1
|
Rabinowich A, Avisdris N, Yehuda B, Zilberman A, Graziani T, Neeman B, Specktor-Fadida B, Link-Sourani D, Wexler Y, Herzlich J, Krajden Haratz K, Joskowicz L, Ben Sira L, Hiersch L, Ben Bashat D. Fetal MRI-Based Body and Adiposity Quantification for Small for Gestational Age Perinatal Risk Stratification. J Magn Reson Imaging 2024; 60:767-774. [PMID: 37982367 DOI: 10.1002/jmri.29141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Small for gestational age (SGA) fetuses are at risk for perinatal adverse outcomes. Fetal body composition reflects the fetal nutrition status and hold promise as potential prognostic indicator. MRI quantification of fetal anthropometrics may enhance SGA risk stratification. HYPOTHESIS Smaller, leaner fetuses are malnourished and will experience unfavorable outcomes. STUDY TYPE Prospective. POPULATION 40 SGA fetuses, 26 (61.9%) females: 10/40 (25%) had obstetric interventions due to non-reassuring fetal status (NRFS), and 17/40 (42.5%) experienced adverse neonatal events (CANO). Participants underwent MRI between gestational ages 30 + 2 and 37 + 2. FIELD STRENGTH/SEQUENCE 3-T, True Fast Imaging with Steady State Free Precession (TruFISP) and T1-weighted two-point Dixon (T1W Dixon) sequences. ASSESSMENT Total body volume (TBV), fat signal fraction (FSF), and the fat-to-body volumes ratio (FBVR) were extracted from TruFISP and T1W Dixon images, and computed from automatic fetal body and subcutaneous fat segmentations by deep learning. Subjects were followed until hospital discharge, and obstetric interventions and neonatal adverse events were recorded. STATISTICAL TESTS Univariate and multivariate logistic regressions for the association between TBV, FBVR, and FSF and interventions for NRFS and CANO. Fisher's exact test was used to measure the association between sonographic FGR criteria and perinatal outcomes. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. A P-value <0.05 was considered statistically significant. RESULTS FBVR (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.2-0.76) and FSF (OR 0.95, CI 0.91-0.99) were linked with NRFS interventions. Furthermore, TBV (OR 0.69, CI 0.56-0.86) and FSF (OR 0.96, CI 0.93-0.99) were linked to CANO. The FBVR sensitivity/specificity for obstetric interventions was 85.7%/87.5%, and the TBV sensitivity/specificity for CANO was 82.35%/86.4%. The sonographic criteria sensitivity/specificity for obstetric interventions was 100%/33.3% and insignificant for CANO (P = 0.145). DATA CONCLUSION Reduced TBV and FBVR may be associated with higher rates of obstetric interventions for NRFS and CANO. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 5.
Collapse
Affiliation(s)
- Aviad Rabinowich
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Netanell Avisdris
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Bossmat Yehuda
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Ayala Zilberman
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Tamir Graziani
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bar Neeman
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bella Specktor-Fadida
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dafna Link-Sourani
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yair Wexler
- School of Neurobiology, Biochemistry and Biophysics, The George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacky Herzlich
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Neonatal Intensive Care Unit, Dana Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Karina Krajden Haratz
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liat Ben Sira
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Liran Hiersch
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
2
|
Uus AU, Hall M, Grigorescu I, Zampieri CA, Collado AE, Payette K, Matthew J, Kyriakopoulou V, Hajnal JV, Hutter J, Rutherford MA, Deprez M, Story L. 3D T2w fetal body MRI: automated organ volumetry, growth charts and population-averaged atlas. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.31.23290751. [PMID: 37398121 PMCID: PMC10312818 DOI: 10.1101/2023.05.31.23290751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Structural fetal body MRI provides true 3D information required for volumetry of fetal organs. However, current clinical and research practice primarily relies on manual slice-wise segmentation of raw T2-weighted stacks, which is time consuming, subject to inter- and intra-observer bias and affected by motion-corruption. Furthermore, there are no existing standard guidelines defining a universal approach to parcellation of fetal organs. This work produces the first parcellation protocol of the fetal body organs for motion-corrected 3D fetal body MRI. It includes 10 organ ROIs relevant to fetal quantitative volumetry studies. We also introduce the first population-averaged T2w MRI atlas of the fetal body. The protocol was used as a basis for training of a neural network for automated organ segmentation. It showed robust performance for different gestational ages. This solution minimises the need for manual editing and significantly reduces time. The general feasibility of the proposed pipeline was also assessed by analysis of organ growth charts created from automated parcellations of 91 normal control 3T MRI datasets that showed expected increase in volumetry during 22-38 weeks gestational age range. In addition, the results of comparison between 60 normal and 12 fetal growth restriction datasets revealed significant differences in organ volumes.
