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Seiter D, Chen R, Ludwig KD, Zhu A, Shah D, Wieben O, Johnson KM. Velocity-selective arterial spin labeling perfusion measurements in 2nd trimester human placenta with varying BMI. Placenta 2024; 150:72-79. [PMID: 38615536 PMCID: PMC11065564 DOI: 10.1016/j.placenta.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Proper placental development is crucial to fetal health but is challenging to functionally assess non-invasively and is thus poorly characterized in populations. Body mass index (BMI) has been linked with adverse outcomes, but the causative mechanism is uncertain. Velocity-selective arterial spin labeling (VS-ASL) MRI provides a method to non-invasively measure placental perfusion with robustness to confounding transit time delays. In this study, we report on the measurement of perfusion in the human placenta in early pregnancy using velocity-selective arterial spin labeling (VS-ASL) MRI, comparing non-obese and obese participants. METHODS Participants (N = 97) undergoing routine prenatal care were recruited and imaged with structural and VS-ASL perfusion MRI at 15 and 21 weeks gestation. Resulting perfusion images were analyzed with respect to obesity based on BMI, gestational age, and the presence of adverse outcomes. RESULTS At 15 weeks gestation BMI was not associated with placental perfusion or perfusion heterogeneity. However, at 21 weeks gestation BMI was associated with higher placental perfusion (p < 0.01) and a decrease in perfusion heterogeneity (p < 0.05). In alignment with past studies, perfusion values were also higher at 21 weeks compared to 15 weeks gestation. In a small cohort of participants with adverse outcomes, at 21 weeks lower perfusion was observed compared to participants with uncomplicated pregnancies. DISCUSSION These results suggest low placental perfusion in the early second trimester may not be the culpable factor driving associations of obesity with adverse outcomes.
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Affiliation(s)
- Daniel Seiter
- Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Ruiming Chen
- Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Kai D Ludwig
- Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Ante Zhu
- Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States; Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Dinesh Shah
- Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, United States
| | - Oliver Wieben
- Medical Physics, University of Wisconsin-Madison, Madison, WI, United States; Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Kevin M Johnson
- Medical Physics, University of Wisconsin-Madison, Madison, WI, United States; Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States; Radiology, University of Wisconsin-Madison, Madison, WI, United States.
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Herrera CL, Wang Y, Udayakumar D, Xi Y, Do QN, Lewis MA, Owen DM, Fei B, Spong CY, Twickler DM, Madhuranthakam AJ. Longitudinal assessment of placental perfusion in normal and hypertensive pregnancies using pseudo-continuous arterial spin-labeled MRI: preliminary experience. Eur Radiol 2023; 33:9223-9232. [PMID: 37466705 PMCID: PMC10796849 DOI: 10.1007/s00330-023-09945-x] [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: 08/07/2022] [Revised: 05/05/2023] [Accepted: 05/17/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To evaluate longitudinal placental perfusion using pseudo-continuous arterial spin-labeled (pCASL) MRI in normal pregnancies and in pregnancies affected by chronic hypertension (cHTN), who are at the greatest risk for placental-mediated disease conditions. METHODS Eighteen normal and 23 pregnant subjects with cHTN requiring antihypertensive therapy were scanned at 3 T using free-breathing pCASL-MRI at 16-20 and 24-28 weeks of gestational age. RESULTS Mean placental perfusion was 103.1 ± 48.0 and 71.4 ± 18.3 mL/100 g/min at 16-20 and 24-28 weeks respectively in normal pregnancies and 79.4 ± 27.4 and 74.9 ± 26.6 mL/100 g/min in cHTN pregnancies. There was a significant decrease in perfusion between the first and second scans in normal pregnancies (p = 0.004), which was not observed in cHTN pregnancies (p = 0.36). The mean perfusion was not statistically different between normal and cHTN pregnancies at both scans, but the absolute change in perfusion per week was statistically different between these groups (p = 0.044). Furthermore, placental perfusion was significantly lower at both time points (p = 0.027 and 0.044 respectively) in the four pregnant subjects with cHTN who went on to have infants that were small for gestational age (52.7 ± 20.4 and 50.4 ± 20.9 mL/100 g/min) versus those who did not (85 ± 25.6 and 80.0 ± 25.1 mL/100 g/min). CONCLUSION pCASL-MRI enables longitudinal assessment of placental perfusion in pregnant subjects. Placental perfusion in the second trimester declined in normal pregnancies whereas it remained unchanged in cHTN pregnancies, consistent with alterations due to vascular disease pathology. Perfusion was significantly lower in those with small for gestational age infants, indicating that pCASL-MRI-measured perfusion may be an effective imaging biomarker for placental insufficiency. CLINICAL RELEVANCE STATEMENT pCASL-MRI enables longitudinal assessment of placental perfusion without administering exogenous contrast agent and can identify placental insufficiency in pregnant subjects with chronic hypertension that can lead to earlier interventions. KEY POINTS • Arterial spin-labeled (ASL) magnetic resonance imaging (MRI) enables longitudinal assessment of placental perfusion without administering exogenous contrast agent. • ASL-MRI-measured placental perfusion decreased significantly between 16-20 week and 24-28 week gestational age in normal pregnancies, while it remained relatively constant in hypertensive pregnancies, attributed to vascular disease pathology. • ASL-MRI-measured placental perfusion was significantly lower in subjects with hypertension who had a small for gestational age infant at 16-20-week gestation, indicating perfusion as an effective biomarker of placental insufficiency.
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Affiliation(s)
- Christina L Herrera
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Yiming Wang
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9061, USA
| | - Durga Udayakumar
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9061, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9061, USA
- Department of Clinical Science, UT Southwestern Medical Center, Dallas, TX, USA
| | - Quyen N Do
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9061, USA
| | - Matthew A Lewis
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9061, USA
| | - David M Owen
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Baowei Fei
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9061, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, USA
| | - Catherine Y Spong
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Diane M Twickler
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9061, USA
| | - Ananth J Madhuranthakam
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9061, USA.
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA.
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Rubin JM, Pinter SZ, Halloran KM, Pallas BD, Fowlkes JB, Vyas AK, Padmanabhan V, Kripfgans OD. Placental assessment using spectral analysis of the envelope of umbilical venous waveforms in sheep. Placenta 2023; 142:119-127. [PMID: 37699274 PMCID: PMC10954287 DOI: 10.1016/j.placenta.2023.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION This study was designed to test the efficacy of an ultrasound flow measurement method to evaluate placental function in a hyperandrogenic sheep model that produces placental morphologic changes and an intrauterine growth restriction (IUGR) phenotype. MATERIALS AND METHODS Pregnant ewes were assigned randomly between control (n = 12) and testosterone-treatment (T-treated, n = 22) groups. The T-treated group was injected twice weekly intramuscularly (IM) with 100 mg testosterone propionate. Control sheep were injected with corn oil vehicle. Lambs were delivered at 119.5 ± 0.48 days gestation. At the time of delivery of each lamb, flow spectra were generated from one fetal artery and two fetal veins, and the spectral envelopes examined using fast Fourier transform analysis. Base 10 logarithms of the ratio of the amplitudes of the maternal and fetal spectral peaks (LRSP) in the venous power spectrum were compared in the T-treated and control populations. In addition, we calculated the resistive index (RI) for the artery defined as ((peak systole - min diastole)/peak systole). Two-tailed T-tests were used for comparisons. RESULTS LRSPs, after removal of significant outliers, were -0.158 ± 0.238 for T-treated and 0.057 ± 0.213 for control (p = 0.015) animals. RIs for the T-treated sheep fetuses were 0.506 ± 0.137 and 0.497 ± 0.086 for controls (p = 0.792) DISCUSSION: LRSP analysis distinguishes between T-treated and control sheep, whereas RIs do not. LRSP has the potential to identify compromised pregnancies.
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Affiliation(s)
- Jonathan M Rubin
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
| | - Stephen Z Pinter
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
| | - Katherine M Halloran
- University of Michigan Department of Pediatrics, 7510 MSRB1, 1150 W. Medical Center Dr, Ann Arbor, MI, 48109-5718, USA.
| | - Brooke D Pallas
- University of Michigan Address Unit Lab Animal Medicine, 2800 Plymouth Rd. NCRC-G090, Ann Arbor, MI, 48109-2800, USA.
| | - J Brian Fowlkes
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
| | - Arpita K Vyas
- Washington University in St. Louis Department of Pediatrics, St. Louis Children's Hospital, 1 Children's Place, St. Louis, MO, 63110, USA.
| | - Vasantha Padmanabhan
- University of Michigan Department of Pediatrics, 7510 MSRB1, 1150 W. Medical Center Dr, Ann Arbor, MI, 48109-5718, USA.
| | - Oliver D Kripfgans
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
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Taso M, Aramendía-Vidaurreta V, Englund EK, Francis S, Franklin S, Madhuranthakam AJ, Martirosian P, Nayak KS, Qin Q, Shao X, Thomas DL, Zun Z, Fernández-Seara MA. Update on state-of-the-art for arterial spin labeling (ASL) human perfusion imaging outside of the brain. Magn Reson Med 2023; 89:1754-1776. [PMID: 36747380 DOI: 10.1002/mrm.29609] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
This review article provides an overview of developments for arterial spin labeling (ASL) perfusion imaging in the body (i.e., outside of the brain). It is part of a series of review/recommendation papers from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group. In this review, we focus on specific challenges and developments tailored for ASL in a variety of body locations. After presenting common challenges, organ-specific reviews of challenges and developments are presented, including kidneys, lungs, heart (myocardium), placenta, eye (retina), liver, pancreas, and muscle, which are regions that have seen the most developments outside of the brain. Summaries and recommendations of acquisition parameters (when appropriate) are provided for each organ. We then explore the possibilities for wider adoption of body ASL based on large standardization efforts, as well as the potential opportunities based on recent advances in high/low-field systems and machine-learning. This review seeks to provide an overview of the current state-of-the-art of ASL for applications in the body, highlighting ongoing challenges and solutions that aim to enable more widespread use of the technique in clinical practice.
