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de Oliveira DC, Cheikh Sleiman H, Payette K, Hutter J, Story L, Hajnal JV, Alexander DC, Shipley RJ, Slator PJ. A flexible generative algorithm for growing in silico placentas. PLoS Comput Biol 2024; 20:e1012470. [PMID: 39374295 DOI: 10.1371/journal.pcbi.1012470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 09/06/2024] [Indexed: 10/09/2024] Open
Abstract
The placenta is crucial for a successful pregnancy, facilitating oxygen exchange and nutrient transport between mother and fetus. Complications like fetal growth restriction and pre-eclampsia are linked to placental vascular structure abnormalities, highlighting the need for early detection of placental health issues. Computational modelling offers insights into how vascular architecture correlates with flow and oxygenation in both healthy and dysfunctional placentas. These models use synthetic networks to represent the multiscale feto-placental vasculature, but current methods lack direct control over key morphological parameters like branching angles, essential for predicting placental dysfunction. We introduce a novel generative algorithm for creating in silico placentas, allowing user-controlled customisation of feto-placental vasculatures, both as individual components (placental shape, chorionic vessels, placentone) and as a complete structure. The algorithm is physiologically underpinned, following branching laws (i.e. Murray's Law), and is defined by four key morphometric statistics: vessel diameter, vessel length, branching angle and asymmetry. Our algorithm produces structures consistent with in vivo measurements and ex vivo observations. Our sensitivity analysis highlights how vessel length variations and branching angles play a pivotal role in defining the architecture of the placental vascular network. Moreover, our approach is stochastic in nature, yielding vascular structures with different topological metrics when imposing the same input settings. Unlike previous volume-filling algorithms, our approach allows direct control over key morphological parameters, generating vascular structures that closely resemble real vascular densities and allowing for the investigation of the impact of morphological parameters on placental function in upcoming studies.
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Affiliation(s)
- Diana C de Oliveira
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Hani Cheikh Sleiman
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Kelly Payette
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Smart Imaging Lab, Radiological Institute, University Hospital Erlangen, Erlangen, Germany
| | - Lisa Story
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Daniel C Alexander
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Rebecca J Shipley
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Paddy J Slator
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, United Kingdom
- School of Computer Science and Informatics, Cardiff University, Cardiff, United Kingdom
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
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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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Aviles Verdera J, Story L, Hall M, Finck T, Egloff A, Seed PT, Malik SJ, Rutherford MA, Hajnal JV, Tomi-Tricot R, Hutter J. Reliability and Feasibility of Low-Field-Strength Fetal MRI at 0.55 T during Pregnancy. Radiology 2023; 309:e223050. [PMID: 37847139 PMCID: PMC10623193 DOI: 10.1148/radiol.223050] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/20/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
Abstract
Background The benefits of using low-field-strength fetal MRI to evaluate antenatal development include reduced image artifacts, increased comfort, larger bore size, and potentially reduced costs, but studies about fetal low-field-strength MRI are lacking. Purpose To evaluate the reliability and feasibility of low-field-strength fetal MRI to assess anatomic and functional measures in pregnant participants using a commercially available 0.55-T MRI scanner and a comprehensive 20-minute protocol. Materials and Methods This prospective study was performed at a large teaching hospital (St Thomas' Hospital; London, England) from May to November 2022 in healthy pregnant participants and participants with pregnancy-related abnormalities using a commercially available 0.55-T MRI scanner. A 20-minute protocol was acquired including anatomic T2-weighted fast-spin-echo, quantitative T2*, and diffusion sequences. Key measures like biparietal diameter, transcerebellar diameter, lung volume, and cervical length were evaluated by two radiologists and an MRI-experienced obstetrician. Functional organ-specific mean values were given. Comparison was performed with existing published values and higher-field MRI using linear regression, interobserver correlation, and Bland-Altman plots. Results A total of 79 fetal MRI examinations were performed (mean gestational age, 29.4 weeks ± 5.5 [SD] [age range, 17.6-39.3 weeks]; maternal age, 34.4 years ± 5.3 [age range, 18.4-45.5 years]) in 47 healthy pregnant participants (control participants) and in 32 participants with pregnancy-related abnormalities. The key anatomic two-dimensional measures for the 47 healthy participants agreed with large cross-sectional 1.5-T and 3-T control studies. The interobserver correlations for the biparietal diameter in the first 40 consecutive scans were 0.96 (95% CI: 0.7, 0.99; P = .002) for abnormalities and 0.93 (95% CI: 0.86, 0.97; P < .001) for control participants. Functional features, including placental and brain T2* and placental apparent diffusion coefficient values, strongly correlated with gestational age (mean placental T2* in the control participants: 5.2 msec of decay per week; R2 = 0.66; mean T2* at 30 weeks, 176.6 msec; P < .001). Conclusion The 20-minute low-field-strength fetal MRI examination protocol was capable of producing reliable structural and functional measures of the fetus and placenta in pregnancy. Clinical trial registration no. REC 21/LO/0742 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Gowland in this issue.
