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Venkatakrishna SSB, Takahashi MS, Calle-Toro JS, Schoeman S, Saavedra JSM, Alkhulaifat D, Serai SD, Andronikou S. Frequency of MRI Low Signal Intensity in the Buccal Fat of Fetuses and Speculation as to What It May Reflect. CHILDREN (BASEL, SWITZERLAND) 2024; 11:463. [PMID: 38671680 PMCID: PMC11048762 DOI: 10.3390/children11040463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/30/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE We aimed to characterize the fetal buccal fat pad (BFP) on magnetic resonance imaging (MRI) to determine the frequency and types of sequences on which the BFP demonstrates low signal intensity and determine any possible correlation with timing of the MRI during fetal development. MATERIALS AND METHODS A retrospective review of all fetal MR studies was performed, and a pediatric radiologist blinded to the referring and final fetal diagnosis as well as outcome evaluated the included cases. A positive buccal fat pad sign (BFS) was recorded as present if a round, symmetric, and bilateral area was seen in the submalar region of the face with the following signal characteristics: T1 hyperintensity, low signal on echo planar imaging (EPI), low signal on true fast imaging with steady-state free precession (TRUFI), and with restriction on diffusion-weighted imaging (DWI). RESULTS A total of one hundred sixty-seven (167) fetal MRI studies: one hundred fourteen (114) body (68%) and fifty-three (53) neuro (32%) scans were reviewed during the study period. The BFS was most commonly seen on EPI (63%) and TRUFI (49%) sequences. Substantial agreement between TRUFI and EPI (κ = 0.68; p < 0.01); moderate agreement between TRUFI and T1 (κ = 0.53; p < 0.01) as well as T1 and EPI (κ = 0.53; p < 0.01), and fair agreement between EPI and Diffusion (κ = 0.28; p < 0.01) was observed. The median gestational age (GA) was 24 weeks (IQR 22-30 weeks). The fetuses with a positive BFS were significantly older (mean GA of 27 weeks or higher) than those without, for each sequence. CONCLUSIONS The focal low signal in the fetal buccal fat pad, termed the fetal BFS, is a commonly encountered normal finding in the majority of fetal MRI scans on TRUFI and EPI sequences. This finding may be related to the presence and development of brown adipose tissue in the buccal fat pad resulting in T2* effects, but further studies are needed in order to confirm this. Further work can incorporate any of the sensitive sequences demonstrating low signal in brown adipose tissue to map its distribution and development in the fetus and beyond.
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Affiliation(s)
| | - Marcelo S. Takahashi
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Juan S. Calle-Toro
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Sean Schoeman
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - Dana Alkhulaifat
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Suraj D. Serai
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Savvas Andronikou
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Garel J, Rossi A, Blondiaux E, Cassart M, Hoffmann C, Garel C. Prenatal imaging of the normal and abnormal spinal cord: recommendations from the Fetal Task Force of the European Society of Paediatric Radiology (ESPR) and the European Society of Neuroradiology (ESNR) Pediatric Neuroradiology Committee. Pediatr Radiol 2024; 54:548-561. [PMID: 37803194 DOI: 10.1007/s00247-023-05766-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
Spinal dysraphisms are amenable to diagnosis in utero. The prognosis and the neonatal management of these conditions differ significantly depending on their types, mainly on the distinction between open and closed defects. A detailed evaluation not only of the fetal spine, but also of the brain, skull, and lower limbs is essential in allowing for the right diagnosis. In this article, recommendations from the Fetal Task Force of the European Society of Paediatric Radiology (ESPR) and the European Society of Neuroradiology (ESNR) Pediatric Neuroradiology Committee will be presented. The aim of this paper is to review the imaging features of the normal and abnormal fetal spinal cord, to clarify the prenatal classification of congenital spinal cord anomalies and to provide guidance in their reporting.
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Affiliation(s)
- Juliette Garel
- Department of Radiology, Sainte-Justine University Hospital, University of Montreal, Montreal, QC, H3T 1C5, Canada.
