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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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Gibbins KJ, Roberts VHJ, Lo JO, Boniface ER, Schabel MC, Silver RM, Frias AE. MRI assessed placental volume and adverse pregnancy outcomes: Secondary analysis of prospective cohort study. Placenta 2024; 154:168-175. [PMID: 39018609 PMCID: PMC11368624 DOI: 10.1016/j.placenta.2024.07.007] [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: 02/01/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Our goal was to evaluate the potential utility of magnetic resonance imaging (MRI) placental volume as an assessment of placental insufficiency. METHODS Secondary analysis of a prospective cohort undergoing serial placental MRIs at two academic tertiary care centers. The population included 316 participants undergoing MRI up to three times throughout gestation. MRI was used to calculate placental volume in milliliters (ml). Placental-mediated adverse pregnancy outcome (cAPO) included preeclampsia with severe features, abnormal antenatal surveillance, and perinatal mortality. Serial measurements were grouped as time point 1 (TP1) <22 weeks, TP2 22 0/7-29 6/7 weeks, and TP3 ≥30 weeks. Mixed effects models compared change in placental volume across gestation between cAPO groups. Association between cAPO and placental volume was determined using logistic regression at each TP with discrimination evaluated using area under receiver operator curve (AUC). Placental volume was then added to known clinical predictive variables and evaluated with test characteristics and calibration. RESULTS 59 (18.7 %) of 316 participants developed cAPO. Placental volume growth across gestation was slower in the cAPO group (p < 0.001). Placental volume was lower in the cAPO group at all time points, and alone was moderately predictive of cAPO at TP3 (AUC 0.756). Adding placental volume to clinical variables had moderate discrimination at all time points, with strongest test characteristics at TP3 (AUC 0.792) with sensitivity of 77.5 % and specificity of 75.3 % at a predicted probability cutoff of 15 %. DISCUSSION MRI placental volume warrants further study for assessment of placental insufficiency, particularly later in gestation.
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Affiliation(s)
- Karen J Gibbins
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
| | - Victoria H J Roberts
- Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Jamie O Lo
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Oregon National Primate Research Center, Portland, Oregon, USA
| | - Emily R Boniface
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthias C Schabel
- Advanced Imaging Resource Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Robert M Silver
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah, USA
| | - Antonio E Frias
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
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Morris RK, Johnstone E, Lees C, Morton V, Smith G. Investigation and Care of a Small-for-Gestational-Age Fetus and a Growth Restricted Fetus (Green-top Guideline No. 31). BJOG 2024; 131:e31-e80. [PMID: 38740546 DOI: 10.1111/1471-0528.17814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Key recommendations
All women should be assessed at booking (by 14 weeks) for risk factors for fetal growth restriction (FGR) to identify those who require increased surveillance using an agreed pathway [Grade GPP]. Findings at the midtrimester anomaly scan should be incorporated into the fetal growth risk assessment and the risk assessment updated throughout pregnancy. [Grade GPP]
Reduce smoking in pregnancy by identifying women who smoke with the assistance of carbon monoxide (CO) testing and ensuring in‐house treatment from a trained tobacco dependence advisor is offered to all pregnant women who smoke, using an opt‐out referral process. [Grade GPP]
Women at risk of pre‐eclampsia and/or placental dysfunction should take aspirin 150 mg once daily at night from 12+0–36+0 weeks of pregnancy to reduce their chance of small‐for‐gestational‐age (SGA) and FGR. [Grade A]
Uterine artery Dopplers should be carried out between 18+0 and 23+6 weeks for women at high risk of fetal growth disorders [Grade B]. In a woman with normal uterine artery Doppler and normal fetal biometry at the midtrimester scan, serial ultrasound scans for fetal biometry can commence at 32 weeks. Women with an abnormal uterine artery Doppler (mean pulsatility index > 95th centile) should commence ultrasound scans at 24+0–28+6 weeks based on individual history. [Grade B]
Women who are at low risk of FGR should have serial measurement of symphysis fundal height (SFH) at each antenatal appointment after 24+0 weeks of pregnancy (no more frequently than every 2 weeks). The first measurement should be carried out by 28+6 weeks. [Grade C]
Women in the moderate risk category are at risk of late onset FGR so require serial ultrasound scan assessment of fetal growth commencing at 32+0 weeks. For the majority of women, a scan interval of four weeks until birth is appropriate. [Grade B]
Maternity providers should ensure that they clearly identify the reference charts to plot SFH, individual biometry and estimated fetal weight (EFW) measurements to calculate centiles. For individual biometry measurements the method used for measurement should be the same as those used in the development of the individual biometry and fetal growth chart [Grade GPP]. For EFW the Hadlock three parameter model should be used. [Grade C]
Maternity providers should ensure that they have guidance that promotes the use of standard planes of acquisition and calliper placement when performing ultrasound scanning for fetal growth assessment. Quality control of images and measurements should be undertaken. [Grade C]
Ultrasound biometry should be carried out every 2 weeks in fetuses identified to be SGA [Grade C]. Umbilical artery Doppler is the primary surveillance tool and should be carried out at the point of diagnosis of SGA and during follow‐up as a minimum every 2 weeks. [Grade B]
In fetuses with an EFW between the 3rd and 10th centile, other features must be present for birth to be recommended prior to 39+0 weeks, either maternal (maternal medical conditions or concerns regarding fetal movements) or fetal compromise (a diagnosis of FGR based on Doppler assessment, fetal growth velocity or a concern on cardiotocography [CTG]) [Grade C]. For fetuses with an EFW or abdominal circumference less than the 10th centile where FGR has been excluded, birth or the initiation of induction of labour should be considered at 39+0 weeks after discussion with the woman and her partner/family/support network. Birth should occur by 39+6 weeks. [Grade B]
Pregnancies with early FGR (prior to 32+0 weeks) should be monitored and managed with input from tertiary level units with the highest level neonatal care. Care should be multidisciplinary by neonatology and obstetricians with fetal medicine expertise, particularly when extremely preterm (before 28 weeks) [Grade GPP]. Fetal biometry in FGR should be repeated every 2 weeks [Grade B]. Assessment of fetal wellbeing can include multiple modalities but must include computerised CTG and/or ductus venous. [Grade B]
In pregnancies with late FGR, birth should be initiated from 37+0 weeks to be completed by 37+6 weeks [Grade A]. Decisions for birth should be based on fetal wellbeing assessments or maternal indication. [Grade GPP]
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Chen Y, Ye Z, Lin M, Zhu L, Xu L, Wang X. Deciphering the Epigenetic Landscape: Placental Development and Its Role in Pregnancy Outcomes. Stem Cell Rev Rep 2024; 20:996-1014. [PMID: 38457061 DOI: 10.1007/s12015-024-10699-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/09/2024]
Abstract
The placenta stands out as a unique, transitory, and multifaceted organ, essential to the optimal growth and maturation of the fetus. Functioning as a vital nexus between the maternal and fetal circulatory systems, it oversees the critical exchange of nutrients and waste. This exchange is facilitated by placental cells, known as trophoblasts, which adeptly invade and remodel uterine blood vessels. Deviations in placental development underpin a slew of pregnancy complications, notably fetal growth restriction (FGR), preeclampsia (PE), recurrent spontaneous abortions (RSA), and preterm birth. Central to placental function and development is epigenetic regulation. Despite its importance, the intricate mechanisms by which epigenetics influence the placenta are not entirely elucidated. Recently, the scientific community has turned its focus to parsing out the epigenetic alterations during placental development, such as variations in promoter DNA methylation, genomic imprints, and shifts in non-coding RNA expression. By establishing correlations between epigenetic shifts in the placenta and pregnancy complications, researchers are unearthing invaluable insights into the biology and pathophysiology of these conditions. This review seeks to synthesize the latest findings on placental epigenetic regulation, spotlighting its crucial role in shaping fetal growth trajectories and development. Through this lens, we underscore the overarching significance of the placenta in the larger narrative of gestational health.
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Affiliation(s)
- Yujia Chen
- Medical Research Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- National Health Commission (NHC), Key Laboratory of Technical Evaluation of Fertility Regulation for Non-Human Primate, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Zhoujie Ye
- Medical Research Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- National Health Commission (NHC), Key Laboratory of Technical Evaluation of Fertility Regulation for Non-Human Primate, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Meijia Lin
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Liping Zhu
- Medical Research Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- National Health Commission (NHC), Key Laboratory of Technical Evaluation of Fertility Regulation for Non-Human Primate, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center of Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Provincial Key Laboratory of Prenatal Diagnosis and Birth Defect, Fuzhou, China.
| | - Xinrui Wang
- Medical Research Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
- National Health Commission (NHC), Key Laboratory of Technical Evaluation of Fertility Regulation for Non-Human Primate, Fujian Maternity and Child Health Hospital, Fuzhou, China.