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Affiliation(s)
- Manuel Taso
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Erin K Englund
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Francis
- Sir Peter Mansfield Imaging Center, University of Nottingham, Nottingham, UK
| | - Suzanne Franklin
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ananth J Madhuranthakam
- Department of Radiology, Advanced Imaging Research Center, and Biomedical Engineering, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Petros Martirosian
- Section on Experimental Radiology, Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Zungho Zun
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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Link-Sourani D, Avisdris N, Harel S, Ben-Sira L, Ganot T, Gordon Z, Many A, Ben Bashat D. Ex-Vivo MRI of the Normal Human Placenta: Structural-Functional Interplay and the Association With Birth Weight. J Magn Reson Imaging 2021; 56:134-144. [PMID: 34799945 DOI: 10.1002/jmri.28002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advanced magnetic resonance imaging (MRI) methods are increasingly being used to assess the human placenta. Yet, the structure-function interplay in normal placentas and their associations with pregnancy risks are not fully understood. PURPOSE To characterize the normal human placental structure (volume and umbilical cord centricity index (CI)) and function (perfusion) ex-vivo using MRI, to assess their association with birth weight (BW), and identify imaging-markers for placentas at risk for dysfunction. STUDY TYPE Prospective. POPULATION Twenty normal term ex-vivo placentas. FIELD STRENGTH/SEQUENCE 3 T/ T1 and T2 weighted (T1 W, T2 W) turbo spin-echo, three-dimensional susceptibility-weighted image, and time-resolved angiography with interleaved stochastic trajectories (TWIST), during passage of a contrast agent using MRI compatible perfusion system that mimics placental flow. ASSESSMENT Placental volume and CI were manually extracted from the T1 W images by a fetal-placental MRI scientist (D.L., 7 years of experience). Perfusion maps including bolus arrival-time and full-width at half maximum were calculated from the TWIST data. Mean values, entropy, and asymmetries were calculated from each perfusion map, relating to both the whole placenta and volumes of interest (VOIs) within the umbilical cord and its daughter blood vessels. STATISTICAL TESTS Pearson correlations with correction for multiple comparisons using false discovery rate were performed between structural and functional parameters, and with BW, with P < 0.05 considered significant. RESULTS All placentas were successfully perfused and scanned. Significant correlations were found between whole placenta and VOIs perfusion parameters (mean R = 0.76 ± 0.06, range = 0.67-0.89), which were also significantly correlated with CI (mean R = 0.72 ± 0.05, range = 0.65-0.79). BW was correlated with placental volume (R = 0.62), but not with CI (P = 0.40). BW was also correlated with local perfusion asymmetry (R = -0.71). DATA CONCLUSION Results demonstrate a gradient of placental function, associated with CI and suggest several ex-vivo imaging-markers that might indicate an increased risk for placental dysfunction. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
| | - 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
| | - Shaul Harel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Liat Ben-Sira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Ganot
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zoya Gordon
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Medical Engineering, Afeka, Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Ariel Many
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Andersen AS, Anderson KB, Hansen DN, Sinding M, Petersen AC, Peters DA, Frøkjær JB, Sørensen A. Placental MRI: Longitudinal relaxation time (T1) in appropriate and small for gestational age pregnancies. Placenta 2021; 114:76-82. [PMID: 34482232 DOI: 10.1016/j.placenta.2021.08.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/08/2021] [Accepted: 08/05/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The antenatal detection of small for gestational age (SGA) pregnancies is a challenge, which may be improved by placental MRI. The longitudinal relaxation time (T1) is a tissue constant related to tissue morphology and tissue oxygenation, thereby placental T1 may be related to placental function. The aim of this study is to investigate placental T1 in appropriate for gestational age (AGA) and SGA pregnancies. METHODS A total of 132 singleton pregnancies were retrieved from our MRI research database. MRI and ultrasound estimated fetal weight (EFW) was performed at gestational week 20.6-41.7 in a 1.5 T system. SGA was defined as BW ≤ -15% of the expected for gestational age (≤10th centile). A subgroup of SGA pregnancies underwent postnatal placental histological examination (PHE) and abnormal PHE was defined as vascular malperfusion. The placental T1 values were converted into Z-scores adjusted for gestational age at MRI. The predictive performance of placental T1 and EFW was compared by receiver operating curves (ROC). RESULTS In AGA pregnancies, placental T1 showed a negative linear correlation with gestational age (r = -0.36, p = 0.004) Placental T1 was significantly reduced in SGA pregnancies (mean Z-score = -0.34) when compared to AGA pregnancies, p = 0.03. Among SGA pregnancies placental T1 was not reduced in cases with abnormal PHE, p = 0.84. The predictive performance of EFW (AUC = 0.84, 95% CI, 0.77-0.91) was significantly stronger than placental T1 (AUC = 0.62, 95% CI, 0.52-0.72) (p = 0.002). DISCUSSION A low placental T1 relaxation time is associated with SGA at birth. However, the predictive performance of placental T1 is not as strong as EFW.
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Affiliation(s)
- Anna S Andersen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.
| | - Kristi B Anderson
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, 9000, Aalborg, Denmark.
| | - Ditte N Hansen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
| | - Marianne Sinding
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
| | - Astrid C Petersen
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, 9000, Aalborg, Denmark.
| | - David A Peters
- Department of Clinical Engineering, Central Denmark Region, Nørrebrogade 44, 8000, Aarhus C, Denmark.
| | - Jens B Frøkjær
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark; Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
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Deloison B, Arthuis C, Benchimol G, Balvay D, Bussieres L, Millischer AE, Grévent D, Butor C, Chalouhi G, Mahallati H, Hélénon O, Tavitian B, Clement O, Ville Y, Siauve N, Salomon LJ. Human placental perfusion measured using dynamic contrast enhancement MRI. PLoS One 2021; 16:e0256769. [PMID: 34473740 PMCID: PMC8412340 DOI: 10.1371/journal.pone.0256769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/15/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives To evaluate the feasibility of dynamic contrast enhanced magnetic resonance imaging (DCE MRI) and measure values of in vivo placental perfusion in women. Methods This study was part of the Placentimage trial (NCT01092949). Gadolinium-chelate (Gd) enhanced dynamic MRI was performed two days before termination of pregnancies at 16 to 34 weeks gestational age (GA). Quantitative analysis was performed using one-compartment intravascular modeling. DCE perfusion parameters were analyzed across GA and were compared in IUGR and AGA fetuses. Results 134 patients were enrolled. After quality control check, 62 DCE MRI were analyzed including 48 and 14 pregnancies with normal and abnormal karyotypes, respectively. Mean placental blood flow was 129±61 mL/min/100ml in cases with normal karyotypes. Fetuses affected by IUGR (n = 13) showed significantly lower total placental blood flow values than AGA fetuses (n = 35) (F total = 122±88 mL/min versus 259±34 mL/min, p = 0.002). DCE perfusion parameters showed a linear correlation with GA. Conclusions Measuring placental perfusion in vivo is possible using DCE MRI. Although this study has many limitations it gives us the first DCE MRI values that provide a potential standard for future research into placental perfusion methods and suggests that placental functional parameters are altered in IUGR pregnancies.
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Affiliation(s)
- Benjamin Deloison
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Chloé Arthuis
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital mère-enfant, CHU Nantes, Nantes, France
| | - Gabriel Benchimol
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Daniel Balvay
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Laurence Bussieres
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
| | - Anne-Elodie Millischer
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - David Grévent
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Cécile Butor
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
| | - Gihad Chalouhi
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Houman Mahallati
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
| | - Olivier Hélénon
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Bertrand Tavitian
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Olivier Clement
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Yves Ville
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
| | - Nathalie Siauve
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
- Service de Radiologie, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (APHP), Colombes, France
| | - Laurent Julien Salomon
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
- * E-mail:
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Hutter J, Ho A, Jackson LH, Slator PJ, Chappell LC, Hajnal JV, Rutherford MA. An efficient and combined placental T 1 -ADC acquisition in pregnancies with and without pre-eclampsia. Magn Reson Med 2021; 86:2684-2691. [PMID: 34268807 DOI: 10.1002/mrm.28809] [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: 11/13/2020] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE To provide a new approach to jointly assess microstructural and molecular properties of the human placenta in vivo fast and efficiently and to present initial evidence in cohorts of healthy pregnancies and those affected by pre-eclampsia. METHODS Slice and diffusion preparation shuffling, built on the previously proposed ZEBRA method, is presented as a robust and fast way to obtain T 1 and apparent diffusivity coefficient (ADC) values. Joint modeling and evaluation is performed on a cohort of healthy and pre-eclamptic participants at 3T. RESULTS The datasets show the ability to obtain robust and fast T 1 -ADC measurements. Significant decay over gestation in T 1 (-11 ms/week, P < . 05 ) and a trend toward significance in ADC (-0.23 mm/ s 2 /week, P = .08) values can be observed in a control cohort. Values for the pre-eclamptic pregnancies show a negative trend for both ADC and T 1 . CONCLUSIONS The presented sequence allows the simultaneous acquisition of 2 of the most promising quantitative parameters to study placental insufficiency-identified individually as relevant in previous studies-in under 2 minutes. This allows dynamic assessment of physiological processes, reduced inconsistency in spatial comparisons due to reduced motion artefacts and opens novel avenues for analysis. Initial results in pre-eclamptic placentas, with depicted changes in both ADC and T 1 , illustrate its potential to identify cases of placental insufficiency. Future work will focus on expanding the field-of-view using multi-band acceleration techniques and the expansion to larger and more diverse patient groups.
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Affiliation(s)
- Jana Hutter
- Center for Medical Engineering, King's College London, London, UK
- Center for the Developing Brain, School of Biomedical Engineering and Imaging, King's College London, London, UK
| | - Alison Ho
- Academic Women's Health Department, King's College London, London, UK
| | - Laurence H Jackson
- Center for Medical Engineering, King's College London, London, UK
- Center for the Developing Brain, School of Biomedical Engineering and Imaging, King's College London, London, UK
| | - Paddy J Slator
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Lucy C Chappell
- Academic Women's Health Department, King's College London, London, UK
| | - Joseph V Hajnal
- Center for Medical Engineering, King's College London, London, UK
- Center for the Developing Brain, School of Biomedical Engineering and Imaging, King's College London, London, UK
| | - Mary A Rutherford
- Center for Medical Engineering, King's College London, London, UK
- Center for the Developing Brain, School of Biomedical Engineering and Imaging, King's College London, London, UK
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9
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Markovic S, Roussel T, Neeman M, Frydman L. Deuterium Magnetic Resonance Imaging and the Discrimination of Fetoplacental Metabolism in Normal and L-NAME-Induced Preeclamptic Mice. Metabolites 2021; 11:metabo11060376. [PMID: 34200839 PMCID: PMC8230481 DOI: 10.3390/metabo11060376] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022] Open
Abstract
Recent magnetic resonance studies in healthy and cancerous organs have concluded that deuterated metabolites possess highly desirable properties for mapping non-invasively and, as they happen, characterizing glycolysis and other biochemical processes in animals and humans. A promising avenue of this deuterium metabolic imaging (DMI) approach involves looking at the fate of externally administered 2H6,6′-glucose, as it is taken up and metabolized into different products as a function of time. This study employs deuterium magnetic resonance to follow the metabolism of wildtype and preeclamptic pregnant mice models, focusing on maternal and fetoplacental organs over ≈2 h post-injection. 2H6,6′-glucose uptake was observed in the placenta and in specific downstream organs such as the fetal heart and liver. Main metabolic products included 2H3,3′-lactate and 2H-water, which were produced in individual fetoplacental organs with distinct time traces. Glucose uptake in the organs of most preeclamptic animals appeared more elevated than in the control mice (p = 0.02); also higher was the production of 2H-water arising from this glucose. However, the most notable differences arose in the 2H3,3′-lactate concentration, which was ca. two-fold more abundant in the placenta (p = 0.005) and in the fetal (p = 0.01) organs of preeclamptic-like animals, than in control mice. This is consistent with literature reports about hypoxic conditions arising in preeclamptic and growth-restricted pregnancies, which could lead to an enhancement in anaerobic glycolysis. Overall, the present measurements suggest that DMI, a minimally invasive approach, may offer new ways of studying and characterizing health and disease in mammalian pregnancies, including humans.