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Affiliation(s)
- Jordina Aviles Verdera
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Lisa Story
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Megan Hall
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Tom Finck
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Alexia Egloff
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Paul T. Seed
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Shaihan J. Malik
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Mary A. Rutherford
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Joseph V. Hajnal
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Raphaël Tomi-Tricot
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Jana Hutter
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
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Hutter J, Al-Wakeel A, Kyriakopoulou V, Matthew J, Story L, Rutherford M. Exploring the role of a time-efficient MRI assessment of the placenta and fetal brain in uncomplicated pregnancies and these complicated by placental insufficiency. Placenta 2023; 139:25-33. [PMID: 37295055 DOI: 10.1016/j.placenta.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/24/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The development of placenta and fetal brain are intricately linked. Placental insufficiency is related to poor neonatal outcomes with impacts on neurodevelopment. This study sought to investigate whether simultaneous fast assessment of placental and fetal brain oxygenation using MRI T2* relaxometry can play a complementary role to US and Doppler US. METHODS This study is a retrospective case-control study with uncomplicated pregnancies (n = 99) and cases with placental insufficiency (PI) (n = 49). Participants underwent placental and fetal brain MRI and contemporaneous ultrasound imaging, resulting in quantitative assessment including a combined MRI score called Cerebro-placental-T2*-Ratio (CPTR). This was assessed in comparison with US-derived Cerebro-Placental-Ratio (CPR), placental histopathology, assessed using the Amsterdam criteria [1], and delivery details. RESULTS Pplacental and fetal brain T2* decreased with increasing gestational age in both low and high risk pregnancies and were corrected for gestational-age alsosignificantly decreased in PI. Both CPR and CPTR score were significantly correlated with gestational age at delivery for the entire cohort. CPTR was, however, also correlated independently with gestational age at delivery in the PI cohort. It furthermore showed a correlation to birth-weight-centile in healthy controls. DISCUSSION This study indicates that MR analysis of the placenta and brain may play a complementary role in the investigation of fetal development. The additional correlation to birth-weight-centile in controls may suggest a role in the determination of placental health even in healthy controls. To our knowledge, this is the first study assessing quantitatively both placental and fetal brain development over gestation in a large cohort of low and high risk pregnancies. Future larger prospective studies will include additional cohorts.
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Affiliation(s)
- Jana Hutter
- Centre for the Developing Brain, King's College London, UK; Centre for Medical Engineering, King's College London, UK.
| | - Ayman Al-Wakeel
- GKT School of Medical Education, King's College London, London, UK
| | - Vanessa Kyriakopoulou
- Centre for the Developing Brain, King's College London, UK; Centre for Medical Engineering, King's College London, UK
| | - Jacqueline Matthew
- Centre for the Developing Brain, King's College London, UK; Centre for Medical Engineering, King's College London, UK
| | - Lisa Story
- Centre for the Developing Brain, King's College London, UK; Institute for Women's and Children's Health, King's College London, UK; Fetal Medicine Unit, St Thomas' Hospital, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, UK; Centre for Medical Engineering, King's College London, UK
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Clark A, Flouri D, Mufti N, James J, Clements E, Aughwane R, Aertsen M, David A, Melbourne A. Developments in functional imaging of the placenta. Br J Radiol 2023; 96:20211010. [PMID: 35234516 PMCID: PMC10321248 DOI: 10.1259/bjr.20211010] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022] Open
Abstract
The placenta is both the literal and metaphorical black box of pregnancy. Measurement of the function of the placenta has the potential to enhance our understanding of this enigmatic organ and serve to support obstetric decision making. Advanced imaging techniques are key to support these measurements. This review summarises emerging imaging technology being used to measure the function of the placenta and new developments in the computational analysis of these data. We address three important examples where functional imaging is supporting our understanding of these conditions: fetal growth restriction, placenta accreta, and twin-twin transfusion syndrome.