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Peterson HF, Eskild A, Sommerfelt S, Hillestad V. Placental size at gestational week 36: Comparisons between ongoing pregnancies and deliveries. Acta Obstet Gynecol Scand 2024; 103:85-92. [PMID: 37904568 PMCID: PMC10755138 DOI: 10.1111/aogs.14700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION We aimed to compare placental size and placental size relative to fetal size (ratio) in ongoing pregnancies examined by magnetic resonance imaging (MRI) at gestational week 36 with placental size among all deliveries at gestational week 36 during the same time period. MATERIAL AND METHODS Ongoing unselected singleton pregnancies (n = 89) were examined by MRI at median gestational week 36+5 days during 2017-2018, and placental and fetal volumes (cm3 ) were calculated. The placental size and ratio in ongoing pregnancies were compared with placental size and ratio among all deliveries in Norway at gestational week 36 (median gestational week 36+4 days) during 2016-2019 (n = 5582). For comparison of size, we converted volume (cm3 ) in ongoing pregnancies into grams as: cm3 × 1.05 (density of placental and fetal tissue). RESULTS In ongoing pregnancies, median placental size was 873 (interquartile range [IQR] 265) grams and median size of all delivered placentas was 613 (IQR 290) grams. Placental size was smaller among the delivered placentas independent of delivery mode: 760 (IQR 387) grams among elective cesarean deliveries (n = 465) and 590 (IQR 189) grams among vaginal deliveries after spontaneous onset of labor (n = 2478). Median ratio in ongoing pregnancies was higher than among deliveries: 0.31 (IQR 0.08) vs 0.21 (IQR 0.08). The ratio was higher in ongoing pregnancies independent of delivery mode: 0.24 (IQR 0.17) among elective cesarean deliveries vs 0.21 (IQR 0.05) among vaginal deliveries after spontaneous onset of labor. CONCLUSIONS The placenta is larger in ongoing pregnancies than among deliveries. This finding suggests that placental size decreases during labor and delivery, possibly by transfer of blood to the fetus. Our finding also suggests that reference values of placental size based on delivered placentas are not valid for ongoing pregnancies.
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Affiliation(s)
- Helene Fjeldvik Peterson
- Division of Obstetrics and GynecologyAkershus University HospitalLørenskogNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Anne Eskild
- Division of Obstetrics and GynecologyAkershus University HospitalLørenskogNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Silje Sommerfelt
- Division of Obstetrics and GynecologyAkershus University HospitalLørenskogNorway
| | - Vigdis Hillestad
- Division of Obstetrics and GynecologyAkershus University HospitalLørenskogNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Diagnostic ImagingAkershus University HospitalLørenskogNorway
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6
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Aertsen M, Melbourne A, Couck I, King E, Ourselin S, De Keyzer F, Dymarkowski S, Deprest J, Lewi L. Placental differences between uncomplicated and complicated monochorionic diamniotic pregnancies on diffusion and multicompartment Magnetic Resonance Imaging. Placenta 2023; 142:106-114. [PMID: 37683336 DOI: 10.1016/j.placenta.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Twin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are common complications in monochorionic diamniotic (MCDA) pregnancies. The Diffusion-rElaxation Combined Imaging for Detailed Placental Evaluation (DECIDE) model, a placental-specific model, separates the T2 values of the fetal and maternal blood from the background tissue and estimates the fetal blood oxygen saturation. This study investigates diffusion and relaxation differences in uncomplicated MCDA pregnancies and MCDA pregnancies complicated by TTTS and sFGR in mid-pregnancy. METHODS This prospective monocentric cohort study included uncomplicated MCDA pregnancies and pregnancies complicated by TTTS and sFGR. We performed MRI with conventional diffusion-weighted imaging (DWI) and combined relaxometry - DWI-intravoxel incoherent motion. DECIDE analysis was used to quantify different parameters within the placenta related to the fetal, placental, and maternal compartments. RESULTS We included 99 pregnancies, of which 46 were uncomplicated, 12 were complicated by sFGR and 41 by TTTS. Conventional DWI did not find differences between or within cohorts. On DECIDE imaging, fetoplacental oxygen saturation was significantly lower in the smaller member of sFGR (p = 0.07) and in both members of TTTS (p = 0.01 and p = 0.004) compared to the uncomplicated pairs. Additionally, average T2 relaxation time was significantly lower in the smaller twin of the sFGR (p = 0.004) compared to the uncomplicated twins (p = 0.03). CONCLUSION Multicompartment functional MRI showed significant differences in several MRI parameters between the placenta of uncomplicated MCDA pregnancies and those complicated by sFGR and TTTS in mid-pregnancy.
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Affiliation(s)
- M Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium.
| | - A Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Medical Physics and Biomedical Engineering, University College London, UK
| | - I Couck
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - E King
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - S Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Medical Physics and Biomedical Engineering, University College London, UK
| | - F De Keyzer
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - S Dymarkowski
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - J Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium; Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St.Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - L Lewi
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
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Vahedifard F, Adepoju JO, Supanich M, Ai HA, Liu X, Kocak M, Marathu KK, Byrd SE. Review of deep learning and artificial intelligence models in fetal brain magnetic resonance imaging. World J Clin Cases 2023; 11:3725-3735. [PMID: 37383127 PMCID: PMC10294149 DOI: 10.12998/wjcc.v11.i16.3725] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/30/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
Central nervous system abnormalities in fetuses are fairly common, happening in 0.1% to 0.2% of live births and in 3% to 6% of stillbirths. So initial detection and categorization of fetal Brain abnormalities are critical. Manually detecting and segmenting fetal brain magnetic resonance imaging (MRI) could be time-consuming, and susceptible to interpreter experience. Artificial intelligence (AI) algorithms and machine learning approaches have a high potential for assisting in the early detection of these problems, improving the diagnosis process and follow-up procedures. The use of AI and machine learning techniques in fetal brain MRI was the subject of this narrative review paper. Using AI, anatomic fetal brain MRI processing has investigated models to predict specific landmarks and segmentation automatically. All gestation age weeks (17-38 wk) and different AI models (mainly Convolutional Neural Network and U-Net) have been used. Some models' accuracy achieved 95% and more. AI could help preprocess and post-process fetal images and reconstruct images. Also, AI can be used for gestational age prediction (with one-week accuracy), fetal brain extraction, fetal brain segmentation, and placenta detection. Some fetal brain linear measurements, such as Cerebral and Bone Biparietal Diameter, have been suggested. Classification of brain pathology was studied using diagonal quadratic discriminates analysis, K-nearest neighbor, random forest, naive Bayes, and radial basis function neural network classifiers. Deep learning methods will become more powerful as more large-scale, labeled datasets become available. Having shared fetal brain MRI datasets is crucial because there aren not many fetal brain pictures available. Also, physicians should be aware of AI's function in fetal brain MRI, particularly neuroradiologists, general radiologists, and perinatologists.
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Affiliation(s)
- Farzan Vahedifard
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 606012, United States
| | - Jubril O Adepoju
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 606012, United States
| | - Mark Supanich
- Division for Diagnostic Medical Physics, Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL 606012, United States
| | - Hua Asher Ai
- Division for Diagnostic Medical Physics, Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL 606012, United States
| | - Xuchu Liu
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 606012, United States
| | - Mehmet Kocak
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 606012, United States
| | - Kranthi K Marathu
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 606012, United States
| | - Sharon E Byrd
- Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 606012, United States
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Saeed H, Lu YC, Andescavage N, Kapse K, Andersen NR, Lopez C, Quistorff J, Barnett S, Henderson D, Bulas D, Limperopoulos C. Influence of maternal psychological distress during COVID-19 pandemic on placental morphometry and texture. Sci Rep 2023; 13:7374. [PMID: 37164993 PMCID: PMC10172401 DOI: 10.1038/s41598-023-33343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has been accompanied by increased prenatal maternal distress (PMD). PMD is associated with adverse pregnancy outcomes which may be mediated by the placenta. However, the potential impact of the pandemic on in vivo placental development remains unknown. To examine the impact of the pandemic and PMD on in vivo structural placental development using advanced magnetic resonance imaging (MRI), acquired anatomic images of the placenta from 63 pregnant women without known COVID-19 exposure during the pandemic and 165 pre-pandemic controls. Measures of placental morphometry and texture were extracted. PMD was determined from validated questionnaires. Generalized estimating equations were utilized to compare differences in PMD placental features between COVID-era and pre-pandemic cohorts. Maternal stress and depression scores were significantly higher in the pandemic cohort. Placental volume, thickness, gray level kurtosis, skewness and run length non-uniformity were increased in the pandemic cohort, while placental elongation, mean gray level and long run emphasis were decreased. PMD was a mediator of the association between pandemic status and placental features. Altered in vivo placental structure during the pandemic suggests an underappreciated link between disturbances in maternal environment and perturbed placental development. The long-term impact on offspring is currently under investigation.
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Affiliation(s)
- Haleema Saeed
- Department of Obstetrics & Gynecology, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - Yuan-Chiao Lu
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Nickie Andescavage
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
- Division of Neonatology, Children's National Hospital, Washington, DC, 20010, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Nicole R Andersen
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Catherine Lopez
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Jessica Quistorff
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Scott Barnett
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Diedtra Henderson
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Dorothy Bulas
- Division of Radiology, Children's National Hospital, Washington, DC, 20010, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
- Division of Radiology, Children's National Hospital, Washington, DC, 20010, USA.