Collapse
Affiliation(s)
- Alena U. Uus
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Megan Hall
- Centre for the Developing Brain, King’s College London, London, UK
- Department of Women and Children’s Health, King’s College London, London, UK
- Fetal Medicine Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Irina Grigorescu
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Carla Avena Zampieri
- Centre for the Developing Brain, King’s College London, London, UK
- Department of Women and Children’s Health, King’s College London, London, UK
| | | | - Kelly Payette
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
- Centre for the Developing Brain, King’s College London, London, UK
| | - Jacqueline Matthew
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
- Centre for the Developing Brain, King’s College London, London, UK
| | | | - Joseph V. Hajnal
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
- Centre for the Developing Brain, King’s College London, London, UK
| | - Jana Hutter
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
- Centre for the Developing Brain, King’s College London, London, UK
| | | | - Maria Deprez
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Lisa Story
- Centre for the Developing Brain, King’s College London, London, UK
- Department of Women and Children’s Health, King’s College London, London, UK
- Fetal Medicine Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
De Asis-Cruz J, Limperopoulos C. Harnessing the Power of Advanced Fetal Neuroimaging to Understand In Utero Footprints for Later Neuropsychiatric Disorders. Biol Psychiatry 2022; 93:867-879. [PMID: 36804195 DOI: 10.1016/j.biopsych.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/03/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
Adverse intrauterine events may profoundly impact fetal risk for future adult diseases. The mechanisms underlying this increased vulnerability are complex and remain poorly understood. Contemporary advances in fetal magnetic resonance imaging (MRI) have provided clinicians and scientists with unprecedented access to in vivo human fetal brain development to begin to identify emerging endophenotypes of neuropsychiatric disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and schizophrenia. In this review, we discuss salient findings of normal fetal neurodevelopment from studies using advanced, multimodal MRI that have provided unparalleled characterization of in utero prenatal brain morphology, metabolism, microstructure, and functional connectivity. We appraise the clinical utility of these normative data in identifying high-risk fetuses before birth. We highlight available studies that have investigated the predictive validity of advanced prenatal brain MRI findings and long-term neurodevelopmental outcomes. We then discuss how ex utero quantitative MRI findings can inform in utero investigations toward the pursuit of early biomarkers of risk. Lastly, we explore future opportunities to advance our understanding of the prenatal origins of neuropsychiatric disorders using precision fetal imaging.
Collapse
|
4
|
Sethi S, Friesen-Waldner LJ, Wade TP, Courchesne M, Nygard K, Sarr O, Sutherland B, Regnault TRH, McKenzie CA. Feasibility of MRI Quantification of Myelin Water Fraction in the Fetal Guinea Pig Brain. J Magn Reson Imaging 2022; 57:1856-1864. [PMID: 36239714 DOI: 10.1002/jmri.28482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fetal myelination assessment is important for understanding neurodevelopment and neurodegeneration. Myelin water imaging (MWI) quantifies myelin water fraction (MWF), a validated marker for myelin content, and has been used to assess brain myelin in children and neonates. PURPOSE To demonstrate that MWI can quantify MWF in fetal guinea pigs (GPs). STUDY TYPE Animal model. ANIMAL MODEL Nine pregnant, Dunkin-Hartley GPs with 31 fetuses (mean ± standard deviation = 60 ± 1.5 days gestation). FIELD STRENGTH/SEQUENCE 3D spoiled gradient echo and balanced steady-state free precession sequences at 3.0 T. ASSESSMENT MWF maps were reconstructed for maternal and fetal GP brains using the multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT) approach. Myelin basic protein (MBP) stain provided histological validation of the MWF. Regions of interest were placed in the maternal corpus callosum (CC), maternal fornix (FOR), fetal CC, and fetal FOR in MWF maps and MBP stains. STATISTICAL TESTS Linear regression between MWF and MBP stain intensity (SI) of all four regions (coefficient of determination, R2 ). A paired t-test compared the MWF of maternal and mean fetal CC, MBP SI of maternal and mean fetal CC, MWF of maternal and mean fetal FOR, MBP SI of maternal and mean fetal FOR. A paired t-test with a linear mixed model compared the MWF of fetal CC and fetal FOR, and MBP SI of fetal CC and fetal FOR. A P value < 0.0083 was considered statistically significant. RESULTS The mean MWF of the analyzed regions are as follows (mean ± standard deviation): 0.338 + 0.016 (maternal CC), 0.340 ± 0.017 (maternal FOR), 0.214 ± 0.016 (fetal CC), and 0.305 ± 0.025 (fetal FOR). MWF correlated with MBP SI in all regions (R2 = 0.81). Significant differences were found between MWF and MBP SI of maternal and fetal CC, and MWF and MBP SI of fetal CC and fetal FOR. DATA CONCLUSION This study demonstrated the feasibility of MWI in assessing fetal brain myelin content. EVIDENCE LEVEL 2 Technical Efficacy: Stage 1.
Collapse
Affiliation(s)
- Simran Sethi
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | | | - Trevor P Wade
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada
| | - Marc Courchesne
- Biotron Experimental Climate Change Research Centre, Western University, London, Ontario, Canada
| | - Karen Nygard
- Biotron Experimental Climate Change Research Centre, Western University, London, Ontario, Canada
| | - Ousseynou Sarr
- Department of Physiology & Pharmacology, Western University, London, Ontario, Canada
| | - Brian Sutherland
- Department of Physiology & Pharmacology, Western University, London, Ontario, Canada
| | - Timothy R H Regnault
- Department of Physiology & Pharmacology, Western University, London, Ontario, Canada.,Department of Obstetrics & Gynaecology, Western University, London, Ontario, Canada.,Division of Maternal, Fetal, and Newborn Health, Children's Health Research Institute, Lawson Health Research Institute, Western University, London, Ontario, Canada
| | - Charles A McKenzie
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Division of Maternal, Fetal, and Newborn Health, Children's Health Research Institute, Lawson Health Research Institute, Western University, London, Ontario, Canada
| |
Collapse
|
5
|
Reis Teixeira S. Editorial for "Measurement of the Brain Volume/liver Volume Ratio by Three-Dimensional Magnetic Resonance Imaging in Appropriate-for-Gestational Age Fetuses and Those With Fetal Growth Restriction". J Magn Reson Imaging 2021; 54:1802-1803. [PMID: 34355468 DOI: 10.1002/jmri.27876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sara Reis Teixeira
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|