2D ultrasound and more recently with anatomical magnetic resonance imaging. The emergence of advanced magnetic resonance techniques such as T2* relaxometry in combination with the latest motion correction post-processing tools now facilitates assessment of the metabolic activity or perfusion of fetal pulmonary tissue in vivo. OBJECTIVE This study aimed to characterize normal pulmonary development using T2* relaxometry, accounting for fetal motion across gestation. METHODS Datasets from women with uncomplicated pregnancies that delivered at term, were analyzed. All subjects had undergone T2-weighted imaging and T2* relaxometry on a Phillips 3T magnetic resonance imaging system antenatally. T2* relaxometry of the fetal thorax was performed using a gradient echo single-shot echo planar imaging sequence. Following correction for fetal motion using slice-to-volume reconstruction, T2* maps were generated using in-house pipelines. Lungs were manually segmented and mean T2* values calculated for the right and left lungs individually, and for both lungs combined. Lung volumes were generated from the segmented images, and the right and left lungs, as well as both lungs combined were assessed. RESULTS Eighty-seven datasets were suitable for analysis. The mean gestation at scan was 29.9±4.3 weeks (range: 20.6-38.3) and mean gestation at delivery was 40±1.2 weeks (range: 37.1-42.4). Mean T2* values of the lungs increased over gestation for right and left lungs individually and for both lungs assessed together (P=.003; P=.04; P=.003, respectively). Right, left, and total lung volumes were also strongly correlated with increasing gestational age (P<.001 in all cases). CONCLUSION This large study assessed developing lungs using T2* imaging across a wide gestational age range. Mean T2* values increased with gestational age, which may reflect increasing perfusion and metabolic requirements and alterations in tissue composition as gestation advances. In the future, evaluation of findings in fetuses with conditions known to be associated with pulmonary morbidity may lead to enhanced prognostication antenatally, consequently improving counseling and perinatal care planning.
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Affiliation(s)
- Carla L Avena-Zampieri
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story).
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story)
| | - Maria Deprez
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Deprez, Ms Payette, and Ms Uus)
| | - Kelly Payette
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Deprez, Ms Payette, and Ms Uus)
| | - Megan Hall
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Hall, Dr Nanda, and Dr Story)
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Deprez, Ms Payette, and Ms Uus)
| | - Surabhi Nanda
- Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Hall, Dr Nanda, and Dr Story)
| | - Anna Milan
- Neonatal Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Milan)
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story)
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story)
| | - Anne Greenough
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Neonatal Unit, King's College Hospital, London, United Kingdom (Prof Greenough); National Institute for Health and Care Research Biomedical Research Centre based at Guy's & St Thomas NHS Foundation Trusts and King's College London, London, United Kingdom (Prof Greenough)
| | - Lisa Story
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Hall, Dr Nanda, and Dr Story)
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Staicu A, Popa-Stanila R, Albu C, Chira A, Constantin R, Boitor-Borza D, Surcel M, Rotar IC, Cruciat G, Muresan D. Neonatal Hemochromatosis: Systematic Review of Prenatal Ultrasound Findings—Is There a Place for MRI in the Diagnostic Process? J Clin Med 2023; 12:jcm12072679. [PMID: 37048762 PMCID: PMC10094906 DOI: 10.3390/jcm12072679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Neonatal hemochromatosis (NH) is an uncommon, severe disorder that results in fetal loss or neonatal death due to liver failure. NH is currently regarded as the phenotypic expression of gestational alloimmune liver disease (GALD). The diagnosis of NH-GALD is rarely prenatally established. In addition to providing a systematic review of the prenatal features that are identifiable using ultrasound (US) and MRI, we suggest a prenatal diagnosis algorithm for use in suspected NH during the first affected pregnancy. From a total of 586 database entries identified in PubMed, Google Scholar, and ResearchGate, we selected 18 studies published from 1993 to 2021 that reported maternal medical and obstetric history, prenatal ultrasound findings, and postpartum outcomes. We investigated the ultrasound and MRI features of these studies, along with the outcome due to this condition. A total of 74 cases were identified. The main reported prenatal US finding was fetal growth restriction (FGR) (33%), followed by oligohydramnios (13%) and hydrops fetalis (13%), with 13% cases described as uneventful. Other rare prenatal findings were fetal anemia, ascites, and abnormal fetal liver and spleen. Most pregnancies ended with fetal/perinatal death or therapeutic interruption of pregnancy. Favorable evolution with treatment (ensanguine transfusion and intravenous immunoglobulin (IVIG)) was reported for only 7% of fetuses. Using T2-weighted MRI, fetal extrahepatic siderosis confirmed prenatally in two cases and postnatally in 11 cases. IVIG treatment throughout subsequent pregnancies was found to significantly improve fetal prognosis. MRI should be indicated in selected cases of oligohydramnios, fetal hydrops, fetal hepatomegaly, ascites, or unexplained FGR or anemia after ruling out all other more frequently encountered conditions. MRI can be used to detect iron overload in the liver and extrahepatic siderosis.