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Eléonore Blondiaux
- Department of Radiology, Médecine Sorbonne Université, APHP, DMU DIAMENT, GRC Images, Paris, France
| | - Marie Cassart
- Department of Radiology and Fetal Medicine, Iris South Hospitals, 63 Rue J. Paquot, 1050, Brussels, Belgium
| | - Chen Hoffmann
- Department of Radiology, Tel Hashomer Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Catherine Garel
- Department of Radiology, Hôpital d'Enfants Armand-Trousseau, AP-HP, Paris, France
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, Paris, France
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Rabinowich A, Avisdris N, Zilberman A, Link-Sourani D, Lazar S, Herzlich J, Specktor-Fadida B, Joskowicz L, Malinger G, Ben-Sira L, Hiersch L, Ben Bashat D. Reduced adipose tissue in growth-restricted fetuses using quantitative analysis of magnetic resonance images. Eur Radiol 2023; 33:9194-9202. [PMID: 37389606 DOI: 10.1007/s00330-023-09855-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Fat-water MRI can be used to quantify tissues' lipid content. We aimed to quantify fetal third trimester normal whole-body subcutaneous lipid deposition and explore differences between appropriate for gestational age (AGA), fetal growth restriction (FGR), and small for gestational age fetuses (SGAs). METHODS We prospectively recruited women with FGR and SGA-complicated pregnancies and retrospectively recruited the AGA cohort (sonographic estimated fetal weight [EFW] ≥ 10th centile). FGR was defined using the accepted Delphi criteria, and fetuses with an EFW < 10th centile that did not meet the Delphi criteria were defined as SGA. Fat-water and anatomical images were acquired in 3 T MRI scanners. The entire fetal subcutaneous fat was semi-automatically segmented. Three adiposity parameters were calculated: fat signal fraction (FSF) and two novel parameters, i.e., fat-to-body volume ratio (FBVR) and estimated total lipid content (ETLC = FSF*FBVR). Normal lipid deposition with gestation and differences between groups were assessed. RESULTS Thirty-seven AGA, 18 FGR, and 9 SGA pregnancies were included. All three adiposity parameters increased between 30 and 39 weeks (p < 0.001). All three adiposity parameters were significantly lower in FGR compared with AGA (p ≤ 0.001). Only ETLC and FSF were significantly lower in SGA compared with AGA using regression analysis (p = 0.018-0.036, respectively). Compared with SGA, FGR had a significantly lower FBVR (p = 0.011) with no significant differences in FSF and ETLC (p ≥ 0.053). CONCLUSIONS Whole-body subcutaneous lipid accretion increased throughout the third trimester. Reduced lipid deposition is predominant in FGR and may be used to differentiate FGR from SGA, assess FGR severity, and study other malnourishment pathologies. CLINICAL RELEVANCE STATEMENT Fetuses with growth restriction have reduced lipid deposition than appropriately developing fetuses measured using MRI. Reduced fat accretion is linked with worse outcomes and may be used for growth restriction risk stratification. KEY POINTS • Fat-water MRI can be used to assess the fetal nutritional status quantitatively. • Lipid deposition increased throughout the third trimester in AGA fetuses. • FGR and SGA have reduced lipid deposition compared with AGA fetuses, more predominant in FGR.