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Song F, Li R, Lin J, Lv M, Qian Z, Wang L, Wu W. Predicting the risk of fetal growth restriction by radiomics analysis of the placenta on T2WI: A retrospective case-control study. Placenta 2023; 134:15-22. [PMID: 36863127 DOI: 10.1016/j.placenta.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Fetal growth restriction (FGR) is associated with placental abnormalities, and its precise diagnosis is challenging. This study aimed to explore the role of radiomics based on placental MRI in predicting FGR. METHODS A retrospective study using T2-weighted placental MRI data were conducted. A total of 960 radiomic features were automatically extracted. Features were selected using three-step machine learning methods. A combined model was constructed by combining MRI-based radiomic features and ultrasound-based fetal measurements. The receiver operating characteristic curves (ROC) were conducted to assess model performance. Additionally, decision curves and calibration curves were performed to evaluate prediction consistency of different models. RESULTS Among the study participants, pregnant women who delivered from January 2015 to June 2021 were randomly divided into training (n = 119) and test (n = 40) sets. Forty-three other pregnant women who delivered from July 2021 to December 2021 were used as the time-independent validation set. After training and testing, three radiomic features that were strongly correlated with FGR were selected. The area under the ROC curves (AUCs) of the MRI-based radiomics model reached 0.87 (95% confidence interval [CI]: 0.74-0.96) and 0.87 (95% CI: 0.76-0.97) in the test and validation sets, respectively. Moreover, the AUCs for the model comprising MRI-based radiomic features and ultrasound-based measurements were 0.91 (95% CI: 0.83-0.97) and 0.94 (95% CI: 0.86-0.99) in the test and validation sets, respectively. DISCUSSION MRI-based placental radiomics could accurately predict FGR. Moreover, combining placental MRI-based radiomic features with ultrasound indicators of the fetus could improve the diagnostic accuracy of FGR.
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Affiliation(s)
- Fuzhen Song
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Institute of Birth Defects and Rare Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Ruikun Li
- Institute of Image Processing and Pattern Recognition, Department of Automation, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Lin
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Institute of Birth Defects and Rare Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Mingli Lv
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Institute of Birth Defects and Rare Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaoxia Qian
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Institute of Birth Defects and Rare Diseases, Shanghai Jiao Tong University, Shanghai, China.
| | - Lisheng Wang
- Institute of Image Processing and Pattern Recognition, Department of Automation, Shanghai Jiao Tong University, Shanghai, China; Key Laboratory of System Control and Information Processing, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.
| | - Weibin Wu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Institute of Birth Defects and Rare Diseases, Shanghai Jiao Tong University, Shanghai, China.
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10
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Mydtskov ND, Sinding M, Aarøe KK, Thaarup LV, Madsen SBB, Hansen DN, Frøkjær JB, Peters DA, Sørensen ANW. Placental volume, thickness and transverse relaxation time (T2*) estimated by magnetic resonance imaging in relation to small for gestational age at birth. Eur J Obstet Gynecol Reprod Biol 2023; 282:72-76. [PMID: 36669243 DOI: 10.1016/j.ejogrb.2023.01.013] [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: 09/25/2022] [Revised: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Placental magnetic resonance imaging (MRI) may be a valuable tool in the prediction of small for gestational age (SGA) at birth. MRI provides reliable estimates of placental volume and thickness. In addition, placental transverse relaxation time (T2*) may be directly related to placental function. This study aimed to explore and compare the predictive performance of three placental MRI parameters - volume, thickness and T2* - in relation to SGA at birth. METHODS A mixed cohort of 85 pregnancies was retrieved from the placental MRI database at the study hospital. MRI was performed in a 1.5 T system at gestational weeks 15-41. In normal birthweight (BW) pregnancies [BW > -22 % of expected for gestational age (GA)], the correlation between each of the MRI parameters and GA was investigated by linear regression. The prediction of SGA was investigated by logistic regression analysis adjusted for GA at MRI. RESULTS In normal BW pregnancies, a significant linear correlation was found between GA and each of the MRI parameters. Univariate analysis demonstrated that placental volume [odds ratio (OR) 0.97, p = 0.001] and placental T2* (OR 0.79, p = 0.003), but not placental thickness (OR 0.92, p = 0.862) were significant predictors of SGA. A multi-variate model including all three MRI parameters found that placental T2* was the only independent predictor of SGA (OR 0.81, p = 0.04). CONCLUSION Among the MRI parameters investigated in this study, placental T2* was the only independent predictor of SGA in a multi-variate model. This finding underlines the strong position of T2*-weighted placental MRI in the prediction of SGA.
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Affiliation(s)
- N D Mydtskov
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
| | - M Sinding
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - K K Aarøe
- Department of Surgery, North Denmark Regional Hospital, Hjørring, Denmark
| | - L V Thaarup
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - S B B Madsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - D N Hansen
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - J B Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - D A Peters
- Department of Clinical Engineering, Central Denmark Region, Aarhus N, Denmark
| | - A N W Sørensen
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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11
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Deng J, Zhang A, Zhao M, Zhou X, Mu X, Qu F, Song J, Chen T. Placental perfusion using intravoxel incoherent motion MRI combined with Doppler findings in differentiating between very low birth weight infants and small for gestational age infants. Placenta 2023; 135:16-24. [PMID: 36889012 DOI: 10.1016/j.placenta.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Abnormalities in placental morphology and function can lead to small for gestational age infants (SGA) and very low birth weight infants (VLBWI). In this study, we explored the value of intravoxel incoherent motion (IVIM) histogram parameters, MRI morphological parameters, and Doppler findings of the placenta in differentiating between VLBWI and SGA. METHODS Thirty-three pregnant women who were diagnosed with SGA and met the inclusion criteria were enrolled in this retrospective study and divided into two groups: 22 with non-VLBWI and 11 with VLBWI. The IVIM histogram parameters (perfusion fraction (f), true diffusion coefficient (D), and pseudo-diffusion coefficient (D*)), MRI morphological parameters, and Doppler findings were compared between groups. The diagnostic efficiency was compared by receiver operating characteristic (ROC) curve analysis. RESULTS The Dmean, D90th, D*90th, fmax, and placental area of the VLBWI group were significantly lower than those of the non-VLBWI group (p < 0.05). The values of umbilical artery pulsatility index, resistance index (RI), and peak systolic velocity/end-diastolic velocity were significantly higher in the VLBWI group than in the non-VLBWI group (p < 0.05). D90th, placental area, and umbilical artery RI had the highest areas under the curve (AUCs) of the ROC curves, at 0.787, 0.785, and 0.762, respectively. A combined predictive model (D90th, placental area, and umbilical artery RI) improved the performance in differentiating between VLBWI and SGA compared with the single model (AUC = 0.942). DISCUSSION IVIM histogram (D90th) and MRI morphological (placental area) parameters and a Doppler finding (umbilical artery RI) may be sensitive indicators for differentiating between VLBWI and SGA.
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Affiliation(s)
- Jing Deng
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Aining Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Meng Zhao
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xin Zhou
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xihu Mu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Feifei Qu
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China.