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Affiliation(s)
- Adelina Staicu
- 1st Department of Obstetrics and Gynecology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- 1st Clinics of Obstetrics and Gynecology Cluj-Napoca, Emergency County Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Roxana Popa-Stanila
- Department of Radiology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Centre of Advanced Research Studies, Emergency County Hospital, IMOGEN, 400006 Cluj-Napoca, Romania
| | - Camelia Albu
- Centre of Advanced Research Studies, Emergency County Hospital, IMOGEN, 400006 Cluj-Napoca, Romania
- Department of Pathology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alexandra Chira
- Department of Internal Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- 2nd Medical Clinic, Emergency County Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Roxana Constantin
- 1st Clinics of Obstetrics and Gynecology Cluj-Napoca, Emergency County Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Dan Boitor-Borza
- 1st Department of Obstetrics and Gynecology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- 1st Clinics of Obstetrics and Gynecology Cluj-Napoca, Emergency County Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Mihai Surcel
- 1st Department of Obstetrics and Gynecology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- 1st Clinics of Obstetrics and Gynecology Cluj-Napoca, Emergency County Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Ioana Cristina Rotar
- 1st Department of Obstetrics and Gynecology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- 1st Clinics of Obstetrics and Gynecology Cluj-Napoca, Emergency County Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Gheorghe Cruciat
- 1st Department of Obstetrics and Gynecology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- 1st Clinics of Obstetrics and Gynecology Cluj-Napoca, Emergency County Clinical Hospital, 400006 Cluj-Napoca, Romania
| | - Daniel Muresan
- 1st Department of Obstetrics and Gynecology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- 1st Clinics of Obstetrics and Gynecology Cluj-Napoca, Emergency County Clinical Hospital, 400006 Cluj-Napoca, Romania
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4
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Watzenboeck ML, Heidinger BH, Rainer J, Schmidbauer V, Ulm B, Rubesova E, Prayer D, Kasprian G, Prayer F. Reproducibility of 2D versus 3D radiomics for quantitative assessment of fetal lung development: a retrospective fetal MRI study. Insights Imaging 2023; 14:31. [PMID: 36752863 PMCID: PMC9908803 DOI: 10.1186/s13244-023-01376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
PURPOSE To investigate the reproducibility of radiomics features extracted from two-dimensional regions of interest (2D ROIs) versus whole lung (3D) ROIs in repeated in-vivo fetal magnetic resonance imaging (MRI) acquisitions. METHODS Thirty fetal MRI scans including two axial T2-weighted acquisitions of the lungs were analysed. 2D (lung at the level of the carina) and 3D (whole lung) ROIs were manually segmented using ITK-Snap. Ninety-five radiomics features were extracted from 2 and 3D ROIs in initial and repeat acquisitions using Pyradiomics. Radiomics feature intra-class correlation coefficients (ICC) were calculated between 2 and 3D ROIs in the initial acquisition, and between 2 and 3D ROIs in repeated acquisitions, respectively. RESULTS MRI data of 11 (36.7%) female and 19 (63.3%) male fetuses acquired at a median 25 + 0 gestational weeks plus days (GW) (interquartile range [IQR] 23 + 4 - 27 + 0 GW) were assessed. Median radiomics feature ICC between 2 and 3D ROIs in the initial MRI acquisition was 0.733 (IQR 0.313-0.814, range 0.018-0.970). ICCs between radiomics features extracted using 3D ROIs in initial and repeat acquisitions (median 0.908 [IQR 0.824-0.929, range 0.335-0.996]) were significantly higher compared to 2D ROIs (0.771 [0.699-0.835, 0.048-0.965]) (p < 0.001). CONCLUSION Fetal MRI radiomics features extracted from 3D whole lung segmentation masks showed significantly higher reproducibility across repeat acquisitions compared to 2D ROIs. Therefore, fetal MRI whole lung radiomics features are robust diagnostic and potentially prognostic tools in the image-based in-vivo quantitative assessment of lung development.