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Affiliation(s)
- Stefan Markovic
- Department of Chemical and Biological Physics, Weizmann Institute of Science, Rehovot 7610001, Israel;
| | - Tangi Roussel
- Center for Magnetic Resonance in Biology and Medicine, 13385 Marseille, France;
| | - Michal Neeman
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 7610001, Israel;
| | - Lucio Frydman
- Department of Chemical and Biological Physics, Weizmann Institute of Science, Rehovot 7610001, Israel;
- Correspondence: ; Tel.: +972-8934-4093
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10
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Saini BS, Darby JRT, Marini D, Portnoy S, Lock MC, Yin Soo J, Holman SL, Perumal SR, Wald RM, Windrim R, Macgowan CK, Kingdom JC, Morrison JL, Seed M. An MRI approach to assess placental function in healthy humans and sheep. J Physiol 2021; 599:2573-2602. [PMID: 33675040 DOI: 10.1113/jp281002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/15/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Human placental function is evaluated using non-invasive Doppler ultrasound of umbilical and uterine artery pulsatility indices as measures of resistance in placental vascular beds, while measurement of placental oxygen consumption ( V O 2 ) is only possible during Caesarean delivery. This study shows the feasibility of using magnetic resonance imaging (MRI) in utero to measure blood flow and oxygen content in uterine and umbilical vessels to calculate oxygen delivery to and V O 2 by the gravid uterus, uteroplacenta and fetus. Normal late gestational human uteroplacental V O 2 by MRI was ∼4 ml min-1 kg-1 fetal weight, which was similar to our MRI measurements in sheep and to those previously measured using invasive techniques. Our MRI approach can quantify uteroplacental V O 2 , which involves the quantification of maternal- and fetal-placental blood flows, fetal oxygen delivery and V O 2 , and the oxygen gradient between uterine- and umbilical-venous blood, providing a comprehensive assessment of placental function with clinical potential. ABSTRACT It has not been feasible to perform routine clinical measurement of human placental oxygen consumption ( V O 2 ) and in vitro studies do not reflect true metabolism in utero. Here we propose an MRI method to non-invasively quantify in utero placental and fetal oxygen delivery ( D O 2 ) and V O 2 in healthy humans and sheep. Women (n = 20) and Merino sheep (n = 10; 23 sets of measurements) with singleton pregnancies underwent an MRI in late gestation (36 ± 2 weeks and 128 ± 9 days, respectively; mean ± SD). Blood flow (phase-contrast) and oxygen content (T1 and T2 relaxometry) were measured in the major uterine- and umbilical-placental vessels, allowing calculation of uteroplacental and fetal D O 2 and V O 2 . Maternal D O 2 (ml min-1 kg-1 fetus) to the gravid uterus was similar in humans and sheep (human = 54 ± 15, sheep = 53 ± 21, P = 0.854), while fetal D O 2 (human = 25 ± 4, sheep = 22 ± 5, P = 0.049) was slightly lower in sheep. Uteroplacental and fetal V O 2 (ml min-1 kg-1 fetus; uteroplacental: human = 4.1 ± 1.5, sheep = 3.5 ± 1.9, P = 0.281; fetus: human = 6.8 ± 1.3, sheep = 7.2 ± 1.7, P = 0.426) were similar between species. Late gestational uteroplacental:fetal V O 2 ratio did not change with age (human, P = 0.256; sheep, P = 0.121). Human umbilical blood flow (ml min-1 kg-1 fetus) decreased with advancing age (P = 0.008), while fetal V O 2 was preserved through an increase in oxygen extraction (P = 0.046). By contrast, sheep fetal V O 2 was preserved through stable umbilical flow (ml min-1 kg-1 ; P = 0.443) and oxygen extraction (P = 0.582). MRI derived measurements of uteroplacental and fetal V O 2 between humans and sheep were similar and in keeping with prior data obtained using invasive techniques. Taken together, these data confirm the reliability of our approach, which offers a novel clinical 'placental function test'.
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Affiliation(s)
- Brahmdeep S Saini
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Jack R T Darby
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Davide Marini
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Sharon Portnoy
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada
| | - Mitchell C Lock
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Jia Yin Soo
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Stacey L Holman
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Sunthara R Perumal
- Preclinical, Imaging and Research Laboratories, South Australian Health and Medical Research Institute, Adelaide, South Australia, 5086, Australia
| | - Rachel M Wald
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, M5G 2N2, Canada
| | - Rory Windrim
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1E2, Canada
| | - Christopher K Macgowan
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada.,Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1L7, Canada
| | - John C Kingdom
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1E2, Canada
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Mike Seed
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.,Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada.,Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1E2, Canada
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11
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The application of in utero magnetic resonance imaging in the study of the metabolic and cardiovascular consequences of the developmental origins of health and disease. J Dev Orig Health Dis 2020; 12:193-202. [PMID: 33308364 PMCID: PMC8162788 DOI: 10.1017/s2040174420001154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Observing fetal development in utero is vital to further the understanding of later-life diseases. Magnetic resonance imaging (MRI) offers a tool for obtaining a wealth of information about fetal growth, development, and programming not previously available using other methods. This review provides an overview of MRI techniques used to investigate the metabolic and cardiovascular consequences of the developmental origins of health and disease (DOHaD) hypothesis. These methods add to the understanding of the developing fetus by examining fetal growth and organ development, adipose tissue and body composition, fetal oximetry, placental microstructure, diffusion, perfusion, flow, and metabolism. MRI assessment of fetal growth, organ development, metabolism, and the amount of fetal adipose tissue could give early indicators of abnormal fetal development. Noninvasive fetal oximetry can accurately measure placental and fetal oxygenation, which improves current knowledge on placental function. Additionally, measuring deficiencies in the placenta’s transport of nutrients and oxygen is critical for optimizing treatment. Overall, the detailed structural and functional information provided by MRI is valuable in guiding future investigations of DOHaD.
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12
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Bockoven C, Gastfield RD, Victor T, Venkatasubramanian PN, Wyrwicz AM, Ernst LM. Correlation of Placental Magnetic Resonance Imaging With Histopathologic Diagnosis: Detection of Aberrations in Structure and Water Diffusivity. Pediatr Dev Pathol 2020; 23:260-266. [PMID: 31870210 DOI: 10.1177/1093526619895438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Noninvasive methods to identify placental pathologic conditions are being sought in order to recognize these conditions at an earlier stage leading to improved clinical interventions and perinatal outcomes. The objective of this study was to examine fixed tissue slices of placenta by T2- and diffusion-weighted magnetic resonance imaging (MRI) and correlate the images with placental pathologic findings defined by routine gross and histologic examination. METHODS Four formalin-fixed placentas with significant placental pathology (maternal vascular malperfusion, chronic villitis of unknown etiology, and massive perivillous fibrin deposition) and 2 histologically normal placentas were evaluated by high-resolution MRI. Representative placental slices were selected (2 cm long and 10 mm wide) and rehydrated. Imaging was performed on a Bruker Avance 14.1 T microimager. Diffusion-weighted images were acquired from 16 slices using slice thickness 0.5 mm and in-plane resolution approximately 100 µm × 100 µm. T2 maps were obtained from the same slices. T2 relaxation time and apparent diffusion coefficient (ADC) were acquired from representative regions of interest and compared between normal and diseased placentas. RESULTS In T2- and diffusion-weighted images, the placental microstructure differed subjectively between diseased and normal placentas. Furthermore, diseased placentas showed statistically significantly longer mean T2 relaxation times and generally higher mean ADC. CONCLUSION Diffusion- and T2-weighted MRI can potentially be used to detect significant placental pathology by using T2 relaxation time and ADC as markers of altered placental microstructure.
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Affiliation(s)
- Crystal Bockoven
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois
| | - Roland D Gastfield
- Center for Basic MR Research, Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois
| | - Thomas Victor
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois
| | | | - Alice M Wyrwicz
- Center for Basic MR Research, Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois
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13
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Dellschaft NS, Hutchinson G, Shah S, Jones NW, Bradley C, Leach L, Platt C, Bowtell R, Gowland PA. The haemodynamics of the human placenta in utero. PLoS Biol 2020; 18:e3000676. [PMID: 32463837 PMCID: PMC7255609 DOI: 10.1371/journal.pbio.3000676] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
We have used magnetic resonance imaging (MRI) to provide important new insights into the function of the human placenta in utero. We have measured slow net flow and high net oxygenation in the placenta in vivo, which are consistent with efficient delivery of oxygen from mother to fetus. Our experimental evidence substantiates previous hypotheses on the effects of spiral artery remodelling in utero and also indicates rapid venous drainage from the placenta, which is important because this outflow has been largely neglected in the past. Furthermore, beyond Braxton Hicks contractions, which involve the entire uterus, we have identified a new physiological phenomenon, the ‘utero-placental pump’, by which the placenta and underlying uterine wall contract independently of the rest of the uterus, expelling maternal blood from the intervillous space. MRI provides important new insights into the function of the human placenta, revealing slow net flow and high, uniform oxygenation in healthy pregnancies, detecting changes that will lead to compromised oxygen delivery to the fetus in preeclampsia, and identifying a new physiological phenomenon, the ‘utero-placental pump’.
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Affiliation(s)
- Neele S. Dellschaft
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - George Hutchinson
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Simon Shah
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Nia W. Jones
- Department of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Chris Bradley
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Lopa Leach
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Craig Platt
- Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Penny A. Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- * E-mail:
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14
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Harteveld AA, Hutter J, Franklin SL, Jackson LH, Rutherford M, Hajnal JV, van Osch MJP, Bos C, De Vita E. Systematic evaluation of velocity-selective arterial spin labeling settings for placental perfusion measurement. Magn Reson Med 2020; 84:1828-1843. [PMID: 32141655 PMCID: PMC7384055 DOI: 10.1002/mrm.28240] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 01/15/2023]
Abstract
Purpose Placental function is key for successful human pregnancies. Perfusion may be a sensitive marker for the in vivo assessment of placental function. Arterial spin labeling (ASL) MRI enables noninvasive measurement of tissue perfusion and it was recently suggested that ASL with velocity‐selective (VS) labeling could be advantageous in the placenta. We systematically evaluated essential VS‐ASL sequence parameters to determine optimal settings for efficient placental perfusion measurements. Methods Eleven pregnant women were scanned at 3T using VS‐ASL with 2D multislice echo planar imaging (EPI)‐readout. One reference VS‐ASL scan was acquired in all subjects; within subgroups the following parameters were systematically varied: cutoff velocity, velocity encoding direction, and inflow time. Visual evaluation and region of interest analyses were performed to compare perfusion signal differences between acquisitions. Results In all subjects, a perfusion pattern with clear hyperintense focal regions was observed. Perfusion signal decreased with inflow time and cutoff velocity. Subject‐specific dependence on velocity encoding direction was observed. High temporal signal‐to‐noise ratios with high contrast on the perfusion images between the hyperintense regions and placental tissue were seen at ~1.6 cm/s cutoff velocity and ~1000 ms inflow time. Evaluation of measurements at multiple inflow times revealed differences in blood flow dynamics between placental regions. Conclusion Placental perfusion measurements are feasible at 3T using VS‐ASL with 2D multislice EPI‐readout. A clear dependence of perfusion signal on VS labeling parameters and inflow time was demonstrated. Whereas multiple parameter combinations may advance the interpretation of placental circulation dynamics, this study provides a basis to select an effective set of parameters for the observation of placenta perfusion natural history and its potential pathological changes.