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Affiliation(s)
- Alys Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Joanna James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eleanor Clements
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Rosalind Aughwane
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Anna David
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
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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: 17] [Impact Index Per Article: 17.0] [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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Hutter J, Slator PJ, Avena Zampieri C, Hall M, Rutherford M, Story L. Multi-modal MRI reveals changes in placental function following preterm premature rupture of membranes. Magn Reson Med 2023; 89:1151-1159. [PMID: 36255151 PMCID: PMC10091779 DOI: 10.1002/mrm.29483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Preterm premature rupture of membranes complicates up to 40% of premature deliveries. Fetal infection may occur in the absence of maternal symptoms, delaying diagnosis and increasing morbidity and mortality. A noninvasive antenatal assessment of early signs of placental inflammation is therefore urgently required. METHODS Sixteen women with preterm premature rupture of membranes < 34 weeks gestation and 60 women with uncomplicated pregnancies were prospectively recruited. A modified diffusion-weighted spin-echo single shot EPI sequence with a diffusion preparation acquiring 264 unique parameter combinations in < 9 min was obtained on a clinical 3 Tesla MRI scanner. The data was fitted to a 2-compartment T 2 * $$ {\mathrm{T}}_2^{\ast } $$ -intravoxel incoherent motion model comprising fast and slowly circulating fluid pools to obtain quantitative information on perfusion, density, and tissue composition. Z values were calculated, and correlation with time from between the rupture of membranes and the scan, gestational age at delivery, and time between scan and delivery assessed. RESULTS Placental T 2 * $$ {\mathrm{T}}_2^{\ast } $$ was significantly reduced in preterm premature rupture of membranes, and the 2-compartmental model demonstrated that this decline is mainly linked to the perfusion component observed in the placental parenchyma. Multi-modal MRI measurement of placental function is linked to gestational age at delivery and time from membrane rupture. CONCLUSION More complex models and data acquisition can potentially improve fitting of the underlying etiology of preterm birth compared with individual single-contrast models and contribute to additional insights in the future. This will need validation in larger cohorts. A multi-modal MRI acquisition between rupture of the membranes and delivery can be used to measure placental function and is linked to gestational age at delivery.
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Affiliation(s)
- Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom.,Centre for Medical Engineering, King's College London, London, United Kingdom
| | | | - Carla Avena Zampieri
- Centre for the Developing Brain, King's College London, London, United Kingdom.,Centre for Medical Engineering, King's College London, London, United Kingdom
| | - Megan Hall
- Centre for the Developing Brain, King's College London, London, United Kingdom.,Institute for Women's and Children's Health, King's College London, London, United Kingdom.,Fetal Medicine Unit, St Thomas' Hospital, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom.,Centre for Medical Engineering, King's College London, London, United Kingdom
| | - Lisa Story
- Centre for the Developing Brain, King's College London, London, United Kingdom.,Institute for Women's and Children's Health, King's College London, London, United Kingdom.,Fetal Medicine Unit, St Thomas' Hospital, London, United Kingdom
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8
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Zun Z, Shin T. Velocity-selective excitation: Principles and applications. NMR IN BIOMEDICINE 2023; 36:e4820. [PMID: 35994473 PMCID: PMC9845137 DOI: 10.1002/nbm.4820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/12/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Velocity-selective (VS) excitation is a relatively new type of excitation that can be useful for generating image contrast based on spin's motion. This review aims to explain the principles of VS excitation and their utilization for clinical applications. We first review the generalized excitation k-space formalism, which reveals a Fourier relationship between sequence parameters and excitation profiles for spins with arbitrary spatial location, off-resonance, and velocity. Based on the k-space framework, we analyze practical VS excitation pulse sequences that yield sinusoidal or sinc-shaped velocity profiles. Then we demonstrate how these two types of VS excitation can be used as magnetization preparation for clinical applications, including saturation- or inversion-based arterial spin labeling and black- or bright-blood angiography. We also discuss practical considerations and issues for each application, including the determination of design parameters and the effects of MR system errors, such as magnetic field offsets and eddy currents.