| | - Jiacheng Song
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Ting Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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12
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Himoto Y, Fujimoto K, Kido A, Otani S, Matsumoto YK, Mogami H, Nakao KK, Kurata Y, Moribata Y, Chigusa Y, Minamiguchi S, Mandai M, Nakamoto Y. Risk Stratification for Pregnancies Diagnosed With Fetal Growth Restriction Based on Placental MRI. J Magn Reson Imaging 2022; 56:1650-1658. [PMID: 35713388 DOI: 10.1002/jmri.28298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diagnosis of fetal growth restriction (FGR) entails difficulties with differentiating fetuses not fulfilling their growth potential because of pathologic conditions, such as placental insufficiency, from constitutionally small fetuses. The feasibility of placental MRI for risk stratification among pregnancies diagnosed with FGR remains unexplored. PURPOSE To explore quantitative MRI features useful to identify pregnancies with unfavorable outcomes and to assess the diagnostic performance of visual analysis of MRI to detect pregnancies with unfavorable outcomes, among pregnancies diagnosed with FGR. STUDY TYPE Retrospective. POPULATION Thirteen pregnancies with unfavorable outcomes (preterm emergency cesarean section or intrauterine fetal death) and 11 pregnancies with favorable outcomes performed MRI at gestational weeks 21-36. FIELD STRENGTH/SEQUENCE A 5-T, half-Fourier-acquired single-shot turbo spin echo (HASTE), spin-echo echo-planar imaging (SE-EPI) and T2 map derived from SE-EPI. ASSESSMENT Placental size on HASTE sequences and T2 mapping-based histogram features were extracted. Three radiologists qualitatively evaluated the visibility of maternal cotyledon on HASTE and SE-EPI sequences with echo times (TEs) = 60, 90, and 120 msec using 3-point Likert scales: 0, absent; 1, equivocal; and 2, present. STATISTICAL TESTS Welch's t-test or Mann-Whitney U test for quantitative features between the favorable and unfavorable outcome groups. Areas under the receiver operating curves (AUCs) of the three readers' visual analyses to detect pregnancies with unfavorable outcomes. A P value of <0.05 was inferred as statistically significant. RESULTS Placental size (major and minor axis, estimated area of placental bed, and volume of placenta) and T2 mapping-based histogram features (mean, skewness, and kurtosis) were statistically significantly different between the two groups. Visual analysis of HASTE and SE-EPI with TE = 60 msec showed AUCs of 0.80-0.86 to detect pregnancies with unfavorable outcomes. DATA CONCLUSION Placental size, histogram features, and visual analysis of placental MRI may allow for risk stratification regarding outcomes among pregnancies diagnosed with FGR. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Yuki Himoto
- Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Koji Fujimoto
- Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuka Kuriyama Matsumoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Kyoko Kameyama Nakao
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhisa Kurata
- Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yusaku Moribata
- Preemptive Medicine and Lifestyle-related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
| | | | | | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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13
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Percentiles of intrauterine placental volume and placental volume relative to fetal volume: A prospective magnetic resonance imaging study. Placenta 2022; 121:40-45. [DOI: 10.1016/j.placenta.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/07/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022]
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Ho A, Chappell LC, Story L, Al-Adnani M, Egloff A, Routledge E, Rutherford M, Hutter J. Visual assessment of the placenta in antenatal magnetic resonance imaging across gestation in normal and compromised pregnancies: Observations from a large cohort study. Placenta 2022; 117:29-38. [PMID: 34768166 PMCID: PMC8761363 DOI: 10.1016/j.placenta.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 09/12/2021] [Accepted: 10/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Visual assessment of the placenta in antenatal magnetic resonance imaging is important to confirm healthy appearances or to identify pathology complicating fetal anomaly or maternal disease. METHODS We assessed the placenta in a large cohort of 228 women with low and high risk pregnancies across gestation. All women gave written informed consent and were imaged using either a 3T Philips Achieva or 1.5T Philips Ingenia scanner. Images were acquired with a T2-weighted single shot turbo spin echo sequence of the whole uterus (thereby including placenta) for anatomical information. RESULTS A structured approach to visual assessment of the placenta on T2-weighted imaging has been provided including determination of key anatomical landmarks to aid orientation, placental shape, signal intensity, lobularity and granularity. Transient factors affecting imaging are shown including the effect of fetal movement, gross fetal motion and contractions. Placental appearances across gestation in low risk pregnancies are shown and compared to pregnancies complicated by preeclampsia and chronic hypertension. The utility of other magnetic resonance techniques (T2* mapping as an indirect marker for quantifying oxygenation) and histological assessment alongside visual assessment of placental T2-weighted imaging are demonstrated. DISCUSSION A systematic approach with qualitative descriptors for placental visual assessment using T2-weighted imaging allows confirmation of normal placental development and can detect placental abnormalities in pregnancy complications. T2-weighted imaging can be visually assessed alongside functional imaging (such as T2* maps) in order to further probe the visual characteristics seen.
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Affiliation(s)
- Alison Ho
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Lucy C. Chappell
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Lisa Story
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Mudher Al-Adnani
- Department of Cellular Pathology, Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - Alexia Egloff
- Centre for the Developing Brain, King’s College London, London, United Kingdom
| | - Emma Routledge
- Centre for the Developing Brain, King’s College London, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King’s College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, King’s College London, London, United Kingdom,Biomedical Engineering Department, King’s College London, London, United Kingdom
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Liu XL, Feng J, Huang CT, Mei YJ, Xu YK. Use of intravoxel incoherent motion MRI to assess placental perfusion in normal and Fetal Growth Restricted pregnancies on their third trimester. Placenta 2021; 118:10-15. [PMID: 34995915 DOI: 10.1016/j.placenta.2021.12.019] [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: 07/19/2021] [Revised: 11/11/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Intravoxel Incoherent Motion (IVIM) MRI is a non-invasive, in vivo techniques which can assess placental perfusion quantitatively, and be useful for evaluating placental microcirculation. Our primary aim was to investigate whether fetal growth restriction (FGR) pregnancies have different placental perfusion and diffusion compared with normal pregnancies using IVIM. A secondary aim was to investigate correlations between placental IVIM parameters and gestational age in normal pregnancy. METHODS This study population included 17 FGR pregnancies and 36 normal pregnancies between 28 + 3 to 38 + 0 weeks. All women underwent a MRI examination including an IVIM sequence with 9 b-values on a 3.0 T MRI system. The standard diffusion coefficeint (D), pseudodiffusion (D*) and perfusion fraction (f) were calculated. RESULTS Placental f was significantly lower in the FGR group than that in the normal group (33.96 ± 2.62(%) vs 38.48 ± 5.31(%), p = 0.002). Placental D and D* in two groups showed no statistical significance (P > 0.05). Placental f moderately increased with increasing gestational age in normal pregnancies (r = 0.411, p = 0.013), and there existed a negative correlation between D values and gestational age (r = -0.390, p = 0.019). DISCUSSION The f values are able to distinguish FGR from normal pregnancies. It can be uses as a feasible index to evaluate placenta perfusion. Gestational age-associated changes in placental IVIM parameters likely reveal trajectories of microvascular perfusion fraction and diffusion characteristics in the normal developing placenta.
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Affiliation(s)
- Xi-Long Liu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Jie Feng
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Chan-Tao Huang
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Ying-Jie Mei
- Philips Healthcare, Guangzhou, Guangdong, 510055, China
| | - Yi-Kai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China.
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Rafique Z, Awan MW, Iqbal S, Usmani NN, Ahmad M, Amjad M, Ullah S, Mumtaz H. The Ability of Ultrasound Sonography (USG) to Detect Intrauterine Growth Restriction (IUGR) in the Third Trimester of Pregnancy With the Gold Standard of IUGR (Parameters by USG Hadlock) as a Diagnostic Criterion. Cureus 2021; 13:e20523. [PMID: 35070557 PMCID: PMC8767181 DOI: 10.7759/cureus.20523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/06/2022] Open
Abstract
Objective To investigate the diagnostic accuracy of the placental thickness measured by ultrasound sonography test (USG) in detecting intrauterine growth restriction (IUGR) babies in the third trimester of pregnancy, keeping IUGR (by parameters using Hadlock) as the gold standard. Methods and materials This cross-sectional study was conducted at the radiology department of KRL Hospital from August 5, 2020, to October 25, 2021. Informed written consent was also obtained from each patient, and the hospital's ethical committee approved the study. Three hundred and sixty-two (N=362) pregnant women patients knowing of their last menstrual period, age group 20-35 years, BMI usual, and 24 weeks gestation were included. The patient's complete history was taken by clinical examination and then ultrasound was carried out to measure the placental thickness. At 24, 32, and 36 weeks, the thickness of the placenta was assessed. The Hadlock method was used to compute the predicted fetal weight by measuring biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) on the GC Logiq P/6 three-dimensional machine (GE, Tampa, FL). SPSS v 23 (IBM Corp., Armonk, NY) was used to calculate the mean and standard deviation from the collected data. Results A total of 362 patients who presented in the radiology department for antenatal ultrasound in the third trimester were recruited in our study. The mean age was 27.26 ± 4.21 years (20-35 years). In our study, the mean placenta thickness at 24 gestation weeks was 24.55 ± 0.79 mm, at 32 gestation weeks was 31.84 ± 1.34 mm, and at 36 gestation weeks was 35.54 ± 2.78. Thus, ultrasound's sensitivity, specificity, positive predictive value, and negative predictive value to determine IUGR by placental thickness was 86.30%, 86.70%, 75%, and 92%, respectively. The diagnostic accuracy of ultrasound incorrectly estimating low placental thickness was 86.40%. Conclusion Between 24 and 36 weeks of pregnancy, placental thickness rises almost linearly. As a result, measuring placental thickness and other factors is critical for estimating fetal age, particularly in the late second and early third trimesters, when the exact duration of pregnancy is uncertain. Placentas that were less than 29 mm thick at 32 weeks and 31 mm thick at 36 weeks were related to higher morbidity, lower Apgar scores, and more nursery admissions.
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17
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MRI based morphological examination of the placenta. Placenta 2021; 115:20-26. [PMID: 34536809 DOI: 10.1016/j.placenta.2021.08.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022]
Abstract
Ultrasound is widely used as the initial diagnostic imaging modality during pregnancy with both high spatial and temporal resolution. Although MRI in pregnancy has long focused on the fetus, its use in placental imaging has greatly increased over recent years. In addition to the possibilities of evaluating function, MRI with a wide field of view and high contrast resolution allows characterization of placental anatomy, particularly in situations that are difficult to specify with ultrasound, especially for suspected placenta accreta. MRI also appears to be a particularly useful examination for the anatomical evaluation of the placenta independent of maternal body habitus or fetal position. Indeed, surprisingly little attention is paid to the placenta in MRI when the indication for the examination is fetal. Thus, some aspects of the placenta seem to us to be important to be recognized by the radiologist and to be described on the MRI report. In this review, we will describe MRI sequences used for, and common features seen in, imaging of i) the normal placenta, ii) abnormal aspects of the placenta that should be identified on MRI performed for fetal reason, and iii) placental anomalies for which placental MRI may be indicated.