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Affiliation(s)
- Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jana Hutter
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Suzanne L Franklin
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,C.J. Gorter Center for high field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Laurence H Jackson
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Mary Rutherford
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Matthias J P van Osch
- C.J. Gorter Center for high field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Clemens Bos
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Enrico De Vita
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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15
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Liu D, Shao X, Danyalov A, Chanlaw T, Masamed R, Wang DJJ, Janzen C, Devaskar SU, Sung K. Human Placenta Blood Flow During Early Gestation With Pseudocontinuous Arterial Spin Labeling MRI. J Magn Reson Imaging 2019; 51:1247-1257. [PMID: 31680405 DOI: 10.1002/jmri.26944] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Noninvasive measurement of placental blood flow is the major technical challenge for predicting ischemic placenta (IPD). Pseudocontinuous arterial spin labeling (pCASL) MRI was recently shown to be promising, but the potential value in predicting the subsequence development of IPD is not known. PURPOSE To derive global and regional placental blood flow parameters from longitudinal measurements of pCASL MRI and to assess the associations between perfusion-related parameters and IPD. STUDY TYPE Prospective. POPULATION Eighty-four women completed two pCASL MRI scans (first; 14-18 weeks and second; 19-24 weeks) from prospectively recruited 118 subjects. A total of 69 subjects were included for the analysis, of which 15 subjects developed IPD. FIELD STRENGTH/SEQUENCE 3T/T2 -weighted half-Fourier single-shot turbo spin-echo (HASTE) and pCASL. ASSESSMENT Four perfusion-related parameters in the placenta were derived: placenta volume, placental blood flow (PBF), high PBF (hPBF), and relative hPBF. The longitudinal changes of the parameters and their association with IPD were tested after being normalizing to the 16th and 20th weeks of gestation. STATISTICAL TESTS Comparisons between two gestational ages within subjects were performed using the paired Wilcoxon tests, and comparisons between normal and IPD groups were performed using the unpaired Wilcoxon tests. RESULTS The difference between the first and second MRI scans was statistically significant for volume (156.6 cm3 vs. 269.7 cm3 , P < 0.001) and PBF (104.9 ml/100g/min vs. 111.3 ml/100g/min, P = 0.02) for normal subjects, indicating an increase in pregnancy with advancing gestation. Of the parameters tested, the difference between the normal and IPD subjects was most pronounced in hPBF (278.1 ml/100g/min vs. 180.7 ml/100g/min, P < 0.001) and relative hPBF (259.1% vs. 183.2%, P < 0.001) at 16 weeks. DATA CONCLUSION The high perfusion-related image parameters for IPD were significantly decreased from normal pregnancy at 14-18 weeks of gestation. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1 J. Magn. Reson. Imaging 2020;51:1247-1257.
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Affiliation(s)
- Dapeng Liu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, California, USA
| | - Alibek Danyalov
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Teresa Chanlaw
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Rinat Masamed
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, California, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, Division of Perinatology Maternal Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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16
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Afacan O, Estroff JA, Yang E, Barnewolt CE, Connolly SA, Parad RB, Mulkern RV, Warfield SK, Gholipour A. Fetal Echoplanar Imaging: Promises and Challenges. Top Magn Reson Imaging 2019; 28:245-254. [PMID: 31592991 PMCID: PMC6788763 DOI: 10.1097/rmr.0000000000000219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Fetal magnetic resonance imaging (MRI) has been gaining increasing interest in both clinical radiology and research. Echoplanar imaging (EPI) offers a unique potential, as it can be used to acquire images very fast. It can be used to freeze motion, or to get multiple images with various contrast mechanisms that allow studying the microstructure and function of the fetal brain and body organs. In this article, we discuss the current clinical and research applications of fetal EPI. This includes T2*-weighted imaging to better identify blood products and vessels, using diffusion-weighted MRI to investigate connections of the developing brain and using functional MRI (fMRI) to identify the functional networks of the developing brain. EPI can also be used as an alternative structural sequence when banding or standing wave artifacts adversely affect the mainstream sequences used routinely in structural fetal MRI. We also discuss the challenges with EPI acquisitions, and potential solutions. As EPI acquisitions are inherently sensitive to susceptibility artifacts, geometric distortions limit the use of high-resolution EPI acquisitions. Also, interslice motion and transmit and receive field inhomogeneities may create significant artifacts in fetal EPI. We conclude by discussing promising research directions to overcome these challenges to improve the use of EPI in clinical and research applications.
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Affiliation(s)
- Onur Afacan
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Judy A. Estroff
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Advanced Fetal Care Center, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Edward Yang
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Advanced Fetal Care Center, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Carol E. Barnewolt
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Advanced Fetal Care Center, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Susan A. Connolly
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Advanced Fetal Care Center, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Richard B. Parad
- Advanced Fetal Care Center, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Robert V. Mulkern
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Simon K. Warfield
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Ali Gholipour
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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17
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Hutter J, Harteveld AA, Jackson LH, Franklin S, Bos C, van Osch MJP, O'Muircheartaigh J, Ho A, Chappell L, Hajnal JV, Rutherford M, De Vita E. Perfusion and apparent oxygenation in the human placenta (PERFOX). Magn Reson Med 2019; 83:549-560. [PMID: 31433077 PMCID: PMC6825519 DOI: 10.1002/mrm.27950] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE To study placental function-both perfusion and an oxygenation surrogate ( T 2 * )-simultaneously and quantitatively in-vivo. METHODS Fifteen pregnant women were scanned on a 3T MR scanner. For perfusion measurements, a velocity selective arterial spin labeling preparation module was placed before a multi-echo gradient echo EPI readout to integrate T 2 * and perfusion measurements in 1 joint perfusion-oxygenation (PERFOX) acquisition. Joint motion correction and quantification were performed to evaluate changes in T 2 * and perfusion over GA. RESULTS The optimized integrated PERFOX protocol and post-processing allowed successful visualization and quantification of perfusion and T 2 * in all subjects. Areas of high T 2 * and high perfusion appear to correspond to placental sub-units and show a systematic offset in location along the maternal-fetal axis. The areas of highest perfusion are consistently closer to the maternal basal plate and the areas of highest T 2 * closer to the fetal chorionic plate. Quantitative results show a strong negative correlation of gestational age with T 2 * and weak negative correlation with perfusion. CONCLUSIONS A strength of the joint sequence is that it provides truly simultaneous and co-registered estimates of local T 2 * and perfusion, however, to achieve this, the time per slice is prolonged compared to a perfusion only scan which can potentially limit coverage. The achieved interlocking can be particularly useful when quantifying transient physiological effects such as uterine contractions. PERFOX opens a new avenue to elucidate the relationship between maternal supply and oxygen uptake, both of which are central to placental function and dysfunction.
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Affiliation(s)
- Jana Hutter
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Anita A. Harteveld
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Laurence H. Jackson
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Suzanne Franklin
- C.J. Gorter Center for High Field MRIDepartment of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Clemens Bos
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Matthias J. P. van Osch
- C.J. Gorter Center for High Field MRIDepartment of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jonathan O'Muircheartaigh
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Alison Ho
- Academic Women's Health DepartmentKing's College LondonLondonUnited Kingdom
| | - Lucy Chappell
- Academic Women's Health DepartmentKing's College LondonLondonUnited Kingdom
| | - Joseph V. Hajnal
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Mary Rutherford
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Enrico De Vita
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
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18
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Ludwig KD, Fain SB, Nguyen SM, Golos TG, Reeder SB, Bird IM, Shah DM, Wieben OE, Johnson KM. Perfusion of the placenta assessed using arterial spin labeling and ferumoxytol dynamic contrast enhanced magnetic resonance imaging in the rhesus macaque. Magn Reson Med 2019; 81:1964-1978. [PMID: 30357902 PMCID: PMC6715150 DOI: 10.1002/mrm.27548] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 08/29/2018] [Accepted: 09/03/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE To investigate the correspondence between arterial spin labeling (ASL) flow-sensitive alternating inversion recovery (FAIR) and ferumoxytol DCE MRI for the assessment of placental intervillous perfusion. METHODS Ten pregnant macaques in late second trimester were imaged at 3 T using a 2D ASL FAIR, with and without outer-volume saturation pulses used to control the bolus width, and a 3D ferumoxytol DCE-MRI acquisition. The ASL tagged/control pairs were averaged, subtracted, and normalized to create perfusion ratio maps. Contrast arrival time and uptake slope were estimated by fitting the DCE data to a sigmoid function. Macaques (N = 4) received interleukin-1β to induce inflammation and disrupt perfusion. RESULTS The FAIR tag modification with outer-volume saturation reduced the median ASL ratio percentage compared with conventional FAIR (0.64% ± 1.42% versus 0.71% ± 2.00%; P < .05). Extended ferumoxytol arrival times (34 ± 25 seconds) were observed across the placenta. No significant DCE signal change was measured in fetal tissue ( - 0.6% ± 3.0%; P = .52) or amniotic fluid (1.9% ± 8.8%; P = .59). High ASL ratio was significantly correlated with early arrival time and high uptake slope (P < .05), but ASL signal was not above noise in late-DCE-enhancing regions. No significant differences were observed in perfusion measurements between the interleukin-1β and controls (P > .05). CONCLUSION The ASL-FAIR and ferumoxytol DCE-MRI methods are feasible to detect early blood delivery to the macaque placenta. Outer volume saturation reduced the high macrovascular ASL signal. Interleukin-1β exposure did not alter placental intervillous perfusion. An endogenous-labeling perfusion technique is limited due to extended transit times for flow within the placenta beyond the immediate vicinity of the maternal spiral arteries.
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Affiliation(s)
- Kai D. Ludwig
- Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, Madison, WI, USA 53705
| | - Sean B. Fain
- Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, Madison, WI, USA 53705
- Radiology, University of Wisconsin, 600 Highland Ave, Madison, Madison, WI, USA 53792
- Biomedical Engineering, University of Wisconsin, 1415 Engineering Dr, Madison, Madison, WI, USA 53706
| | - Sydney M. Nguyen
- Wisconsin National Primate Research Center, 1220 Capitol Court, Madison, WI, USA 53715
- Obstetrics and Gynecology, University of Wisconsin, 600 Highland Ave, Madison, WI, USA 53792
| | - Thaddeus G. Golos
- Wisconsin National Primate Research Center, 1220 Capitol Court, Madison, WI, USA 53715
- Obstetrics and Gynecology, University of Wisconsin, 600 Highland Ave, Madison, WI, USA 53792
- Comparative Biosciences, University of Wisconsin, 2015 Linden Dr, Madison, Madison, WI, USA 53706
| | - Scott B. Reeder
- Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, Madison, WI, USA 53705
- Radiology, University of Wisconsin, 600 Highland Ave, Madison, Madison, WI, USA 53792
- Biomedical Engineering, University of Wisconsin, 1415 Engineering Dr, Madison, Madison, WI, USA 53706
- Medicine, University of Wisconsin, 600 Highland Ave, Madison, Madison, WI, USA 53792
- Emergency Medicine, University of Wisconsin, 600 Highland Ave, Madison, Madison, WI, USA 53792
| | - Ian M. Bird
- Obstetrics and Gynecology, University of Wisconsin, 600 Highland Ave, Madison, WI, USA 53792
| | - Dinesh M. Shah
- Obstetrics and Gynecology, University of Wisconsin, 600 Highland Ave, Madison, WI, USA 53792
| | - Oliver E. Wieben
- Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, Madison, WI, USA 53705
- Radiology, University of Wisconsin, 600 Highland Ave, Madison, Madison, WI, USA 53792
| | - Kevin M. Johnson
- Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, Madison, WI, USA 53705
- Radiology, University of Wisconsin, 600 Highland Ave, Madison, Madison, WI, USA 53792
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19
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Non-invasive assessment of placental perfusion in vivo using arterial spin labeling (ASL) MRI: A preclinical study in rats. Placenta 2019; 77:39-45. [PMID: 30827354 DOI: 10.1016/j.placenta.2019.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 01/13/2019] [Accepted: 01/21/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Non-invasive assessment of placental perfusion is of great interest to characterize placental function in clinical practice. This article proposes a strictly non-invasive MRI technique using ASL to quantify placental blood flow in vivo. The aim of this study was to develop a fMRI tool to quantify placental blood flow (PBF) in rat, by using arterial spin labeling (ASL) MRI at 4.7 T. MATERIALS AND METHODS MRI was performed with a dedicated magnet for small animals, in pregnant rats on day 20 of the 22-day gestation period. A Look-Locker flow-sensitive alternating inversion recovery gradient echo sequence was developed as ASL technique (TE: 1.55 ms; TR: 3.5 ms, TI: 56 ms, deltaTI: 56 ms, FA: 20°, Matrix: 128 × 128, 8 segments, 4 Nex). Labeling was performed with global and slice-selective inversions, and T1 map was obtained for each mode of inversion. PBF was then derived from a compartmental model of the variation of T1 between global and slice-selective inversions. RESULTS The full protocol was completed and ASL image post-processing was successful in 18 rats. Forty-seven placentas were analyzed, with a mean PBF of 147 ± 70 ml/min/100 g of placenta, consistent with published values of placental perfusion using invasive techniques. CONCLUSION ASL MRI is feasible for the quantification of PBF in rats at 4.7 T. This technique, which requires no administration of contrast media, could have implications for non-invasive longitudinal and in vivo animal studies and may be useful for the management of human pregnancies.