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Affiliation(s)
- Aviad Rabinowich
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Netanell Avisdris
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ayala Zilberman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Sapir Lazar
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacky Herzlich
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Neonatal Intensive Care Unit, Dana Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Bella Specktor-Fadida
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gustavo Malinger
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Liat Ben-Sira
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Liran Hiersch
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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Rabinowich A, Avisdris N, Yehuda B, Zilberman A, Graziani T, Neeman B, Specktor-Fadida B, Link-Sourani D, Wexler Y, Herzlich J, Krajden Haratz K, Joskowicz L, Ben Sira L, Hiersch L, Ben Bashat D. Fetal MRI-Based Body and Adiposity Quantification for Small for Gestational Age Perinatal Risk Stratification. J Magn Reson Imaging 2023. [PMID: 37982367 DOI: 10.1002/jmri.29141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Small for gestational age (SGA) fetuses are at risk for perinatal adverse outcomes. Fetal body composition reflects the fetal nutrition status and hold promise as potential prognostic indicator. MRI quantification of fetal anthropometrics may enhance SGA risk stratification. HYPOTHESIS Smaller, leaner fetuses are malnourished and will experience unfavorable outcomes. STUDY TYPE Prospective. POPULATION 40 SGA fetuses, 26 (61.9%) females: 10/40 (25%) had obstetric interventions due to non-reassuring fetal status (NRFS), and 17/40 (42.5%) experienced adverse neonatal events (CANO). Participants underwent MRI between gestational ages 30 + 2 and 37 + 2. FIELD STRENGTH/SEQUENCE 3-T, True Fast Imaging with Steady State Free Precession (TruFISP) and T1 -weighted two-point Dixon (T1 W Dixon) sequences. ASSESSMENT Total body volume (TBV), fat signal fraction (FSF), and the fat-to-body volumes ratio (FBVR) were extracted from TruFISP and T1 W Dixon images, and computed from automatic fetal body and subcutaneous fat segmentations by deep learning. Subjects were followed until hospital discharge, and obstetric interventions and neonatal adverse events were recorded. STATISTICAL TESTS Univariate and multivariate logistic regressions for the association between TBV, FBVR, and FSF and interventions for NRFS and CANO. Fisher's exact test was used to measure the association between sonographic FGR criteria and perinatal outcomes. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. A P-value <0.05 was considered statistically significant. RESULTS FBVR (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.2-0.76) and FSF (OR 0.95, CI 0.91-0.99) were linked with NRFS interventions. Furthermore, TBV (OR 0.69, CI 0.56-0.86) and FSF (OR 0.96, CI 0.93-0.99) were linked to CANO. The FBVR sensitivity/specificity for obstetric interventions was 85.7%/87.5%, and the TBV sensitivity/specificity for CANO was 82.35%/86.4%. The sonographic criteria sensitivity/specificity for obstetric interventions was 100%/33.3% and insignificant for CANO (P = 0.145). DATA CONCLUSION Reduced TBV and FBVR may be associated with higher rates of obstetric interventions for NRFS and CANO. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Aviad Rabinowich
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Netanell Avisdris
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Bossmat Yehuda
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Ayala Zilberman
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Tamir Graziani
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bar Neeman
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bella Specktor-Fadida
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dafna Link-Sourani
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yair Wexler
- School of Neurobiology, Biochemistry and Biophysics, The George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacky Herzlich
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Neonatal Intensive Care Unit, Dana Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Karina Krajden Haratz
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liat Ben Sira
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Liran Hiersch
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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Strobel KM, Kafali SG, Shih SF, Artura AM, Masamed R, Elashoff D, Wu HH, Calkins KL. Pregnancies complicated by gestational diabetes and fetal growth restriction: an analysis of maternal and fetal body composition using magnetic resonance imaging. J Perinatol 2023; 43:44-51. [PMID: 36319757 PMCID: PMC9840659 DOI: 10.1038/s41372-022-01549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Maternal body composition may influence fetal body composition. OBJECTIVE The objective of this pilot study was to investigate the relationship between maternal and fetal body composition. METHODS Three pregnant women cohorts were studied: healthy, gestational diabetes (GDM), and fetal growth restriction (FGR). Maternal body composition (visceral adipose tissue volume (VAT), subcutaneous adipose tissue volume (SAT), pancreatic and hepatic proton-density fat fraction (PDFF) and fetal body composition (abdominal SAT and hepatic PDFF) were measured using MRI between 30 to 36 weeks gestation. RESULTS Compared to healthy and FGR fetuses, GDM fetuses had greater hepatic PDFF (5.2 [4.2, 5.5]% vs. 3.2 [3, 3.3]% vs. 1.9 [1.4, 3.7]%, p = 0.004). Fetal hepatic PDFF was associated with maternal SAT (r = 0.47, p = 0.02), VAT (r = 0.62, p = 0.002), and pancreatic PDFF (r = 0.54, p = 0.008). When controlling for maternal SAT, GDM increased fetal hepatic PDFF by 0.9 ([0.51, 1.3], p = 0.001). CONCLUSION In this study, maternal SAT, VAT, and GDM status were positively associated with fetal hepatic PDFF.