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18
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Andescavage N, Kapse K, Lu YC, Barnett SD, Jacobs M, Gimovsky AC, Ahmadzia H, Quistorff J, Lopez C, Andersen NR, Bulas D, Limperopoulos C. Normative placental structure in pregnancy using quantitative Magnetic Resonance Imaging. Placenta 2021; 112:172-179. [PMID: 34365206 DOI: 10.1016/j.placenta.2021.07.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/08/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To characterize normative morphometric, textural and microstructural placental development by applying advanced and quantitative magnetic resonance imaging (qMRI) techniques to the in-vivo placenta. METHODS We enrolled 195 women with uncomplicated, healthy singleton pregnancies in a prospective observational study. Women underwent MRI between 16- and 40-weeks' gestation. Morphometric and textural metrics of placental growth were calculated from T2-weighted (T2W) images, while measures of microstructural development were calculated from diffusion-weighted images (DWI). Normative tables and reference curves were constructed for each measured index across gestation and according to fetal sex. RESULTS Data from 269 MRI studies from 169 pregnant women were included in the analyses. During the study period, placentas undergo significant increases in morphometric measures of volume, thickness, and elongation. Placental texture reveals increasing variability with advancing gestation as measured by grey level non uniformity, run length non uniformity and long run high grey level emphasis. Placental microstructure did not vary with gestational age. Placental elongation was the only metric that differed significantly between male and female fetuses. DISCUSSION We report quantitative metrics of placental morphometry, texture and microstructure in a large cohort of healthy controls during the second and third trimesters of pregnancy. These measures can serve as normative references of in-vivo placental development to better understand placental function in high-risk conditions and allow for the early detection of placental mal-development.
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Affiliation(s)
- Nickie Andescavage
- Division of Neonatology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA; Department of Pediatrics, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Kushal Kapse
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Yuan-Chiao Lu
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Scott D Barnett
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Marni Jacobs
- Division of Biostatistics & Study Methodology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20037, USA
| | - Alexis C Gimovsky
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Homa Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Jessica Quistorff
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Catherine Lopez
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Nicole Reinholdt Andersen
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Dorothy Bulas
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA; Department of Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Catherine Limperopoulos
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA; Department of Pediatrics, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA; Department of Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
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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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Byrne M, Aughwane R, James JL, Hutchinson JC, Arthurs OJ, Sebire NJ, Ourselin S, David AL, Melbourne A, Clark AR. Structure-function relationships in the feto-placental circulation from in silico interpretation of micro-CT vascular structures. J Theor Biol 2021; 517:110630. [PMID: 33607145 DOI: 10.1016/j.jtbi.2021.110630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
A well-functioning placenta is critical for healthy fetal development, as the placenta brings fetal blood in close contact with nutrient rich maternal blood, enabling exchange of nutrients and waste between mother and fetus. The feto-placental circulation forms a complex branching structure, providing blood to fetal capillaries, which must receive sufficient blood flow to ensure effective exchange, but at a low enough pressure to prevent damage to placental circulatory structures. The branching structure of the feto-placental circulation is known to be altered in complications such as fetal growth restriction, and the presence of regions of vascular dysfunction (such as hypovascularity or thrombosis) are proposed to elevate risk of placental pathology. Here we present a methodology to combine micro-computed tomography and computational model-based analysis of the branching structure of the feto-placental circulation in ex vivo placentae from normal term pregnancies. We analyse how vascular structure relates to function in this key organ of pregnancy; demonstrating that there is a 'resilience' to placental vascular structure-function relationships. We find that placentae with variable chorionic vascular structures, both with and without a Hyrtl's anastomosis between the umbilical arteries, and those with multiple regions of poorly vascularised tissue are able to function with a normal vascular resistance. Our models also predict that by progressively introducing local heterogeneity in placental vascular structure, large increases in feto-placental vascular resistances are induced. This suggests that localised heterogeneities in placental structure could potentially provide an indicator of increased risk of placental dysfunction.
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Affiliation(s)
- Monika Byrne
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Rosalind Aughwane
- Department of Maternal Fetal Medicine, Prenatal Cell and Gene Therapy Group, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, WC1E 6HX, United Kingdom
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - J Ciaran Hutchinson
- NIHR GOS Institute of Child Health Biomedical Research Centre, University College, London, United Kingdom; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Owen J Arthurs
- NIHR GOS Institute of Child Health Biomedical Research Centre, University College, London, United Kingdom; Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Neil J Sebire
- NIHR GOS Institute of Child Health Biomedical Research Centre, University College, London, United Kingdom; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom
| | - Anna L David
- Department of Maternal Fetal Medicine, Prenatal Cell and Gene Therapy Group, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, WC1E 6HX, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, 149 Tottenham Court Road, London, W1T 7DN, United Kingdom
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom
| | - Alys R Clark
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
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21
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Characterization of Uterine Motion in Early Gestation Using MRI-Based Motion Tracking. Diagnostics (Basel) 2020; 10:diagnostics10100840. [PMID: 33086473 PMCID: PMC7603139 DOI: 10.3390/diagnostics10100840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/25/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a promising non-invasive imaging technique that can be safely used to study placental development and function. However, studies of the human placenta performed by MRI are limited by uterine motion and motion in the uterus during MRI remains one of the major limiting factors. Here, we aimed to investigate the characterization of uterine activity during MRI in the second trimester of pregnancy using MRI-based motion tracking. In total, 46 pregnant women were scanned twice (first scan between 14 and 18 weeks and second scan between 19 and 24 weeks), and 20 pregnant subjects underwent a single MRI between 14 and 18 weeks GA, resulting in 112 MRI scans. An MRI-based algorithm was used to track uterine motion in the superior-inferior and left-right directions. Uterine contraction and maternal motion cases were separated by the experts, and unpaired Wilcoxon tests were performed within the groups of gestational age (GA), fetal sex, and placental location in terms of the overall intensity measures of the uterine activity. In total, 22.3% of cases had uterine contraction during MRI, which increased from 18.6% at 14–18 weeks to 26.4% at 19–24 weeks GA. The dominant direction of the uterine contraction and maternal motion was the superior to the inferior direction during early gestation.
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Ayala-Ramírez P, Serrano N, Barrera V, Bejarano JP, Silva JL, Martínez R, Gil F, Olaya-C M, García-Robles R. Risk factors and fetal outcomes for preeclampsia in a Colombian cohort. Heliyon 2020; 6:e05079. [PMID: 33015399 PMCID: PMC7522495 DOI: 10.1016/j.heliyon.2020.e05079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/23/2020] [Accepted: 09/23/2020] [Indexed: 01/12/2023] Open
Abstract
In Latin America and the Caribbean, hypertensive pregnancy disorders are responsible for almost 26% of all maternal deaths [1] and, in Colombia, they account for 59% of all severe maternal morbidity (SMM) cases, and 59.7% of all SMM cases in adolescents [2]. One of the most important hypertensive pregnancy disorders is preeclampsia (PE). Lives can be saved, if PE is prevented, or detected early and properly managed. Prevention and detection depend on identifying the risk factors associated with PE, and, as these have been shown vary by population, they should be determined on a population-by-population basis. The following study utilized the nested case-control model to evaluate 45 potential PE risk factors of a cohort in Bogotá, Colombia, making it perhaps the most comprehensive study of its kind in Colombia. It found PE to have a statistically significant association with 7 of the 45 factors evaluated: 1) pre-gestational BMI >30 kg/m2, 2) pregnancy weight gain >12 kg, 3) previous history preeclampsia/eclampsia, 4) previous history of IUGR-SGA (Intrauterine Growth Restriction-Small for Gestational Age), 5) maternal age <20 or ≥35 years (20–34 was not associated), and 6) family history of diabetes. Finally, prenatal consumption of folic acid was found to lower the risk of PE. We recommend that, in Colombia, factors 1–6 be used to identify at risk mothers during pregnancy check-ups; that mothers be encouraged to take folic acid during pregnancy; and, that Colombia's health system and public policy address the problem of pregestational obesity.
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Affiliation(s)
- Paola Ayala-Ramírez
- Human Genetics Institute, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Corresponding author.
| | - Natalia Serrano
- Research Seedbed in Perinatal Medicine Pontificia Universidad Javeriana: Medical School Pontificia Universidad Javeriana and Medical Residents Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Viviana Barrera
- Research Seedbed in Perinatal Medicine Pontificia Universidad Javeriana: Medical School Pontificia Universidad Javeriana and Medical Residents Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juan Pablo Bejarano
- Research Seedbed in Perinatal Medicine Pontificia Universidad Javeriana: Medical School Pontificia Universidad Javeriana and Medical Residents Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Jaime Luis Silva
- Department of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Rodolfo Martínez
- Department of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Fabian Gil
- Clinical Epidemiology and Biostatistics Department, Medical School, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Mercedes Olaya-C
- Department of Pathology, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Reggie García-Robles
- Department of Physiological Sciences, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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23
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Advances in imaging feto-placental vasculature: new tools to elucidate the early life origins of health and disease. J Dev Orig Health Dis 2020; 12:168-178. [PMID: 32746961 DOI: 10.1017/s2040174420000720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Optimal placental function is critical for fetal development, and therefore a crucial consideration for understanding the developmental origins of health and disease (DOHaD). The structure of the fetal side of the placental vasculature is an important determinant of fetal growth and cardiovascular development. There are several imaging modalities for assessing feto-placental structure including stereology, electron microscopy, confocal microscopy, micro-computed tomography, light-sheet microscopy, ultrasonography and magnetic resonance imaging. In this review, we present current methodologies for imaging feto-placental vasculature morphology ex vivo and in vivo in human and experimental models, their advantages and limitations and how these provide insight into placental function and fetal outcomes. These imaging approaches add important perspective to our understanding of placental biology and have potential to be new tools to elucidate a deeper understanding of DOHaD.