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20
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Kosaka N, Fujiwara Y, Kurokawa T, Matsuda T, Kanamoto M, Takei N, Takata K, Takahashi J, Yoshida Y, Kimura H. Evaluation of retained products of conception using pulsed continuous arterial spin-labeling MRI: clinical feasibility and initial results. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2018; 31:577-584. [PMID: 29549455 DOI: 10.1007/s10334-018-0681-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We evaluated the vascularity of retained products of conception (RPOC) using arterial spin-labeling magnetic resonance imaging (ASL-MRI) to clarify the clinical feasibility of this approach. MATERIALS AND METHODS A pulsed-continuous ASL sequence with echo-planar imaging (EPI) acquisitions was used. Ten consecutive patients with RPOC were enrolled. All ASL images were evaluated visually and semiquantitatively and compared with the findings of Doppler ultrasound (US) and dynamic contrast-enhanced MRI (DCE-MRI). RESULTS The technical success rate was 93.7% (15/16 scans). One failed case was excluded from the analysis. Six patients showed quite high signals over RPOC, while three patients showed no abnormal signals. Doppler US alone failed to detect the hypervascular area in two cases, and ASL-MRI alone failed in three. A significant linear correlation was found between semiquantitative values of ASL-MRI and DCE-MRI. All six patients showing high signals on ASL-MRI underwent follow-up MRI after therapy. High signals in five patients decreased visually and semiquantitatively, while one patient showed signal increases. CONCLUSION Evaluation of RPOC using ASL-MRI was clinically feasible and response to therapy could be evaluated. However, the clinical advantages over conventional imaging remain unclear and need to be evaluated.
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Affiliation(s)
- Nobuyuki Kosaka
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Yasuhiro Fujiwara
- Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto, Kumamoto, 862-0976, Japan
| | - Tetsuji Kurokawa
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Tsuyoshi Matsuda
- Global MR Applications and Workflow, GE Healthcare Japan Corporation, 4-7-127, Asahigaoka, Hino, Tokyo, 191-8503, Japan
| | - Masayuki Kanamoto
- Radiological Center, University of Fukui Hospital, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Naoyuki Takei
- Global MR Applications and Workflow, GE Healthcare Japan Corporation, 4-7-127, Asahigaoka, Hino, Tokyo, 191-8503, Japan
| | - Kenji Takata
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Jin Takahashi
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
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21
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Nye GA, Ingram E, Johnstone ED, Jensen OE, Schneider H, Lewis RM, Chernyavsky IL, Brownbill P. Human placental oxygenation in late gestation: experimental and theoretical approaches. J Physiol 2018; 596:5523-5534. [PMID: 29377190 PMCID: PMC6265570 DOI: 10.1113/jp275633] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/18/2018] [Indexed: 01/26/2023] Open
Abstract
The placenta is crucial for life. It is an ephemeral but complex organ acting as the barrier interface between maternal and fetal circulations, providing exchange of gases, nutrients, hormones, waste products and immunoglobulins. Many gaps exist in our understanding of the detailed placental structure and function, particularly in relation to oxygen handling and transfer in healthy and pathological states in utero. Measurements to understand oxygen transfer in vivo in the human are limited, with no general agreement on the most appropriate methods. An invasive method for measuring partial pressure of oxygen in the intervillous space through needle electrode insertion at the time of Caesarean sections has been reported. This allows for direct measurements in vivo whilst maintaining near normal placental conditions; however, there are practical and ethical implications in using this method for determination of placental oxygenation. Furthermore, oxygen levels are likely to be highly heterogeneous within the placenta. Emerging non-invasive techniques, such as MRI, and ex vivo research are capable of enhancing and improving current imaging methodology for placental villous structure and increase the precision of oxygen measurement within placental compartments. These techniques, in combination with mathematical modelling, have stimulated novel cross-disciplinary approaches that could advance our understanding of placental oxygenation and its metabolism in normal and pathological pregnancies, improving clinical treatment options and ultimately outcomes for the patient.
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Affiliation(s)
- Gareth A Nye
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK.,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Emma Ingram
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK.,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Edward D Johnstone
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK.,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Oliver E Jensen
- School of Mathematics, University of Manchester, Manchester, M13 9PL, UK
| | - Henning Schneider
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, CH-3010, Bern, Switzerland
| | - Rohan M Lewis
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Igor L Chernyavsky
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK.,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK.,School of Mathematics, University of Manchester, Manchester, M13 9PL, UK
| | - Paul Brownbill
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK.,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
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22
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Placental physiology monitored by hyperpolarized dynamic 13C magnetic resonance. Proc Natl Acad Sci U S A 2018; 115:E2429-E2436. [PMID: 29444856 DOI: 10.1073/pnas.1715175115] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Placental functions, including transport and metabolism, play essential roles in pregnancy. This study assesses such processes in vivo, from a hyperpolarized MRI perspective. Hyperpolarized urea, bicarbonate, and pyruvate were administered to near-term pregnant rats, and all metabolites displayed distinctive behaviors. Little evidence of placental barrier crossing was observed for bicarbonate, at least within the timescales allowed by 13C relaxation. By contrast, urea was observed to cross the placental barrier, with signatures visible from certain fetal organs including the liver. This was further evidenced by the slower decay times observed for urea in placentas vis-à-vis other maternal compartments and validated by mass spectrometric analyses. A clear placental localization, as well as concurrent generation of hyperpolarized lactate, could also be detected for [1-13C]pyruvate. These metabolites also exhibited longer lifetimes in the placentas than in maternal arteries, consistent with a metabolic activity occurring past the trophoblastic interface. When extended to a model involving the administration of a preeclampsia-causing chemical, hyperpolarized MR revealed changes in urea's transport, as well as decreases in placental glycolysis vs. the naïve animals. These distinct behaviors highlight the potential of hyperpolarized MR for the early, minimally invasive detection of aberrant placental metabolism.
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23
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Zun Z, Limperopoulos C. Placental perfusion imaging using velocity-selective arterial spin labeling. Magn Reson Med 2018; 80:1036-1047. [PMID: 29436733 DOI: 10.1002/mrm.27100] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/30/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Zungho Zun
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.,Division of Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.,Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC.,Department of Radiology, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Catherine Limperopoulos
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.,Division of Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.,Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC.,Department of Radiology, School of Medicine and Health Sciences, George Washington University, Washington, DC
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24
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Non-Invasive Placental Perfusion Imaging in Pregnancies Complicated by Fetal Heart Disease Using Velocity-Selective Arterial Spin Labeled MRI. Sci Rep 2017; 7:16126. [PMID: 29170468 PMCID: PMC5700998 DOI: 10.1038/s41598-017-16461-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022] Open
Abstract
The placenta is a vital organ for fetal growth and development during pregnancy. Congenital heart disease (CHD) is a leading cause of morbidity and mortality in newborns. Despite the parallel development of the placenta and fetal heart early in pregnancy, very few studies suggested an association between placental dysfunction and fetal CHD. In this study, we report placental perfusion of healthy pregnancies and pregnancies complicated by fetal CHD measured using advanced fetal MRI techniques. We studied forty-eight pregnant women (31 healthy volunteers and 17 with fetal CHD) that underwent fetal MRI during their second or third trimester of pregnancy. Placental perfusion imaging was performed using velocity-selective arterial spin labeling (VSASL) and 3D image acquisition with whole-placenta coverage. In pregnancies with fetal CHD, global placental perfusion significantly decreased and regional variation of placental perfusion significantly increased with advancing gestational age; however, no such correlation was found in healthy pregnancies. Also, global placental perfusion was significantly higher in fetal CHD versus controls, in the lateral side-lying patient position versus supine, and in the posterior placental position versus anterior placental position. This study reports for the first time non-invasive whole-placenta perfusion imaging in utero. These data suggest that placental VSASL may serve as a potential biomarker of placental dysfunction in fetuses diagnosed with CHD.
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25
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Shao X, Liu D, Martin T, Chanlaw T, Devaskar SU, Janzen C, Murphy AM, Margolis D, Sung K, Wang DJJ. Measuring human placental blood flow with multidelay 3D GRASE pseudocontinuous arterial spin labeling at 3T. J Magn Reson Imaging 2017; 47:1667-1676. [PMID: 29135072 DOI: 10.1002/jmri.25893] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/26/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Placenta influences the health of both a woman and her fetus during pregnancy. Maternal blood supply to placenta can be measured noninvasively using arterial spin labeling (ASL). PURPOSE To present a multidelay pseudocontinuous arterial spin labeling (pCASL) combined with a fast 3D inner-volume gradient- and spin-echo (GRASE) imaging technique to simultaneously measure placental blood flow (PBF) and arterial transit time (ATT), and to study PBF and ATT evolution with gestational age during the second trimester. The PBF values were compared with uterine arterial Doppler ultrasound to assess its potential clinical utility. STUDY TYPE This was a prospective study. SUBJECTS Thirty-four pregnant women. FIELD STRENGTH/SEQUENCE Multidelay 3D inner-volume GRASE pCASL sequence on 3T MR scanners. ASSESSMENT Subjects underwent two longitudinal MRI scans within the second trimester, conducted between 14-16 and 19-22 weeks of gestational age, respectively. Placental perfusion was measured using the free-breathing pCASL sequence at three postlabeling delays (PLDs), followed by offline motion correction and model fitting for estimation of PBF and ATT. STATISTICAL TESTS A paired t-test was conducted to evaluate the significance of PBF/ATT variations with placental development. A two-sample t-test was conducted to evaluate the significance of PBF difference in subjects with and without early diastolic notch. RESULTS The mean PBF and ATT for the second trimester were 111.4 ± 26.7 ml/100g/min and 1387.5 ± 88.0 msec, respectively. The average PBF increased by 10.4% (P < 0.05), while no significant change in ATT (P = 0.72) was found along gestational ages during the second trimester. PBF decreased 20.3% (P < 0.01) in subjects with early diastolic notches in ultrasound flow waveform patterns. DATA CONCLUSION Multidelay pCASL with inner-volume 3D GRASE is promising for noninvasive assessment of PBF during pregnancy. Its clinical use for the detection of aberrations in placental function and prediction of fetal developmental disorders awaits evaluation. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1667-1676.