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Affiliation(s)
- Zungho Zun
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Taehoon Shin
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, South Korea
- Graduate Program in Smart Factory, Ewha Womans University, Seoul, South Korea
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
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9
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Qin Q, Alsop DC, Bolar DS, Hernandez‐Garcia L, Meakin J, Liu D, Nayak KS, Schmid S, van Osch MJP, Wong EC, Woods JG, Zaharchuk G, Zhao MY, Zun Z, Guo J. Velocity-selective arterial spin labeling perfusion MRI: A review of the state of the art and recommendations for clinical implementation. Magn Reson Med 2022; 88:1528-1547. [PMID: 35819184 PMCID: PMC9543181 DOI: 10.1002/mrm.29371] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/16/2022] [Accepted: 06/08/2022] [Indexed: 12/11/2022]
Abstract
This review article provides an overview of the current status of velocity-selective arterial spin labeling (VSASL) perfusion MRI and is part of a wider effort arising from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group. Since publication of the 2015 consensus paper on arterial spin labeling (ASL) for cerebral perfusion imaging, important advancements have been made in the field. The ASL community has, therefore, decided to provide an extended perspective on various aspects of technical development and application. Because VSASL has the potential to become a principal ASL method because of its unique advantages over traditional approaches, an in-depth discussion was warranted. VSASL labels blood based on its velocity and creates a magnetic bolus immediately proximal to the microvasculature within the imaging volume. VSASL is, therefore, insensitive to transit delay effects, in contrast to spatially selective pulsed and (pseudo-) continuous ASL approaches. Recent technical developments have improved the robustness and the labeling efficiency of VSASL, making it a potentially more favorable ASL approach in a wide range of applications where transit delay effects are of concern. In this review article, we (1) describe the concepts and theoretical basis of VSASL; (2) describe different variants of VSASL and their implementation; (3) provide recommended parameters and practices for clinical adoption; (4) describe challenges in developing and implementing VSASL; and (5) describe its current applications. As VSASL continues to undergo rapid development, the focus of this review is to summarize the fundamental concepts of VSASL, describe existing VSASL techniques and applications, and provide recommendations to help the clinical community adopt VSASL.
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Affiliation(s)
- Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - David C. Alsop
- Department of RadiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Divya S. Bolar
- Center for Functional Magnetic Resonance Imaging, Department of RadiologyUniversity of CaliforniaSan Diego La JollaCaliforniaUSA
| | | | - James Meakin
- Department of Radiology, Nuclear Medicine and AnatomyRadboud University Medical CenterNijmegenThe Netherlands
| | - Dapeng Liu
- The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Krishna S. Nayak
- Magnetic Resonance Engineering Laboratory, Ming Hsieh Department of Electrical EngineeringUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sophie Schmid
- C.J. Gorter Center for high field MRI, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Matthias J. P. van Osch
- C.J. Gorter Center for high field MRI, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Eric C. Wong
- Center for Functional Magnetic Resonance Imaging, Department of RadiologyUniversity of CaliforniaSan Diego La JollaCaliforniaUSA
| | - Joseph G. Woods
- Center for Functional Magnetic Resonance Imaging, Department of RadiologyUniversity of CaliforniaSan Diego La JollaCaliforniaUSA
| | - Greg Zaharchuk
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Moss Y. Zhao
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Zungho Zun
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Jia Guo
- Department of BioengineeringUniversity of California RiversideRiversideCaliforniaUSA
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10
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Li Q, Wu H, Wang Y, Wang H. Current understanding in deciphering trophoblast cell differentiation during human placentation. Biol Reprod 2022; 107:317-326. [PMID: 35478014 DOI: 10.1093/biolre/ioac083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/01/2022] [Accepted: 04/18/2022] [Indexed: 11/14/2022] Open
Abstract
The placenta is a unique organ that forms during gestation and supports fetus survival and communication with the mother. However, of such an arguably essential organ for a successful pregnancy, our knowledge is limited. New progress has been made for human placenta study in recent years. We herein summarize the current understanding of human placental trophoblast differentiation and the molecules that govern trophoblast cell lineage specification. More importantly, the powerful tools for placental studies are also explained, such as human trophoblast stem cells (hTSCs), 3-dimensional (3D) trophoblast organoids, engineering-based placental devices, and single-cell RNA sequencing (sc-RNAseq). These advances have brought us new insights into placental development and provided multiple investigation strategies for deciphering molecular mechanisms.