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Affiliation(s)
- Katie M. Strobel
- Department of Pediatrics, Division of Neonatology & Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sevgi Gokce Kafali
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Shu-Fu Shih
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Rinat Masamed
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- University of California Los Angeles, Los Angeles, CA, USA
| | - Holden H. Wu
- Department of Medicine, Biostatistics and Computational Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kara L. Calkins
- Department of Pediatrics, Division of Neonatology & Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
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Akselim B, Karaşin SS, Altekin Y, Toksoy Karaşin Z. The effect of ultrasonographically measured fetal adipose tissue components on labor. J Obstet Gynaecol Res 2021; 48:94-102. [PMID: 34655258 DOI: 10.1111/jog.15074] [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: 06/29/2021] [Revised: 09/19/2021] [Accepted: 10/08/2021] [Indexed: 12/23/2022]
Abstract
AIM To investigate whether increased fetal adiposity diagnosed ultrasonographical is associated with labor dystocia, and increased risk of operative delivery. METHOD This was a prospective study and included 400 pregnant women between 37 and 41 weeks of gestation. In addition to standard ultrasonographic measurements, we evaluated fetal soft tissue thickness before delivery. We also recorded data on delivery method, shoulder dystocia, fetal birthweight and labor duration. We considered the period between 6 and 10 cm cervical opening as the active phase, and the period from full dilation to birth as the second stage. RESULTS While the vaginal delivery rate was 77.3%, a cesarean was performed in 22.7% of pregnant women. We found a positive correlation between fetal adipose tissue components and durations of the active phase and second-stage labor and the baby's birthweight. Also, we examined and determined that cesarean section and labor dystocia increased as the fetus adipose tissue thickness increased. We investigated the effect of parameters on the study results with logistic regression analysis and possible threshold values with receiver operating characteristics analysis. CONCLUSION Our study evaluated the fetal adipose tissue complex during delivery was significant in terms of labor dystocia and operative delivery. We think it may be a guide for future studies in the literature.
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Affiliation(s)
- Burak Akselim
- Department of Obstetrics and Gynecology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Süleyman Serkan Karaşin
- Department of Obstetrics and Gynecology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Yasin Altekin
- Department of Obstetrics and Gynecology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Zeynep Toksoy Karaşin
- Department of Obstetrics and Gynecology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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Giza SA, Koreman TL, Sethi S, Miller MR, Penava DA, Eastabrook GD, McKenzie CA, de Vrijer B. Water-fat magnetic resonance imaging of adipose tissue compartments in the normal third trimester fetus. Pediatr Radiol 2021; 51:1214-1222. [PMID: 33512538 DOI: 10.1007/s00247-020-04955-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/21/2020] [Accepted: 12/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Assessment of fetal adipose tissue gives information about the future metabolic health of an individual, with evidence that the development of this tissue has regional heterogeneity. OBJECTIVE To assess differences in the proton density fat fraction (PDFF) between fetal adipose tissue compartments in the third trimester using water-fat magnetic resonance imaging (MRI). MATERIALS AND METHODS Water-fat MRI was performed in a 1.5-T scanner. Fetal adipose tissue was segmented into cheeks, thorax, abdomen, upper arms, forearms, thighs and lower legs. PDFF and R2* values were measured in each compartment. RESULTS Twenty-eight women with singleton pregnancies were imaged between 28 and 38 weeks of gestation. At 30 weeks' gestation (n=22), the PDFF was statistically different between the compartments (P<0.0001), with the highest PDFF in cheeks, followed by upper arms, thorax, thighs, forearms, lower legs and abdomen. There were no statistical differences in the rate of PDFF change with gestational age between the white adipose tissue compartments (P=0.97). Perirenal brown adipose tissue had a different PDFF and R2* compared to white adipose tissue, while the rate of R2* change did not significantly change with gestational age between white adipose tissue compartments (P=0.96). CONCLUSION Fetal adipose tissue accumulates lipids at a similar rate in all white adipose tissue compartments. PDFF variances between the compartments suggest that accumulation begins at different gestational ages, starting with cheeks, followed by extremities, trunk and abdomen. Additionally, MRI was able to detect differences in the PDFF between fetal brown adipose tissue and white adipose tissue.