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Affiliation(s)
- Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Dapeng Liu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Thomas Martin
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Teresa Chanlaw
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Aisling M Murphy
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Daniel Margolis
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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26
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Fadl S, Moshiri M, Fligner CL, Katz DS, Dighe M. Placental Imaging: Normal Appearance with Review of Pathologic Findings. Radiographics 2017; 37:979-998. [PMID: 28493802 DOI: 10.1148/rg.2017160155] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The placenta plays a crucial role throughout pregnancy, and its importance may be overlooked during routine antenatal imaging evaluation. Detailed systematic assessment of the placenta at ultrasonography (US), the standard imaging examination during pregnancy, is important. Familiarity with the normal and abnormal imaging appearance of the placenta along with the multimodality and methodical approach for evaluation of its related abnormalities is necessary, so that radiologists can alert clinicians regarding appropriate prompt management decisions. This will potentially decrease fetal and maternal morbidity and mortality. This article reviews early placental formation and the expected imaging appearance of the placenta during pregnancy, as well as variations in its morphology. It also discusses various placental diseases and their potential clinical consequences. Placental pathologic conditions include abnormalities of placental size, cord insertion, placental and cord location, and placental adherence. Other conditions such as bleeding in and around the placenta, as well as trophoblastic and nontrophoblastic tumors of the placenta, are also discussed. US with Doppler imaging is the initial imaging modality of choice for placental evaluation. Magnetic resonance (MR) imaging is reserved for equivocal cases or when additional information is needed. Computed tomography (CT) has a limited role in evaluation of placental abnormalities because of the ionizing radiation exposure and the relatively limited assessment of the placenta; however, CT can provide important information in specific circumstances, particularly evaluation of trauma and staging of choriocarcinoma. This article also addresses recent techniques and updates in placental imaging, including elastography, diffusion-weighted MR imaging, and blood oxygen level-dependent (BOLD) MR imaging. These advanced imaging techniques may provide additional information in evaluation of abnormal placental adherence and new insights into placental pathophysiology in selected patients. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Shaimaa Fadl
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Mariam Moshiri
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Corinne L Fligner
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Douglas S Katz
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Manjiri Dighe
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
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Siauve N, Hayot PH, Deloison B, Chalouhi GE, Alison M, Balvay D, Bussières L, Clément O, Salomon LJ. Assessment of human placental perfusion by intravoxel incoherent motion MR imaging. J Matern Fetal Neonatal Med 2017; 32:293-300. [PMID: 28974131 DOI: 10.1080/14767058.2017.1378334] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To provide functional information on the human placenta, including perfusion, and diffusion, with no contrast agent injection, and to study correlations between intravoxel incoherent motion (IVIM) placental parameters and fetal growth. MATERIALS AND METHODS MRI was performed in women undergoing legal termination of pregnancy at 17-34 weeks, including a 4-b-value and 11-b-value DW sequences. The apparent diffusion coefficient (ADC), the restricted diffusion coefficient (D), the pseudoperfusion coefficient (D*), and the perfusion fraction (f) were calculated. Their relationships with gestational age, Z-scores for fetal and placental weight were evaluated by means of regression analysis. Logistic regression analysis was used to assess the ability of IVIM parameters to predict/detect intrauterine growth retardation (SGA). RESULTS Fifty-five pregnant women, including nine cases of SGA (16%), were included in the study. The ADC (n = 55) showed a quadratic correlation with gestational age (p < .001) and a linear correlation with the fetal weight Z-score (p = .02). Mean ADC values were significantly different between normally growing and SGA fetuses (2.37 ± 0.25 versus 2.29 ± 0.33 10-3.mm2.s-1, p=.048). The perfusion fraction f (n = 23) showed a quadratic correlation with gestational age (p = .017) and a linear correlation with the fetal weight Z - score (p = .008). Mean f values differed significantly between normally growing and SGA fetuses (42.55 ± 9.30% versus 27.94 ± 8.76%, p = .002). The receiver operating characteristics (ROC) curve for f to predict SGA was produced (area under the ROC curve = 0.9). CONCLUSIONS The observed association between f and fetal weight suggests that fMRI could be suitable for studying placental insufficiency and for identifying risk of SGA.
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Affiliation(s)
- Nathalie Siauve
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,c Assistance Publique: Hôpitaux de Paris , Hôpital Européen Georges Pompidou , Paris , France
| | - Pierre Humbert Hayot
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Benjamin Deloison
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Gihad E Chalouhi
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Marianne Alison
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France
| | - Daniel Balvay
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,e Plateforme d'Imagerie du Vivant , Université Paris Descartes, Sorbonne Paris Cité , Paris , France
| | - Laurence Bussières
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Olivier Clément
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France
| | - Laurent J Salomon
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
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28
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Mourier E, Tarrade A, Duan J, Richard C, Bertholdt C, Beaumont M, Morel O, Chavatte-Palmer P. Non-invasive evaluation of placental blood flow: lessons from animal models. Reproduction 2016; 153:R85-R96. [PMID: 27845691 DOI: 10.1530/rep-16-0428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/03/2016] [Accepted: 11/14/2016] [Indexed: 01/11/2023]
Abstract
In human obstetrics, placental vascularisation impairment is frequent as well as linked to severe pathological events (preeclampsia and intrauterine growth restriction), and there is a need for reliable methods allowing non-invasive evaluation of placental blood flow. Uteroplacental vascularisation is complex, and animal models are essential for the technical development and safety assessment of these imaging tools for human clinical use; however, these techniques can also be applied in the veterinary context. This paper reviews how ultrasound-based imaging methods such as 2D and 3D Doppler can provide valuable insight for the exploration of placental blood flow both in humans and animals and how new approaches such as the use of ultrasound contrast agents or ultrafast Doppler may allow to discriminate between maternal (non-pulsatile) and foetal (pulsatile) blood flow in the placenta. Finally, functional magnetic resonance imaging could also be used to evaluate placental blood flow, as indicated by studies in animal models, but its safety in human pregnancy still requires to be confirmed.
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Affiliation(s)
- E Mourier
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France .,PremUp FoundationParis, France
| | - A Tarrade
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
| | - J Duan
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - C Richard
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
| | - C Bertholdt
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - M Beaumont
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - O Morel
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - P Chavatte-Palmer
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
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29
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Sinding M, Peters DA, Frøkjaer JB, Christiansen OB, Petersen A, Uldbjerg N, Sørensen A. Placental magnetic resonance imaging T2* measurements in normal pregnancies and in those complicated by fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:748-754. [PMID: 26041014 DOI: 10.1002/uog.14917] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/27/2015] [Accepted: 05/31/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The magnetic resonance imaging (MRI) variable transverse relaxation time (T2*) depends on multiple factors, one important one being the presence of deoxyhemoglobin. We aimed to describe placental T2* measurements in normal pregnancies and in those with fetal growth restriction (FGR). METHODS We included 24 normal pregnancies at 24-40 weeks' gestation and four FGR cases with an estimated fetal weight below the 1(st) centile. Prior to MRI, an ultrasound examination, including Doppler flow measurements, was performed. The T2* value was calculated using a gradient echo MRI sequence with readout at 16 different echo times. In normal pregnancies, repeat T2* measurements were performed and interobserver reproducibility was assessed in order to estimate the reproducibility of the method. Placental histological examination was performed in the FGR cases. RESULTS The method was robust regarding the technical and interobserver reproducibility. However, some slice-to-slice variation existed owing to the heterogeneous nature of the normal placenta. We therefore based T2* estimations on the average of two slices from each placenta. In normal pregnancies, the placental T2* value decreased significantly with increasing gestational age, with mean ± SD values of 120 ± 17 ms at 24 weeks' gestation, 84 ± 16 ms at 32 weeks and 47 ± 17 ms at 40 weeks. Three FGR cases had abnormal Doppler flow, histological signs of maternal hypoperfusion and a reduced T2* value (Z-score < -3.5). In the fourth FGR case, Doppler flow, placental histology and T2* value (Z-score, -0.34) were normal. CONCLUSIONS The established reference values for placental T2* may be clinically useful, as T2* values were significantly lower in FGR cases with histological signs of maternal hypoperfusion. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Sinding
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - D A Peters
- Department of Clinical Engineering, Central Denmark Region, Aarhus, Denmark
| | - J B Frøkjaer
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - O B Christiansen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - A Petersen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - N Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - A Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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30
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Grigsby PL. Animal Models to Study Placental Development and Function throughout Normal and Dysfunctional Human Pregnancy. Semin Reprod Med 2016; 34:11-6. [PMID: 26752715 DOI: 10.1055/s-0035-1570031] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Abnormalities of placental development and function are known to underlie many pathologies of pregnancy, including spontaneous preterm birth, fetal growth restriction, and preeclampsia. A growing body of evidence also underscores the importance of placental dysfunction in the lifelong health of both mother and offspring. However, our knowledge regarding placental structure and function throughout pregnancy remains limited. Understanding the temporal growth and functionality of the human placenta throughout the entirety of gestation is important if we are to gain a better understanding of placental dysfunction. The utilization of new technologies and imaging techniques that could enable safe monitoring of placental growth and function in vivo has become a major focus area for the National Institutes of Child Health and Human Development, as evident by the establishment of the "Human Placenta Project." Many of the objectives of the Human Placenta Project will necessitate preclinical studies and testing in appropriately designed animal models that can be readily translated to the clinical setting. This review will describe the advantages and limitations of relevant animals such as the guinea pig, sheep, and nonhuman primate models that have been used to study the role of the placenta in fetal growth disorders, preeclampsia, or other maternal diseases during pregnancy.
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Affiliation(s)
- Peta L Grigsby
- Division of Reproductive and Developmental Sciences, Department of Obstetrics and Gynecology, Oregon Health and Science University, Beaverton, Oregon
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31
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Siauve N, Chalouhi GE, Deloison B, Alison M, Clement O, Ville Y, Salomon LJ. Functional imaging of the human placenta with magnetic resonance. Am J Obstet Gynecol 2015; 213:S103-14. [PMID: 26428488 DOI: 10.1016/j.ajog.2015.06.045] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/29/2022]
Abstract
Abnormal placentation is responsible for most failures in pregnancy; however, an understanding of placental functions remains largely concealed from noninvasive, in vivo investigations. Magnetic resonance imaging (MRI) is safe in pregnancy for magnetic fields of up to 3 Tesla and is being used increasingly to improve the accuracy of prenatal imaging. Functional MRI (fMRI) of the placenta has not yet been validated in a clinical setting, and most data are derived from animal studies. FMRI could be used to further explore placental functions that are related to vascularization, oxygenation, and metabolism in human pregnancies by the use of various enhancement processes. Dynamic contrast-enhanced MRI is best able to quantify placental perfusion, permeability, and blood volume fractions. However, the transplacental passage of Gadolinium-based contrast agents represents a significant safety concern for this procedure in humans. There are alternative contrast agents that may be safer in pregnancy or that do not cross the placenta. Arterial spin labeling MRI relies on magnetically labeled water to quantify the blood flows within the placenta. A disadvantage of this technique is a poorer signal-to-noise ratio. Based on arterial spin labeling, placental perfusion in normal pregnancy is 176 ± 91 mL × min(-1) × 100 g(-1) and decreases in cases with intrauterine growth restriction. Blood oxygen level-dependent and oxygen-enhanced MRIs do not assess perfusion but measure the response of the placenta to changes in oxygen levels with the use of hemoglobin as an endogenous contrast agent. Diffusion-weighted imaging and intravoxel incoherent motion MRI do not require exogenous contrast agents, instead they use the movement of water molecules within tissues. The apparent diffusion coefficient and perfusion fraction are significantly lower in placentas of growth-restricted fetuses when compared with normal pregnancies. Magnetic resonance spectroscopy has the ability to extract information regarding metabolites from the placenta noninvasively and in vivo. There are marked differences in all 3 metabolites N-acetyl aspartate/choline levels, inositol/choline ratio between small, and adequately grown fetuses. Current research is focused on the ability of each fMRI technique to make a timely diagnosis of abnormal placentation that would allow for appropriate planning of follow-up examinations and optimal scheduling of delivery. These research programs will benefit from the use of well-defined sequences, standardized imaging protocols, and robust computational methods.