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24
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Njeze NR, Ogbochukwu JO, Chinawa JM. Correlation of ultrasound placental diameter & thickness with gestational age. Pak J Med Sci 2020; 36:1058-1062. [PMID: 32704289 PMCID: PMC7372674 DOI: 10.12669/pjms.36.5.1938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/17/2019] [Accepted: 05/20/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND & OBJECTIVES Estimation of fetal maturity is common in obstetric practice especially when the women do not keep accurate menstrual records. An accurate establishment of expected date of delivery is fundamental to the management of both high risk and normal pregnancies. The objective of this study was to determine the placental diameter (PD), placental thickness (PT) and to establish a correlation between PD, PT and gestational age. METHODS This is an observational cross-sectional study that examines by means of ultrasonography the correlation between placental diameter and thickness with gestational age in Enugu, South East, Nigeria. RESULTS A total of 400 healthy subjects were recruited in 3rd trimester of pregnancy having fulfilled the inclusion criteria. PD and PT in this study did not correlate with parity. There is a linear increase of gestational age and placental thickness and diameter. These increases heighten between 38th week gestation and 40 weeks' gestation. 205.0±1.4, 43.00±0.0 to 215.0±1.4, 46.00±2.8 respectively. CONCLUSION Placental thickness and Placental diameter can be used to predict gestational age. It is therefore advised to use PT & PD in ultrasound obstetric assessment especially when Last menstrual period (LMP) is not clear.
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Affiliation(s)
- Ngozi R. Njeze
- Ngozi R. Njeze, Senior lecturer Department of Radiation Medicine, University of Nigeria Medical School, Nsukka, Nigeria
| | - Joseph O. Ogbochukwu
- Joseph O. Ogbochukwu, Consultant Radiologist, Department of Radiology, Federal Medical Center Nguru, Nigeria
| | - Josephat M. Chinawa
- Josephat M. Chinawa Associate Professor, Department of Pediatrics, University of Nigeria Medical School, Nsukka, Nigeria
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25
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Dellschaft NS, Hutchinson G, Shah S, Jones NW, Bradley C, Leach L, Platt C, Bowtell R, Gowland PA. The haemodynamics of the human placenta in utero. PLoS Biol 2020; 18:e3000676. [PMID: 32463837 PMCID: PMC7255609 DOI: 10.1371/journal.pbio.3000676] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
We have used magnetic resonance imaging (MRI) to provide important new insights into the function of the human placenta in utero. We have measured slow net flow and high net oxygenation in the placenta in vivo, which are consistent with efficient delivery of oxygen from mother to fetus. Our experimental evidence substantiates previous hypotheses on the effects of spiral artery remodelling in utero and also indicates rapid venous drainage from the placenta, which is important because this outflow has been largely neglected in the past. Furthermore, beyond Braxton Hicks contractions, which involve the entire uterus, we have identified a new physiological phenomenon, the ‘utero-placental pump’, by which the placenta and underlying uterine wall contract independently of the rest of the uterus, expelling maternal blood from the intervillous space. MRI provides important new insights into the function of the human placenta, revealing slow net flow and high, uniform oxygenation in healthy pregnancies, detecting changes that will lead to compromised oxygen delivery to the fetus in preeclampsia, and identifying a new physiological phenomenon, the ‘utero-placental pump’.
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Affiliation(s)
- Neele S. Dellschaft
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - George Hutchinson
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Simon Shah
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Nia W. Jones
- Department of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Chris Bradley
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Lopa Leach
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Craig Platt
- Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Penny A. Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- * E-mail:
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26
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Sun C, Groom KM, Oyston C, Chamley LW, Clark AR, James JL. The placenta in fetal growth restriction: What is going wrong? Placenta 2020; 96:10-18. [PMID: 32421528 DOI: 10.1016/j.placenta.2020.05.003] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
The placenta is essential for the efficient delivery of nutrients and oxygen from mother to fetus to maintain normal fetal growth. Dysfunctional placental development underpins many pregnancy complications, including fetal growth restriction (FGR) a condition in which the fetus does not reach its growth potential. The FGR placenta is smaller than normal placentae throughout gestation and displays maldevelopment of both the placental villi and the fetal vasculature within these villi. Specialized epithelial cells called trophoblasts exhibit abnormal function and development in FGR placentae. This includes an altered balance between proliferation and apoptotic death, premature cellular senescence, and reduced colonisation of the maternal decidual tissue. Thus, the placenta undergoes aberrant changes at the macroscopic to cellular level in FGR, which can limit exchange capacity and downstream fetal growth. This review aims to compile stereological, in vitro, and imaging data to create a holistic overview of the FGR placenta and its pathophysiology, with a focus on the contribution of trophoblasts.
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Affiliation(s)
- Cherry Sun
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Katie M Groom
- Liggins Institute, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, The University of Auckland, Auckland Bioengineering, House, Level 6/70 Symonds Street, Grafton, Auckland, 1010, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
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27
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Kumar I, Verma A, Jain M, Shukla RC. Structured evaluation and reporting in imaging of placenta and umbilical cord. Acta Radiol 2020; 61:685-704. [PMID: 31550171 DOI: 10.1177/0284185119875644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The human placenta plays a pivotal role in development and growth of the fetus. Disorder of this multifunctional organ is central to various fetal disorders. Doppler sonography and MRI provide excellent diagnostic evaluation of the placental morphology and umbilical cord. Decades of experience in obstetric imaging have highlighted the need of careful prenatal assessment of placenta. However, in most of the routine obstetric scans, the evaluation and reporting of the placental examination is limited to the location and grade of the placenta. The purpose of this article is to review the existing literature and facilitate step-by-step evaluation of the placenta and umbilical cord by the radiologists.
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Affiliation(s)
- Ishan Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Madhu Jain
- Department of Obstetric and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ram C Shukla
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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28
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Görkem SB, Coşkun A, Eşlik M, Kütük MS, Öztürk A. Diffusion-weighted imaging of placenta in intrauterine growth restriction with worsening Doppler US findings. ACTA ACUST UNITED AC 2020; 25:280-284. [PMID: 31120426 DOI: 10.5152/dir.2019.18358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to compare the placental diffusion difference between intrauterine growth restriction (IUGR) patients with worsening Doppler ultrasonography (US) findings and control group with normal Doppler US findings by using diffusion-weighted imaging (DWI). METHODS We performed a prospective study to compare the placental diffusion difference in 63 patients (gestational week, 28-34 weeks), including 50 IUGR patients (mean gestational week, 30 weeks 3 days ±16.2 days) with worsening Doppler US findings and 13 patients with normal Doppler US findings (mean gestational week, 29 weeks 4 days ±12.3 days) by using DWI (b value, 0-1000 s/mm2). We classified IUGR patients into three groups according to the reference values of the umbilical artery pulsatility index (PI) chart. Placenta apparent diffusion coefficient (ADC) calculations were performed by freehand drawn regions-of-interest (ROIs) (min, 8.04 cm2; max, 200 cm2). RESULTS Placental ADC values in IUGR patients (mean, 1.624±0.181 ×10-³ mm²/s; range, 1.35-1.96 ×10-3 mm2/s) were significantly reduced compared with the control group (mean, 1.827±0.191 ×10-³ mm²/s; range, 1.35-2.84 ×10-3 mm2/s) (P = 0.001). For adjusted ROI area calculation, ADC values were significantly lower in groups 3, 2 and 1, respectively, compared with the control group (P < 0.05); and there was no significant difference between groups 1 and 2 (P > 0.05). Preeclampsia significantly reduced the placental diffusion compared with patients without preeclampsia (P = 0.003). Gestational aging did not significantly affect ADC values in control patients (r=0.08, P = 0.561). The sensitivity, specificity, negative and positive predictive values of ADC to detect IUGR were 72%, 84.6%, 44%, and 94.7% with a cutoff value of 1.727 ×10-3 mm2/s, respectively. CONCLUSION The diagnostic estimation of placental ADC values to predict the severity of IUGR is comparable to that of umbilical artery PI. Considering that at the very early onset of IUGR, placental diffusion diminishes, ADC as a marker for IUGR in lieu of umbilical artery PI has the potential to determine the threshold for decreased placental diffusion. Therefore, DWI should be added to routine fetal MRI to show diffusion changes in placenta.