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Affiliation(s)
- Stephanie A Giza
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Tianna L Koreman
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Simran Sethi
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Michael R Miller
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road E, Room B2-412, London, ON, N6A 3B4, Canada.,Department of Paediatrics, Western University, London, ON, Canada
| | - Debbie A Penava
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road E, Room B2-412, London, ON, N6A 3B4, Canada.,Department of Obstetrics and Gynaecology, Western University, London, ON, Canada
| | - Genevieve D Eastabrook
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road E, Room B2-412, London, ON, N6A 3B4, Canada.,Department of Obstetrics and Gynaecology, Western University, London, ON, Canada
| | - Charles A McKenzie
- Department of Medical Biophysics, Western University, London, ON, Canada.,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road E, Room B2-412, London, ON, N6A 3B4, Canada
| | - Barbra de Vrijer
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute, London Health Sciences Centre, Victoria Hospital, 800 Commissioner's Road E, Room B2-412, London, ON, N6A 3B4, Canada. .,Department of Obstetrics and Gynaecology, Western University, London, ON, Canada.
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Matthew J, Skelton E, Story L, Davidson A, Knight CL, Gupta C, Pasupathy D, Rutherford M. MRI-Derived Fetal Weight Estimation in the Midpregnancy Fetus: A Method Comparison Study. Fetal Diagn Ther 2021; 48:708-719. [PMID: 34818233 PMCID: PMC7614116 DOI: 10.1159/000519115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/12/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of this study was to compare the standard ultrasound (US) estimated fetal weight (EFW) and MRI volume-derived methods for the midtrimester fetus. METHODS Twenty-five paired US and MRI scans had the EFW calculated (gestational age [GA] range = 20-26 weeks). The intra- and interobserver variability of each method was assessed (2 operators/modality). A small sub-analysis was performed on 5 fetuses who were delivered preterm (mean GA 29 +3 weeks) and compared to the actual birthweight. RESULTS Two MRI volumetry EFW formulae under-measured compared to US by -10.9% and -14.5% in the midpregnancy fetus (p < 0.001) but had excellent intra- and interobserver agreement (intraclass correlation coefficient = 0.998 and 0.993). In the preterm fetus, the mean relative difference (MRD) between the MRI volume-derived EFW (MRI-EFW) and actual expected birthweight (at the scan GA) was -13.7% (-159.0 g, 95% CI: -341.7 to 23.7 g) and -17.1% (-204.6 g, 95% CI: -380.4 to -28.8 g), for the 2 MRI formulae. The MRD was smaller for US at 5.3% (69.8 g, 95% CI: -34.3 to 173.9). CONCLUSIONS MRI-EFW results should be interpreted with caution in midpregnancy. Despite excellent observer agreement with MRI volumetry, refinement of the EFW formula is needed in the second trimester, for the small and for the GA and preterm fetus to compensate for lower fetal densities.