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Affiliation(s)
- Qian Li
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China.,Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing 100101, China.,Beijing Institute for Stem Cell and Regenerative Medicine, Beijing 100101, China
| | - Hao Wu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China.,Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing 100101, China.,University of Chinese Academy of Sciences, Beijing 100049, China.,Beijing Institute for Stem Cell and Regenerative Medicine, Beijing 100101, China
| | - Yue Wang
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China.,Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing 100101, China.,University of Chinese Academy of Sciences, Beijing 100049, China.,Beijing Institute for Stem Cell and Regenerative Medicine, Beijing 100101, China
| | - Hongmei Wang
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China.,Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing 100101, China.,University of Chinese Academy of Sciences, Beijing 100049, China.,Beijing Institute for Stem Cell and Regenerative Medicine, Beijing 100101, China
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11
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Malmberg M, Kragsterman E, Sinding M, Hansen DN, Peters DA, Frøkjær JB, Petersen AC, Sørensen A. Perfusion fraction derived from IVIM analysis of diffusion-weighted MRI in the assessment of placental vascular malperfusion antenatally. Placenta 2022; 119:1-7. [DOI: 10.1016/j.placenta.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 12/16/2022]
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12
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Blood Flow and Respiratory Gas Exchange in the Human Placenta at Term: A Data Update. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1395:379-384. [PMID: 36527666 DOI: 10.1007/978-3-031-14190-4_62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Reliable measurements using modern techniques and consensus in experimental design have enabled the assessment of novel data sets for normal maternal and foetal respiratory physiology at term. These data sets include (a) principal factors affecting placental gas transfer, e.g., maternal blood flow through the intervillous space (IVS) (500 mL/min) and foeto-placental blood flow (480 mL/min), and (b) O2, CO2 and pH levels in the materno-placental and foeto-placental circulation. According to these data, the foetus is adapted to hypoxaemic hypoxia. Despite flat oxygen partial pressure (pO2) gradients between the blood of the IVS and the umbilical arteries of the foetus, adequate O2 delivery to the foetus is maintained by the higher O2 affinity of the foetal blood, high foetal haemoglobin (HbF) concentrations, the Bohr effect, the double-Bohr effect, and high foeto-placental (=umbilical) blood flow. Again, despite flat gradients, adequate CO2 removal from the foetus is maintained by a high diffusion capacity, high foeto-placental blood flow, the Haldane effect, and the double-Haldane effect. Placental respiratory gas exchange is perfusion-limited, rather than diffusion-limited, i.e., O2 uptake depends on O2 delivery.
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13
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Andescavage N, Limperopoulos C. Emerging placental biomarkers of health and disease through advanced magnetic resonance imaging (MRI). Exp Neurol 2021; 347:113868. [PMID: 34562472 DOI: 10.1016/j.expneurol.2021.113868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022]
Abstract
Placental dysfunction is a major cause of fetal demise, fetal growth restriction, and preterm birth, as well as significant maternal morbidity and mortality. Infant survivors of placental dysfunction are at elevatedrisk for lifelong neuropsychiatric morbidity. However, despite the significant consequences of placental disease, there are no clinical tools to directly and non-invasively assess and measure placental function in pregnancy. In this work, we will review advanced MRI techniques applied to the study of the in vivo human placenta in order to better detail placental structure, architecture, and function. We will discuss the potential of these measures to serve as optimal biomarkers of placental dysfunction and review the evidence of these tools in the discrimination of health and disease in pregnancy. Efforts to advance our understanding of in vivo placental development are necessary if we are to optimize healthy pregnancy outcomes and prevent brain injury in successive generations. Current management of many high-risk pregnancies cannot address placental maldevelopment or injury, given the standard tools available to clinicians. Once accurate biomarkers of placental development and function are constructed, the subsequent steps will be to introduce maternal and fetal therapeutics targeting at optimizing placental function. Applying these biomarkers in future studies will allow for real-time assessments of safety and efficacy of novel interventions aimed at improving maternal-fetal well-being.
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Affiliation(s)
- Nickie Andescavage
- Developing Brain Institute, Department of Radiology, Children's National, Washington DC, USA; Department of Neonatology, Children's National, Washington DC, USA
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14
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Srinivasan V, Melbourne A, Oyston C, James JL, Clark AR. Multiscale and multimodal imaging of utero-placental anatomy and function in pregnancy. Placenta 2021; 112:111-122. [PMID: 34329969 DOI: 10.1016/j.placenta.2021.07.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
Placental structures at the nano-, micro-, and macro scale each play important roles in contributing to its function. As such, quantifying the dynamic way in which placental structure evolves during pregnancy is critical to both clinical diagnosis of pregnancy disorders, and mechanistic understanding of their pathophysiology. Imaging the placenta, both exvivo and invivo, can provide a wealth of structural and/or functional information. This review outlines how imaging across modalities and spatial scales can ultimately come together to improve our understanding of normal and pathological pregnancies. We discuss how imaging technologies are evolving to provide new insights into placental physiology across disciplines, and how advanced computational algorithms can be used alongside state-of-the-art imaging to obtain a holistic view of placental structure and its associated functions to improve our understanding of placental function in health and disease.