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Affiliation(s)
- Nathalie Siauve
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | - Gihad E Chalouhi
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Benjamin Deloison
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Marianne Alison
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France
| | - Olivier Clement
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | - Yves Ville
- EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Laurent J Salomon
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France.
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32
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Avni R, Neeman M, Garbow JR. Functional MRI of the placenta--From rodents to humans. Placenta 2015; 36:615-22. [PMID: 25916594 PMCID: PMC4452090 DOI: 10.1016/j.placenta.2015.04.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/30/2015] [Accepted: 04/04/2015] [Indexed: 01/26/2023]
Abstract
The placenta performs a wide range of physiological functions; insufficiencies in these functions may result in a variety of severe prenatal and postnatal syndromes with long-term negative impacts on human adult health. Recent advances in magnetic resonance imaging (MRI) studies of placental function, in both animal models and humans, have contributed significantly to our understanding of placental structure, blood flow, oxygenation status, and metabolic profile, and have provided important insights into pregnancy complications.
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Affiliation(s)
- R Avni
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 76100, Israel
| | - M Neeman
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 76100, Israel.
| | - J R Garbow
- Biomedical MR Laboratory, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, United States.
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33
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Andescavage NN, DuPlessis A, Limperopoulos C. Advanced MR imaging of the placenta: Exploring the in utero placenta-brain connection. Semin Perinatol 2015; 39:113-23. [PMID: 25765905 PMCID: PMC4409865 DOI: 10.1053/j.semperi.2015.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The placenta is a vital organ necessary for the healthy neurodevelopment of the fetus. Despite the known associations between placental dysfunction and neurologic impairment, there is a paucity of tools available to reliably assess in vivo placental health and function. Existing clinical tools for placental assessment remain insensitive in predicting and evaluating placental well-being. Advanced MRI techniques hold significant promise for the dynamic, non-invasive, real-time assessment of placental health and identification of early placental-based disorders. In this review, we summarize the available clinical tools for placental assessment, including ultrasound, Doppler, and conventional MRI. We then explore the emerging role of advanced placental MR imaging techniques for supporting the developing fetus and appraise the strengths and limitations of quantitative MRI in identifying early markers of placental dysfunction for improved pregnancy monitoring and fetal outcomes.
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Affiliation(s)
- Nickie Niforatos Andescavage
- Division of Neonatology, Children’s National Health System, 111
Michigan Ave. NW, Washington, DC 20010,Fetal & Transitional Medicine, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine,
2300 Eye St. NW, Washington, DC 20037
| | - Adre DuPlessis
- Fetal & Transitional Medicine, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Diagnostic Imaging & Radiology, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine,
2300 Eye St. NW, Washington, DC 20037
| | - Catherine Limperopoulos
- Division of Neonatology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Division of Fetal and Transitional Medicine, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037; Division of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Division of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037.
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34
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Automatic differentiation of placental perfusion compartments by time-to-peak analysis in mice. Placenta 2015; 36:255-61. [DOI: 10.1016/j.placenta.2014.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 11/04/2014] [Accepted: 12/14/2014] [Indexed: 11/24/2022]
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35
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Himoto Y, Kido A, Minamiguchi S, Mogami H, Konishi I, Togashi K. Visualization of placental hypocirculation with typical patterns using conventional magnetic resonance imaging: Two case reports. J Obstet Gynaecol Res 2014; 41:794-8. [PMID: 25511628 DOI: 10.1111/jog.12632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/06/2014] [Indexed: 12/01/2022]
Abstract
We report two cases of clinically suspected placental hypocirculation, as per evidenced by specific half-Fourier acquisition single-shot turbo spin-echo (HASTE) magnetic resonance findings of the whole placenta. Patient 1 was a case of fetal growth restriction caused by pregnancy-induced hypertension, while patient 2 experienced a discordant dichorionic diamniotic twin pregnancy with fetal growth restriction complication with a velamentous insertion of the umbilical cord in the smaller twin. In both cases, HASTE images showed noticeably decreased signal intensity with high-intensity signal spots present in the central region of the placenta. In the twin pregnancy case, the low-intensity signal area in the placenta of the smaller twin was much lower compared to that of the larger twin. Pathological findings failed to support or explain these observations. HASTE images might reflect compensatory alternation of the distribution of maternal blood and villus caused by hypocirculation. In conclusion, our results suggest that HASTE imaging might be a useful approach for the visualization of placental hypocirculation.
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Affiliation(s)
- Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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36
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Frias AE, Schabel MC, Roberts VHJ, Tudorica A, Grigsby PL, Oh KY, Kroenke CD. Using dynamic contrast-enhanced MRI to quantitatively characterize maternal vascular organization in the primate placenta. Magn Reson Med 2014; 73:1570-8. [PMID: 24753177 DOI: 10.1002/mrm.25264] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/09/2022]
Abstract
PURPOSE The maternal microvasculature of the primate placenta is organized into 10-20 perfusion domains that are functionally optimized to facilitate nutrient exchange to support fetal growth. This study describes a dynamic contrast-enhanced magnetic resonance imaging method for identifying vascular domains and quantifying maternal blood flow in them. METHODS A rhesus macaque on the 133rd day of pregnancy (G133, term = 165 days) underwent Doppler ultrasound procedures, dynamic contrast-enhanced magnetic resonance imaging and Cesarean-section delivery. Serial T1 -weighted images acquired throughout intravenous injection of a contrast reagent bolus were analyzed to obtain contrast reagent arrival time maps of the placenta. RESULTS Watershed segmentation of the arrival time map identified 16 perfusion domains. The number and location of these domains corresponded to anatomical cotyledonary units observed following delivery. Analysis of the contrast reagent wave front through each perfusion domain enabled determination of volumetric flow, which ranged from 9.03 to 44.9 mL/s (25.2 ± 10.3 mL/s). These estimates are supported by Doppler ultrasound results. CONCLUSIONS The dynamic contrast-enhanced magnetic resonance imaging analysis described here provides quantitative estimates of the number of maternal perfusion domains in a primate placenta and estimates flow within each domain. Anticipated extensions of this technique are to the study placental function in non-human primate models of obstetric complications.
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Affiliation(s)
- Antonio E Frias
- Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Beaverton, Oregon, USA; Division of Developmental and Reproductive Sciences, Oregon National Primate Research Center, Beaverton, Oregon, USA; Department of Obstetrics and Gynecology, Oregon National Primate Research Center, Beaverton, Oregon, USA
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37
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Derwig I, Lythgoe DJ, Barker GJ, Poon L, Gowland P, Yeung R, Zelaya F, Nicolaides K. Association of placental perfusion, as assessed by magnetic resonance imaging and uterine artery Doppler ultrasound, and its relationship to pregnancy outcome. Placenta 2013; 34:885-91. [PMID: 23937958 DOI: 10.1016/j.placenta.2013.07.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/08/2013] [Accepted: 07/11/2013] [Indexed: 01/16/2023]
Affiliation(s)
- I Derwig
- Harris Birthright Research Centre, Kings College Hospital, London, UK.
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39
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Bobek G, Stait-Gardner T, Surmon L, Makris A, Lind JM, Price WS, Hennessy A. Magnetic resonance imaging detects placental hypoxia and acidosis in mouse models of perturbed pregnancies. PLoS One 2013; 8:e59971. [PMID: 23555853 PMCID: PMC3608595 DOI: 10.1371/journal.pone.0059971] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/19/2013] [Indexed: 01/26/2023] Open
Abstract
Endothelial dysfunction as a result of dysregulation of anti-angiogenic molecules secreted by the placenta leads to the maternal hypertensive response characteristic of the pregnancy complication of preeclampsia. Structural abnormalities in the placenta have been proposed to result in altered placental perfusion, placental oxidative stress, cellular damage and inflammation and the release of anti-angiogenic compounds into the maternal circulation. The exact link between these factors is unclear. Here we show, using Magnetic Resonance Imaging as a tool to examine placental changes in mouse models of perturbed pregnancies, that T2 contrast between distinct regions of the placenta is abolished at complete loss of blood flow. Alterations in T2 (spin-spin or transverse) relaxation times are explained as a consequence of hypoxia and acidosis within the tissue. Similar changes are observed in perturbed pregnancies, indicating that acidosis as well as hypoxia may be a feature of pregnancy complications such as preeclampsia and may play a prominent role in the signalling pathways that lead to the increased secretion of anti-angiogenic compounds.
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Affiliation(s)
- Gabriele Bobek
- School of Medicine, University of Western Sydney, Campbelltown, New South Wales, Australia.
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40
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Dekan S, Linduska N, Kasprian G, Prayer D. MRI of the placenta - a short review. Wien Med Wochenschr 2012; 162:225-8. [PMID: 22717878 DOI: 10.1007/s10354-012-0073-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 03/01/2012] [Indexed: 10/28/2022]
Abstract
While ultrasound is still the gold standard method of placental investigation, magnetic resonance imaging (MRI) has certain benefits. In advanced gestational age, obese women, and posterior placental location, MRI is advantageous due to the larger field of view and its multiplanar capabilities. Some pathologies are seen more clearly in MRI, such as infarctions and placental invasive disorders. The future development is towards functional placental MRI. Placental MRI has become an important complementary method for evaluation of placental anatomy and pathologies contributing to fetal problems such as intrauterine growth restriction.
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Affiliation(s)
- Sabine Dekan
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.
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Deloison B, Siauve N, Aimot S, Balvay D, Thiam R, Cuenod CA, Ville Y, Clement O, Salomon LJ. SPIO-enhanced magnetic resonance imaging study of placental perfusion in a rat model of intrauterine growth restriction. BJOG 2012; 119:626-33. [DOI: 10.1111/j.1471-0528.2011.03251.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chalouhi GE, Deloison B, Siauve N, Aimot S, Balvay D, Cuenod CA, Ville Y, Clément O, Salomon LJ. Dynamic contrast-enhanced magnetic resonance imaging: definitive imaging of placental function? Semin Fetal Neonatal Med 2011; 16:22-8. [PMID: 20851065 DOI: 10.1016/j.siny.2010.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The placenta constitutes a complex circulatory interface between the mother and fetus, but the relationship between the maternal and fetal circulation is still very difficult to study in vivo. There is growing evidence that magnetic resonance imaging (MRI) is useful and safe during pregnancy, and MRI is increasingly used for fetal and placental anatomical imaging. MRI functional imaging is now a modern obstetric tool and has the potential to provide new insights into the physiology of the human placenta. Placental perfusion has been studied during the first pass of an MR contrast agent, by arterial spin labeling, diffusion imaging, T1 and T2 relaxation time measurement using echo-planar imaging, and by a combination of magnetization transfer with established stereological methods. The BOLD (blood oxygen level-dependent) effect offers new perspectives for functional MRI evaluation of the placenta.