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Affiliation(s)
- Jacqueline Matthew
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK
| | - Emily Skelton
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK
| | - Lisa Story
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK,Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Alice Davidson
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK
| | - Caroline L. Knight
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK,Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Chandni Gupta
- North Tees and Hartlepool NHS Foundation Trust, London, UK
| | - Dharmintra Pasupathy
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mary Rutherford
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK,Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
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9
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Desoye G, Herrera E. Adipose tissue development and lipid metabolism in the human fetus: The 2020 perspective focusing on maternal diabetes and obesity. Prog Lipid Res 2020; 81:101082. [PMID: 33383022 DOI: 10.1016/j.plipres.2020.101082] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
During development, the human fetus accrues the highest proportion of fat of all mammals. Precursors of fat lobules can be found at week 14 of pregnancy. Thereafter, they expand, filling with triacylglycerols during pregnancy. The resultant mature lipid-filled adipocytes emerge from a developmental programme of embryonic stem cells, which is regulated differently than adult adipogenesis. Fetal triacylglycerol synthesis uses glycerol and fatty acids derived predominantly from glycolysis and lipogenesis in liver and adipocytes. The fatty acid composition of fetal adipose tissue at the end of pregnancy shows a preponderance of palmitic acid, and differs from the mother. Maternal diabetes mellitus does not influence this fatty acid profile. Glucose oxidation is the main source of energy for the fetus, but mitochondrial fatty acid oxidation also contributes. Indirect evidence suggests the presence of lipoprotein lipase in fetal adipose tissue. Its activity may be increased under hyperinsulinemic conditions as in maternal diabetes mellitus and obesity, thereby contributing to increased triacylglycerol deposition found in the newborns of such pregnancies. Fetal lipolysis is low. Changes in the expression of genes controlling metabolism in fetal adipose tissue appear to contribute actively to the increased neonatal fat mass found in diabetes and obesity. Many of these processes are under endocrine regulation, principally by insulin, and show sex-differences. Novel fatty acid derived signals such as oxylipins are present in cord blood with as yet undiscovered function. Despite many decades of research on fetal lipid deposition and metabolism, many key questions await answers.
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Affiliation(s)
- G Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.
| | - E Herrera
- Faculties of Pharmacy and Medicine, University CEU San Pablo, Madrid, Spain.
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10
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Sun Y, Ning G, Li X, Qu H, Zeng J. MRI characteristics of the fetal tethered spinal cord: a comparative study. Int J Neurosci 2020; 132:975-984. [PMID: 33272085 DOI: 10.1080/00207454.2020.1858829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To compare fetuses and children with confirmed tethered cord syndrome to age-matched controls to provide a reference for prenatally identifying tethered spinal cord and to identify salient points on MRI for diagnosis.Materials and Methods: This retrospective study enrolled 13 fetuses and 20 children with tethered cord syndrome, and age-matched counterparts were included as controls. The MRI features including concomitant malformations, position of the conus medullaris, and thickened filum terminale of the two patient groups were evaluated and compared. Levels of the conus medullaris were discriminated between patients and an equivalent number of controls.Results: Various concomitant malformations manifested on the MRI of all patients, and there were differences between the two patient groups. Significant differences of the level of the conus medullaris were found between the fetal and child patients (U, 26.50; Z, -3.87; p < 0.001) and between the normal fetus and child controls (U, 23.50; Z, -4.13; p < 0.001). The position of the conus medullaris was visibly lower in the patient groups than in the control groups. No significant difference in the diameters of the filum terminale was found between the fetal and child patients (p = 0.67).Conclusions: The current study's results indicate that tethered spinal cord syndrome can be diagnosed in utero with MRI combined with several characteristics, particularly the position of the conus medullaris. Special attention should be paid to the gestational age of the fetus because normal changes in spinal cord position occur with gestational development.
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Affiliation(s)
- Yan Sun
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Gang Ning
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Xuesheng Li
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Haibo Qu
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Jiangang Zeng
- Department of Radiology, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
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11
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Geraldo AF, Valente F, Almeida N, Nunes J. Posterior fossa lipoma without T1 hyperintensity in foetal magnetic resonance imaging performed in the third trimester. Pediatr Radiol 2018; 48:1178-1179. [PMID: 29876683 DOI: 10.1007/s00247-018-4168-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/15/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Ana Filipa Geraldo
- Department of Radiology, Neuroradiology unit, CHVNG/E- Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal.