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Affiliation(s)
- Martin L. Watzenboeck
- grid.22937.3d0000 0000 9259 8492Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Benedikt H. Heidinger
- grid.22937.3d0000 0000 9259 8492Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Julian Rainer
- grid.22937.3d0000 0000 9259 8492Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Victor Schmidbauer
- grid.22937.3d0000 0000 9259 8492Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Barbara Ulm
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Erika Rubesova
- grid.168010.e0000000419368956Department of Pediatric Radiology, Lucile Packard Children’s Hospital at Stanford, Stanford University, 725 Welch Road, Stanford, CA 94305 USA
| | - Daniela Prayer
- Imaging Bellaria, Bellariastrasse 3, 1010 Vienna, Austria
| | - Gregor Kasprian
- grid.22937.3d0000 0000 9259 8492Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Florian Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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5
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Avena-Zampieri CL, Hutter J, Rutherford M, Milan A, Hall M, Egloff A, Lloyd DFA, Nanda S, Greenough A, Story L. Assessment of the fetal lungs in utero. Am J Obstet Gynecol MFM 2022; 4:100693. [PMID: 35858660 PMCID: PMC9811184 DOI: 10.1016/j.ajogmf.2022.100693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023]
Abstract
Antenatal diagnosis of abnormal pulmonary development has improved significantly over recent years because of progress in imaging techniques. Two-dimensional ultrasound is the mainstay of investigation of pulmonary pathology during pregnancy, providing good prognostication in conditions such as congenital diaphragmatic hernia; however, it is less validated in other high-risk groups such as those with congenital pulmonary airway malformation or preterm premature rupture of membranes. Three-dimensional assessment of lung volume and size is now possible using ultrasound or magnetic resonance imaging; however, the use of these techniques is still limited because of unpredictable fetal motion, and such tools have also been inadequately validated in high-risk populations other than those with congenital diaphragmatic hernia. The advent of advanced, functional magnetic resonance imaging techniques such as diffusion and T2* imaging, and the development of postprocessing pipelines that facilitate motion correction, have enabled not only more accurate evaluation of pulmonary size, but also assessment of tissue microstructure and perfusion. In the future, fetal magnetic resonance imaging may have an increasing role in the prognostication of pulmonary abnormalities and in monitoring current and future antenatal therapies to enhance lung development. This review aims to examine the current imaging methods available for assessment of antenatal lung development and to outline possible future directions.
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Affiliation(s)
- Carla L Avena-Zampieri
- Department of Women and Children's Health, King's College London, London, United Kingdom; Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Anna Milan
- Neonatal Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Megan Hall
- Department of Women and Children's Health, King's College London, London, United Kingdom; Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Alexia Egloff
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - David F A Lloyd
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Surabhi Nanda
- Fetal Medicine Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health, King's College London, London, United Kingdom; Neonatal Unit, King's College Hospital, London, United Kingdom; Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom; National Institute for Health and Care Research Biomedical Research Centre, Guy's & St Thomas National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Lisa Story
- Department of Women and Children's Health, King's College London, London, United Kingdom; Centre for the Developing Brain, King's College London, London, United Kingdom; Fetal Medicine Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.
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