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Affiliation(s)
- G E Chalouhi
- Laboratoire de Recherche en Imagerie (LRI), INSERM U970, Equipe N°2, Paris Cardiovascular Research Center - PARCC, 56 rue Leblanc, 75015 Paris, France
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Kikuchi S, Saito K, Takahashi M, Ito K. Temperature elevation in the fetus from electromagnetic exposure during magnetic resonance imaging. Phys Med Biol 2010; 55:2411-26. [PMID: 20360633 DOI: 10.1088/0031-9155/55/8/018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study computationally assessed the temperature elevations due to electromagnetic wave energy deposition during magnetic resonance imaging in non-pregnant and pregnant woman models. We used a thermal model with thermoregulatory response of the human body for our calculations. We also considered the effect of blood temperature variation on body core temperature. In a thermal equilibrium state, the temperature elevations in the intrinsic tissues of the woman and fetal tissues were 0.85 and 0.61 degrees C, respectively, at a whole-body averaged specific absorption rate of 2.0 W kg(-1), which is the restriction value of the International Electrotechnical Commission for the normal operating mode. As predicted, these values are below the temperature elevation of 1.5 degrees C that is expected to be teratogenic. However, these values exceeded the recommended temperature elevation limit of 0.5 degrees C by the International Commission on Non-Ionizing Radiation Protection. We also assessed the irradiation time required for a temperature elevation of 0.5 degrees C at the aforementioned specific absorption rate. As a result, the calculated irradiation time was 40 min.
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Affiliation(s)
- Satoru Kikuchi
- Graduate School of Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan.
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Tomlinson TM, Garbow JR, Anderson JR, Engelbach JA, Nelson DM, Sadovsky Y. Magnetic resonance imaging of hypoxic injury to the murine placenta. Am J Physiol Regul Integr Comp Physiol 2009; 298:R312-9. [PMID: 19923363 DOI: 10.1152/ajpregu.00425.2009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We assessed the use of magnetic resonance imaging (MRI) to define placental hypoxic injury associated with fetal growth restriction. On embryonic day 18.5 (E18.5) we utilized dynamic contrast-enhanced (DCE)-MRI on a 4.7-tesla small animal scanner to examine the uptake and distribution of gadolinium-based contrast agent. Quantitative DCE parameter analysis was performed for the placenta and fetal kidneys of three groups of pregnant C57BL/6 mice: 1) mice that were exposed to Fi(O(2)) = 12% between E15.5 and E18.5, 2) mice in normoxia with food restriction similar to the intake of hypoxic mice between E15.5 and E18.5, and 3) mice in normoxia that were fed ad libitum. After imaging, we assessed fetoplacental weight, placental histology, and gene expression. We found that dams exposed to hypoxia exhibited fetal growth restriction (weight reduction by 28% and 14%, respectively, P < 0.05) with an increased placental-to-fetal ratio. By using MRI-based assessment of placental contrast agent kinetics, referenced to maternal paraspinous muscle, we found decreased placental clearance of contrast media in hypoxic mice, compared with either control group (61%, P < 0.05). This was accompanied by diminished contrast accumulation in the hypoxic fetal kidneys (23%, P < 0.05), reflecting reduced transplacental gadolinium transport. These changes were associated with increased expression of placental Phlda2 and Gcm1 transcripts. Exposure to hypoxia near the end of mouse pregnancy reduces placental perfusion and clearance of contrast. MRI-based DCE imaging provides a novel tool for dynamic, in vivo assessment of placental function.
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Affiliation(s)
- Tracy M Tomlinson
- Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri, USA
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Abstract
Fetal MRI is becoming an increasingly powerful imaging tool for studying brain development in vivo. Until recently, the application of advanced magnetic resonance imaging techniques was limited by motion in the nonsedated fetus. Extensive research efforts currently underway are focusing on the development of dedicated magnetic resonance imaging sequences and sophisticated postprocessing techniques that are revolutionizing our ability to study the healthy and compromised fetus. The ongoing refinement of these magnetic resonance imaging techniques will undoubtedly lead to the development of cornerstone biomarkers that will provide healthcare caregivers with vital, and currently lacking, information upon which to counsel parents effectively, and base rational decisions regarding the timing and type of novel medical and surgical interventions currently on the horizon.
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Moore RJ, Ong SS, Tyler DJ, Duckett R, Baker PN, Dunn WR, Johnson IR, Gowland PA. Spiral artery blood volume in normal pregnancies and those compromised by pre-eclampsia. NMR IN BIOMEDICINE 2008; 21:376-80. [PMID: 17893947 DOI: 10.1002/nbm.1199] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The aim of this work was to use intravoxel incoherent motion (IVIM) to provide a non-invasive in vivo assessment of the function of the maternal spiral arteries that feed the placenta in normal pregnancy and in pre-eclampsia. Eleven normal pregnant women were scanned at 16, 22, 29 and 35 weeks gestation in a longitudinal study. Nine normal pregnant women and six women with pre-eclampsia were scanned in a cross-sectional study, within 10 days of delivery. The MRI IVIM technique was used to measure the moving blood fraction (f%) at the basal plate. There was no evidence that f% changed with gestational age (P = 0.84), but considering the cross-sectional groups, f% in women with pre-eclampsia was reduced compared with normal pregnancy (mean +/- SD: 36 +/- 5% and 27 +/- 5%; P < 0.005). In conclusion, pregnancies complicated by pre-eclampsia exhibit a reduced fraction of moving blood within the region of the spiral arteries. IVIM performed in the mid-trimester may provide an early means of predicting those pregnancies with an increased likelihood of being complicated by pre-eclampsia.
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Affiliation(s)
- Rachel J Moore
- Magnetic Resonance Centre, School of Physics & Astronomy, University of Nottingham, Nottingham, UK
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Taillieu F, Salomon LJ, Siauve N, Clément O, Faye N, Balvay D, Vayssettes C, Frija G, Ville Y, Cuenod CA. Placental Perfusion and Permeability: Simultaneous Assessment with Dual-Echo Contrast-enhanced MR Imaging in Mice. Radiology 2006; 241:737-45. [PMID: 17065560 DOI: 10.1148/radiol.2413051168] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess placental perfusion and permeability in mice with magnetic resonance (MR) imaging. MATERIALS AND METHODS This study was conducted according to French law and National Institutes of Health recommendations for animal care. Twenty-two pregnant BALB/c mice were examined at 1.5 T with a single-section dual-echo fast spoiled gradient-echo sequence. Two injection protocols were used: monophasic injection (double the clinical dose of contrast agent) and biphasic injection (quadruple the clinical dose). Signal intensities (SIs) were measured in the maternal left ventricle, placenta, and fetus (n = 16). At these high gadolinium doses, a T2* effect correction was used. SIs were converted to gadolinium concentrations and were analyzed by using a three-compartment model. Quantitative microcirculation parameters were calculated. Results with the monophasic and biphasic protocols were compared, and final arterial concentrations determined with MR imaging were compared with those determined with atomic emission spectrophotometry by using the unpaired Student t test. RESULTS Perfusion and permeability parameters for monophasic and biphasic injections were similar: Mean placental blood flow was 180 mL/min/100 g, mean permeability surface coefficient from maternal placental to fetal placental compartment was 10.3 x 10(-4) sec(-1) +/- 6.81 (standard deviation), mean permeability surface coefficient from fetal placental to maternal placental compartment was 4.65 x 10(-4) sec(-1) +/- 4.37, and mean fractional volume of the maternal vascular placental compartment was 36.5% +/- 0.9. Placental (146 vs 105 micromol/L, P < .004) and fetal (33.3 vs 19.1 micromol/L, P < .001) gadolinium concentrations were higher with the biphasic than with the monophasic protocol. Arterial gadolinium concentrations at MR imaging did not differ significantly from those at spectrophotometry for the monophasic (P = .254) or biphasic (P = .776) injection protocol. CONCLUSION Placental perfusion and permeability can be measured in vivo by using high gadolinium doses and a dual-echo MR imaging sequence.
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Affiliation(s)
- Fabienne Taillieu
- Université Paris Descartes, Faculté de Médecine, INSERM U494, Laboratory of Research in Imaging, site Necker, 156 rue de Vaugirard, 75015 Paris, France.
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Hoad CL, Fulford J, Raine-Fenning NJ, Campbell BK, Johnson IR, Gowland PA. In vivo perfusion, T1, and T2 measurements in the female pelvis during the normal menstrual cycle: A feasibility study. J Magn Reson Imaging 2006; 24:1350-6. [PMID: 17096391 DOI: 10.1002/jmri.20784] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To quantify T(1), T(2), and regional tissue perfusion in uterine tissues, with MR imaging in clinically feasible imaging times, using echo planar imaging (EPI) techniques over a single menstrual cycle. MATERIALS AND METHODS A total of 24 healthy ovulating women were scanned; however, complete data sets through the menstrual cycle were not obtained from all women. Three scans were performed to coincide prospectively with the follicular, periovulatory, and luteal phases of the cycle. T(1) and perfusion were measured simultaneously using flow alternating inversion recovery (FAIR), while T(2) was measured using a single Hahn spin-echo (SE) EPI sequence. RESULTS Between the follicular and periovulatory phases, statistically significant increases (P < 0.05) were seen for the T(2) of the endometrium and perfusion of the myometrium as well as the T(2)/T(1) ratio for both endometrium and myometrium. A statistically significant decrease was seen in the endometrial T(2) between the periovulatory and luteal phases of the cycle. Tissue differentiation was achieved using the parameters measured, with T(1) and T(2) being statistically greater for the endometrium than for the myometrium, and endometrial perfusion being statistically lower than myometrial perfusion. CONCLUSION These results show the feasibility of using these techniques to measure T(1), T(2), and perfusion in uterine tissues and of extending this work to study pathological conditions.
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Affiliation(s)
- Caroline L Hoad
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
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Salomon LJ, Siauve N, Taillieu F, Balvay D, Clément O, Vayssettes C, Frija G, Ville Y, Cuénod CA. L’IRM fonctionnelle pour l’étude de la fonction placentaire. ACTA ACUST UNITED AC 2005; 34:666-73. [PMID: 16270004 DOI: 10.1016/s0368-2315(05)82899-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Placental insufficiency, a process due to either poor placental perfusion or permeability, may lead to progressive deterioration in placental function and materno-fetal morbidity. Advances in MR contrast media pharmacokinetic studies of transit through tissues and dynamic MRI allow to characterize organs microcirculation in vivo. Placental function assessment might be achieved using analysis of dynamic contrast enhanced MRI of tracers. A murine model of placental assessment has been constructed. Herein, principles, results and limitations of such techniques are discussed as well as their potential interest and weaknesses in humans.
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Affiliation(s)
- L-J Salomon
- Laboratoire de Recherche en Imagerie, Paris V, Faculté de Médecine Necker
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Abstract
Placental function is of fundamental importance for normal fetal growth and development. The movement of blood within the placenta ensures adequate transfer of nutrients and waste products across the feto-maternal barrier. The placenta is a relatively easy organ to study with magnetic resonance imaging (MRI) as it has a very high blood volume. MRI can be used to assess both the growth and function of the normal placenta and can distinguish differences from normal in placentas from pregnancies compromised by fetal growth restriction and pre-eclampsia.
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Affiliation(s)
- Penny Gowland
- Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, UK.
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