| | - Francisco Valente
- Department of Gynecology-Obstetrics, Prenatal Diagnosis unit, CHVNG/E- Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Nuno Almeida
- Department of Radiology, Neuroradiology unit, CHVNG/E- Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Joana Nunes
- Department of Radiology, Neuroradiology unit, CHVNG/E- Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
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12
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Delhaes F, Giza SA, Koreman T, Eastabrook G, McKenzie CA, Bedell S, Regnault TRH, de Vrijer B. Altered maternal and placental lipid metabolism and fetal fat development in obesity: Current knowledge and advances in non-invasive assessment. Placenta 2018; 69:118-124. [PMID: 29907450 DOI: 10.1016/j.placenta.2018.05.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/01/2018] [Accepted: 05/25/2018] [Indexed: 02/06/2023]
Abstract
Abnormal maternal lipid profiles, a hallmark of increased maternal adiposity, are associated with pregnancy complications such as preeclampsia and gestational diabetes, and offspring long-term metabolic health is impacted as the consequence of altered fetal growth, physiology and often iatrogenic prematurity. The metabolic changes associated with maternal obesity and/or the consumption of a high-fat diet effecting maternal lipid profiles and metabolism have also been documented to specifically affect placental function and may underlie changes in fetal development and life course disease risk. The placenta plays a critical role in mediating nutritional signals between the fetus and the mother. As obesity rates in women of reproductive age continue to increase, it is becoming evident that inclusion of new technologies that allow for a better understanding of early changes in placental lipid transport and metabolism, non-invasively in maternal circulation, maternal tissues, placenta, fetal circulation and fetal tissues are needed to aid timely clinical diagnosis and treatment for obesity-associated diseases. This review describes pregnancy lipid homeostasis, with specific reference to changes arising from altered maternal body composition on placental and fetal lipid transport and metabolism. Current technologies for lipid assessments, such as metabolomics and lipidomics may be impacted by labour or mode of delivery and are only reflective of a single time point. This review further addresses how established and novel technologies for assessing lipids and their metabolism non-invasively and during the course of pregnancy may guide future research into the effect of maternal metabolic health on pregnancy outcome, placenta and fetus.
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Affiliation(s)
- Flavien Delhaes
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | - Stephanie A Giza
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | - Tianna Koreman
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | - Genevieve Eastabrook
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
| | - Charles A McKenzie
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
| | - Samantha Bedell
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | - Timothy R H Regnault
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
| | - Barbra de Vrijer
- Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
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13
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Variability of T1-weighted signal intensity of pericallosal lipomas in the fetus. Pediatr Radiol 2018; 48:383-391. [PMID: 29184973 DOI: 10.1007/s00247-017-4028-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/02/2017] [Accepted: 11/03/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pericallosal lipomas are often associated with corpus callosum dysgenesis. The diagnosis of lipoma, suggested on ultrasonography, relies on the classic T1 hyperintensity on magnetic resonance imaging (MRI). However, this feature may be absent prenatally. OBJECTIVE Our objective was to study the changes of T1 intensity in fetal lipomas with comparison to postnatal/postmortem data and to assess the factors influencing the signal variations of pericallosal lipomas on prenatal MRI. MATERIALS AND METHODS Patients with callosum dysgenesis and interhemispheric hyperechogenicity suggestive of a pericallosal lipoma with available postnatal or postmortem data were included. Gestational age, lipoma size and pattern, corpus callosum size and changes in fetal fat T1 intensity were recorded. Comparison with postmortem neuropathology was available for one fetus. RESULTS Eleven patients with callosum dysgenesis and pericallosal lipomas (seven curvilinear and four tubulonodular) were included. All MRI scans were performed in the third trimester. Curvilinear lipomas were thinner and six cases were associated with prenatal T1 iso-intensity. Typical T1 hyperintensity appeared on postnatal MRI only. All tubulonodular lipomas were much larger and showed prenatal T1 hyperintensity. In two patients, the lipoma increased in size on postnatal MRI. CONCLUSION The type and size of a lipoma influence T1 prenatal intensity. Absence of T1 intensity was observed in curvilinear lipomas only. Curvilinear lipomas are much thinner. Changes in T1 intensity may also be related to fat maturation within the lipoma and, subsequently, to gestational age. In the case of callosum dysgenesis, absence of prenatal T1 pericallosal hyperintensity should not exclude the diagnosis of pericallosal lipoma.
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