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Affiliation(s)
- Süreyya Burcu Görkem
- Division of Pediatric Radiology, Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Abdulhakim Coşkun
- Division of Pediatric Radiology, Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Murside Eşlik
- Department of Obstetrics and Gynaecology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Mehmet Serdar Kütük
- Department of Obstetrics and Gynaecology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ahmet Öztürk
- Department of Biostatistics, Erciyes University School of Medicine, Kayseri, Turkey
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29
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Aughwane R, Ingram E, Johnstone ED, Salomon LJ, David AL, Melbourne A. Placental MRI and its application to fetal intervention. Prenat Diagn 2020; 40:38-48. [PMID: 31306507 PMCID: PMC7027916 DOI: 10.1002/pd.5526] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/18/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) of placental invasion has been part of clinical practice for many years. The possibility of being better able to assess placental vascularization and function using MRI has multiple potential applications. This review summarises up-to-date research on placental function using different MRI modalities. METHOD We discuss how combinations of these MRI techniques have much to contribute to fetal conditions amenable for therapy such as singletons at high risk for fetal growth restriction (FGR) and monochorionic twin pregnancies for planning surgery and counselling for selective growth restriction and transfusion conditions. RESULTS The whole placenta can easily be visualized on MRI, with a clear boundary against the amniotic fluid, and a less clear placental-uterine boundary. Contrasts such as diffusion weighted imaging, relaxometry, blood oxygenation level dependent MRI and flow and metabolite measurement by dynamic contrast enhanced MRI, arterial spin labeling, or spectroscopic techniques are contributing to our wider understanding of placental function. CONCLUSION The future of placental MRI is exciting, with the increasing availability of multiple contrasts and new models that will boost the capability of MRI to measure oxygen saturation and placental exchange, enabling examination of placental function in complicated pregnancies.
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Affiliation(s)
| | - Emma Ingram
- Division of Developmental Biology & MedicineUniversity of ManchesterManchesterUK
| | - Edward D. Johnstone
- Division of Developmental Biology & MedicineUniversity of ManchesterManchesterUK
| | - Laurent J. Salomon
- Hôpital Necker‐Enfants Malades, AP‐HP, EHU PACT and LUMIERE PlatformUniversité Paris DescartesParisFrance
| | - Anna L. David
- Institute for Women's HealthUniversity College LondonLondonUK
- National Institute for Health ResearchUniversity College London Hospitals Biomedical Research CentreLondonUK
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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30
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Apparent Diffusion Coefficient of the Placenta and Fetal Organs in Intrauterine Growth Restriction. J Comput Assist Tomogr 2019; 43:507-512. [PMID: 30762655 DOI: 10.1097/rct.0000000000000844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE This study aimed to assess apparent diffusion coefficient (ADC) of the placenta and fetal organs in intrauterine growth restriction (IUGR). MATERIALS AND METHODS A prospective study of 30 consecutive pregnant women (aged 21-38 years with mean age of 31.5 years and a mean gestational week of 35 ± 2.3) with IUGR and 15 age-matched pregnant women was conducted. All patients and controls underwent diffusion-weighted magnetic resonance imaging. The ADCs of the placenta and fetal brain, kidney, and lung were calculated and correlated with neonates needing intensive care unit (ICU) admission. RESULTS There was a significant difference in ADC of the placenta and fetal brain, lung, and kidney (P = 0.001, 0.001, 0.04, and 0.04, respectively) between the patients and the controls. The cutoff ADCs of the placenta and fetal brain, lung, and kidney used to detect IUGR were 1.45, 1.15, 1.80, and 1.40 × 10 mm/s, respectively, with areas under the curve (AUCs) of 0.865, 0.858, 0.812, and 0.650, respectively, and accuracy values of 75%, 72.5%, 72.5%, and 70%, respectively. Combined ADC of the placenta and fetal organs used to detect IUGR revealed an AUC of 1.00 and an accuracy of 100%. There was a significant difference in ADC of the placenta and fetal brain, lung, and kidney between neonates needing admission and those not needing ICU admission (P = 0.001, 0.001, 0.002, and 0.002, respectively). The cutoff ADCs of the placenta and fetal brain, lung, and kidney used to define neonates needing ICU were 1.35, 1.25, 1.95, and 1.15 × 10 mm/s with AUCs of 0.955, 0.880, 0.884, and 0.793, respectively, and accuracy values of 86.7%, 46.7%, 76.7%, and 70%, respectively. Combined placental and fetal brain ADC used to define neonates needing ICU revealed an AUC of 0.968 and an accuracy of 93.3%. CONCLUSION Combined ADC of the placenta and fetal organs can detect IUGR, and combined ADC of the placenta and fetal brain can define fetuses needing ICU.
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31
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Keshavarz E, Motevasselian M, Amirnazeri B, Bahramzadeh S, Mohammadkhani H, Mehrjardi Z, Razzaz M, Bakhtiyari M. Gestational age-specific reference values of placental thickness in normal pregnant women. Women Health 2019; 59:718-729. [PMID: 30786837 DOI: 10.1080/03630242.2018.1553816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of this study was to determine the reference values of the placental thickness in 400 normal pregnant women during weeks 16-41 of gestation who were referred to the Mahdiyeh hospital during January 2014-February 2015. The placental thickness at the junction of the umbilical artery was measured using ultrasonography. Multivariable linear regression was used to model the mean placental thickness and assess associations with measured covariates, including gestational age (GA). Centiles for placental thickness distribution were estimated according to the modulus exponential-normal model. The mean and standard deviation of the age of the participants was 31.4 ± 5.7 years. The Pearson correlation coefficient indicated a very strong positive linear correlation between GA and placental thickness (p <.001; r = 0.93). A nonlinear increase of placental thickness with estimated fetal weights was observed. GA-specific placental thicknesses for the 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97.5th percentiles of placental thickness were calculated. By making use of the provided nomogram in this study, neonatal outcomes associated with the placental thickness, such as Hemoglobin Bart's disease, can be diagnosed early to improve maternal and newborn health.
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Affiliation(s)
- E Keshavarz
- a Department of Radiology , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - M Motevasselian
- b Department of Gynecology & Obstetric , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - B Amirnazeri
- b Department of Gynecology & Obstetric , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - S Bahramzadeh
- b Department of Gynecology & Obstetric , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - H Mohammadkhani
- b Department of Gynecology & Obstetric , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Z Mehrjardi
- b Department of Gynecology & Obstetric , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - M Razzaz
- c Department of Radiology , Kerman University of Medical Sciences , Kerman , Iran
| | - M Bakhtiyari
- d Non-Communicable Diseases Research Center , Alborz University of Medical Sciences , Karaj , Iran.,e Department of Community Medicine , Alborz University of Medical Sciences , Karaj , Iran
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Vasung L, Abaci Turk E, Ferradal SL, Sutin J, Stout JN, Ahtam B, Lin PY, Grant PE. Exploring early human brain development with structural and physiological neuroimaging. Neuroimage 2019; 187:226-254. [PMID: 30041061 PMCID: PMC6537870 DOI: 10.1016/j.neuroimage.2018.07.041] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
Early brain development, from the embryonic period to infancy, is characterized by rapid structural and functional changes. These changes can be studied using structural and physiological neuroimaging methods. In order to optimally acquire and accurately interpret this data, concepts from adult neuroimaging cannot be directly transferred. Instead, one must have a basic understanding of fetal and neonatal structural and physiological brain development, and the important modulators of this process. Here, we first review the major developmental milestones of transient cerebral structures and structural connectivity (axonal connectivity) followed by a summary of the contributions from ex vivo and in vivo MRI. Next, we discuss the basic biology of neuronal circuitry development (synaptic connectivity, i.e. ensemble of direct chemical and electrical connections between neurons), physiology of neurovascular coupling, baseline metabolic needs of the fetus and the infant, and functional connectivity (defined as statistical dependence of low-frequency spontaneous fluctuations seen with functional magnetic resonance imaging (fMRI)). The complementary roles of magnetic resonance imaging (MRI), electroencephalography (EEG), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS) are discussed. We include a section on modulators of brain development where we focus on the placenta and emerging placental MRI approaches. In each section we discuss key technical limitations of the imaging modalities and some of the limitations arising due to the biology of the system. Although neuroimaging approaches have contributed significantly to our understanding of early brain development, there is much yet to be done and a dire need for technical innovations and scientific discoveries to realize the future potential of early fetal and infant interventions to avert long term disease.
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Affiliation(s)
- Lana Vasung
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Esra Abaci Turk
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Silvina L Ferradal
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jason Sutin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jeffrey N Stout
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Banu Ahtam
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Pei-Yi Lin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Hutter J, Slator PJ, Jackson L, Gomes ADS, Ho A, Story L, O’Muircheartaigh J, Teixeira RPAG, Chappell LC, Alexander DC, Rutherford MA, Hajnal JV. Multi-modal functional MRI to explore placental function over gestation. Magn Reson Med 2019; 81:1191-1204. [PMID: 30242899 PMCID: PMC6585747 DOI: 10.1002/mrm.27447] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate, visualize and quantify the physiology of the human placenta in several dimensions - functional, temporal over gestation, and spatial over the whole organ. METHODS Bespoke MRI techniques, combining a rich diffusion protocol, anatomical data and T2* mapping together with a multi-modal pipeline including motion correction and extracted quantitative features were developed and employed on pregnant women between 22 and 38 weeks gestational age including two pregnancies diagnosed with pre-eclampsia. RESULTS A multi-faceted assessment was demonstrated showing trends of increasing lacunarity, and decreasing T2* and diffusivity over gestation. CONCLUSIONS The obtained multi-modal acquisition and quantification shows promising opportunities for studying evolution, adaptation and compensation processes.