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Affiliation(s)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, Kings College London, UK
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand
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15
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Steinweg JK, Hui GTY, Pietsch M, Ho A, van Poppel MP, Lloyd D, Colford K, Simpson JM, Razavi R, Pushparajah K, Rutherford M, Hutter J. T2* placental MRI in pregnancies complicated with fetal congenital heart disease. Placenta 2021; 108:23-31. [PMID: 33798991 DOI: 10.1016/j.placenta.2021.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is one of the most important and common group of congenital malformations in humans. Concurrent development and close functional links between the fetal heart and placenta emphasise the importance of understanding placental function and its influence in pregnancy outcomes. The aim of this study was to evaluate placental oxygenation by relaxometry (T2*) to assess differences in placental phenotype and function in CHD. METHODS In this prospective cross-sectional observational study, 69 women with a fetus affected with CHD and 37 controls, whole placental T2* was acquired using a 1.5-Tesla MRI scanner. Gaussian Process Regression was used to assess differences in placental phenotype in CHD cohorts compared to our controls. RESULTS Placental T2* maps demonstrated significant differences in CHD compared to controls at equivalent gestational age. Mean T2* values over the entire placental volume were lowest compared to predicted normal in right sided obstructive lesions (RSOL) (Z-Score 2.30). This cohort also showed highest lacunarity indices (Z-score -1.7), as a marker of lobule size. Distribution patterns of T2* values over the entire placental volume were positively skewed in RSOL (Z-score -4.69) and suspected, not confirmed coarctation of the aorta (CoA-) (Z-score -3.83). Deviations were also reflected in positive kurtosis in RSOL (Z-score -3.47) and CoA- (Z-score -2.86). CONCLUSION Placental structure and function appear to deviate from normal development in pregnancies with fetal CHD. Specific patterns of altered placental function assessed by T2* deliver crucial complementary information to antenatal assessments in the presence of fetal CHD.
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Affiliation(s)
- Johannes K Steinweg
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom.
| | - Grace Tin Yan Hui
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Maximilian Pietsch
- Centre for the Developing Brain, King's College London, London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
| | - Alison Ho
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Milou Pm van Poppel
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
| | - David Lloyd
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Kathleen Colford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - John M Simpson
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Reza Razavi
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Kuberan Pushparajah
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
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16
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Burton GJ, Jauniaux E. Placentation in the Human and Higher Primates. ADVANCES IN ANATOMY, EMBRYOLOGY, AND CELL BIOLOGY 2021; 234:223-254. [PMID: 34694484 DOI: 10.1007/978-3-030-77360-1_11] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Placentation in humans is precocious and highly invasive compared to other mammals. Implantation is interstitial, with the conceptus becoming completely embedded within the endometrium towards the end of the second week post-fertilization. Villi initially form over the entire surface of the chorionic sac, stimulated by histotrophic secretions from the endometrial glands. The secondary yolk sac never makes contact with the chorion, and a choriovitelline placenta is never established. However, recent morphological and transcriptomic analyses suggest that the yolk sac plays an important role in the uptake of nutrients from the coelomic fluid. Measurements performed in vivo demonstrate that early development takes place in a physiological, low-oxygen environment that protects against teratogenic free radicals and maintains stem cells in a multipotent state. The maternal arterial circulation to the placenta is only fully established around 10-12 weeks of gestation. By then, villi have regressed over the superficial, abembryonic pole, leaving the definitive discoid placenta, which is of the villous, hemochorial type. Remodeling of the maternal spiral arteries is essential to ensure a high-volume but low-velocity inflow into the mature placenta. Extravillous trophoblast cells migrate from anchoring villi and surround the arteries. Their interactions with maternal immune cells release cytokines and proteases that are key to remodeling, and a successful pregnancy.
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Affiliation(s)
- Graham J Burton
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
| | - Eric Jauniaux
- Faculty of Population Health Sciences, EGA Institute for Women's Health, University College London, London, UK
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17
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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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18
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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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19
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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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