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Affiliation(s)
- Jana Hutter
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Paddy J. Slator
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Laurence Jackson
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Ana Dos Santos Gomes
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Alison Ho
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | - Lisa Story
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | | | - Rui P. A. G. Teixeira
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Lucy C. Chappell
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | - Daniel C. Alexander
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonUnited Kingdom
| | | | - Joseph V. Hajnal
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
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Salavati N, Smies M, Ganzevoort W, Charles AK, Erwich JJ, Plösch T, Gordijn SJ. The Possible Role of Placental Morphometry in the Detection of Fetal Growth Restriction. Front Physiol 2019; 9:1884. [PMID: 30670983 PMCID: PMC6331677 DOI: 10.3389/fphys.2018.01884] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/12/2018] [Indexed: 01/08/2023] Open
Abstract
Fetal growth restriction (FGR) is often the result of placental insufficiency and is characterized by insufficient transplacental transport of nutrients and oxygen. The main underlying entities of placental insufficiency, the pathophysiologic mechanism, can broadly be divided into impairments in blood flow and exchange capacity over the syncytiovascular membranes of the fetal placenta villi. Fetal growth restriction is not synonymous with small for gestational age and techniques to distinguish between both are needed. Placental insufficiency has significant associations with adverse pregnancy outcomes (perinatal mortality and morbidity). Even in apparently healthy survivors, altered fetal programming may lead to long-term neurodevelopmental and metabolic effects. Although the concept of fetal growth restriction is well appreciated in contemporary obstetrics, the appropriate detection of FGR remains an issue in clinical practice. Several approaches have aimed to improve detection, e.g., uniform definition of FGR, use of Doppler ultrasound profiles and use of growth trajectories by ultrasound fetal biometry. However, the role of placental morphometry (placental dimensions/shape and weight) deserves further exploration. This review article covers the clinical relevance of placental morphometry during pregnancy and at birth to help recognize fetuses who are growth restricted. The assessment has wide intra- and interindividual variability with various consequences. Previous studies have shown that a small placental surface area and low placental weight are associated with a slower growth of the fetus. Parameters such as placental surface area, placental volume and placental weight in relation to birth weight can help to identify FGR. In the future, a model including sophisticated antenatal placental morphometry may prove to be a clinically useful method for screening or diagnosing growth restricted fetuses, in order to provide optimal monitoring.
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Affiliation(s)
- Nastaran Salavati
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maddy Smies
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Jan Jaap Erwich
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sanne J. Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Kameyama KN, Kido A, Himoto Y, Moribata Y, Minamiguchi S, Konishi I, Togashi K. What is the most suitable MR signal index for quantitative evaluation of placental function using Half-Fourier acquisition single-shot turbo spin-echo compared with T2-relaxation time? Acta Radiol 2018; 59:748-754. [PMID: 28862023 DOI: 10.1177/0284185117727786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Half-Fourier acquisition single-shot turbo spin-echo (HASTE) imaging is now widely used for placental and fetal imaging because of its rapidity and low sensitivity to fetal movement. If placental dysfunction is also predicted by quantitative value obtained from HASTE image, then it might be beneficial for evaluating placental wellbeing. Purpose To ascertain the most suitable magnetic resonance (MR) signal indexes reflecting placental function using HASTE imaging. Material and Methods This retrospective study included 37 consequent patients who had given informed consent to MR imaging (MRI) examinations. All had undergone MRI examinations between February 2014 and June 2015. First, the correlation between T2-relaxation time of normal placenta and gestational age (GA) was examined. Second, correlation between signal intensity ratios (SIRs) using HASTE imaging and placental T2-relaxation time were assessed. The SIRs were calculated using placental signal intensity (SI) relative to the SI of the amniotic fluid, fetal ocular globes, gastric fluid, bladder, maternal psoas major muscles, and abdominal subcutaneous adipose tissue. Results Among the 37 patients, the correlation between T2-relaxation time of the 25 normal placentas and GA showed a moderately strong correlation (Spearman rho = -0.447, P = 0.0250). The most significant correlation with placental T2-relaxation time was observed with the placental SIR relative to the maternal psoas major muscles (SIRpl./psoas muscle) (Spearman rho = -0.531, P = 0.0007). Conclusion This study revealed that SIRpl./psoas muscle showed the best correlation to placental T2-relaxation time. Results show that SIRpl./psoas muscle might be optimal as a clinically available quantitative index of placental function.
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Affiliation(s)
- Kyoko Nakao Kameyama
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ikuo Konishi
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Lo JO, Roberts VHJ, Schabel MC, Wang X, Morgan TK, Liu Z, Studholme C, Kroenke CD, Frias AE. Novel Detection of Placental Insufficiency by Magnetic Resonance Imaging in the Nonhuman Primate. Reprod Sci 2018; 25:64-73. [PMID: 28330415 PMCID: PMC5993076 DOI: 10.1177/1933719117699704] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The placenta is a vital organ necessary for healthy fetal development. Placental insufficiency creates an in utero environment where the fetus is at risk of insufficient oxygen or nutrient exchange. This is primarily caused by impairment of either maternal or fetal circulation or vascular thrombosis such as placental infarction. As a result of placental dysfunction, affected fetuses may be growth restricted, neurologically impaired, and at risk of increased morbidity and mortality. In a cohort of 4 pregnant Rhesus macaques, we describe antenatal detection of naturally occurring intrauterine growth restriction (IUGR) and aberrant fetal neurodevelopment in 1 animal. Abnormal growth parameters were detected by Doppler ultrasound, and vascular insufficiency in the intervillous space was characterized by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Furthermore, placental oxygen reserve was shown to be reduced compared to control animals by measurements of placental water T2*. To characterize the effects of IUGR on fetal brain development, T2 and diffusion anisotropy images of the fetal brain were acquired in utero. Reduced brain volume and cerebral cortical surface area were apparent macroscopically. Microstructural abnormalities within the developing white matter and cerebral cortex were also observed through analysis of water diffusion anisotropy. After delivery by cesarean section, pathological examination confirmed placental insufficiency with hypoxia. These findings exemplify how DCE-MRI and T2*-based measurements of blood oxygenation within the placenta can provide noninvasive imaging methods for assessing in vivo placental health to potentially identify pregnancies affected by placental insufficiency and abnormal fetal neurodevelopment prior to the onset of fetal and neonatal distress.
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Affiliation(s)
- Jamie O. Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Victoria H. J. Roberts
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR, USA
| | - Matthias C. Schabel
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Xiaojie Wang
- Division of Neuroscience, Oregon National Primate Research Center, Portland, OR, USA
| | - Terry K. Morgan
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Zheng Liu
- Division of Neuroscience, Oregon National Primate Research Center, Portland, OR, USA
| | - Colin Studholme
- Division of Neonatology, University of Washington, Seattle, WA, USA
| | - Christopher D. Kroenke
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Antonio E. Frias
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR, USA
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Andescavage N, duPlessis A, Metzler M, Bulas D, Vezina G, Jacobs M, Iqbal SN, Baschat A, Limperopoulos C. In vivo assessment of placental and brain volumes in growth-restricted fetuses with and without fetal Doppler changes using quantitative 3D MRI. J Perinatol 2017; 37:1278-1284. [PMID: 28837138 PMCID: PMC5711581 DOI: 10.1038/jp.2017.129] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/01/2017] [Accepted: 06/23/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The relationship between placental and fetal brain growth is poorly understood and difficult to assess. The objective of this study was to interrogate placental and fetal brain growth in healthy pregnancies and those complicated by fetal growth restriction (FGR). STUDY DESIGN In a prospective, observational study, pregnant women with normal pregnancies or pregnancies complicated by FGR underwent fetal magnetic resonance imaging (MRI). Placental, global and regional brain volumes were calculated. RESULTS A total of 114 women (79 controls and 35 FGR) underwent MRI (median gestational age (GA) 30 weeks, range 18 to 39). All measured volumes increased exponentially with advancing GA. Placental, total brain, cerebral and cerebellar volumes were smaller in FGR compared with controls (P<0.05). Increasing placental volume was associated with increasing cerebral and cerebellar volumes (P<0.05). CONCLUSION Quantitative fetal MRI can accurately detect decreased placental and brain volumes in pregnancies with FGR and may provide insight into the timing and mechanisms of brain injury in FGR.
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Affiliation(s)
- Nickie Andescavage
- Division of Neonatology, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037
| | - Adre duPlessis
- Division of Fetal & Transitional Medicine, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037
| | - Marina Metzler
- Division of Fetal & Transitional Medicine, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010
| | - Dorothy Bulas
- Division of Diagnostic Imaging & Radiology, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037
| | - Gilbert Vezina
- Division of Diagnostic Imaging & Radiology, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037
| | - Marni Jacobs
- Division of Biostatistics & Study Methodology, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010
| | - Sara N Iqbal
- Division of Maternal Fetal-Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010
| | - Ahmet Baschat
- Department of Gynecology and Obstetrics, Johns Hopkins Center for Fetal Therapy, 600 North Wolfe Street, Nelson 228, Baltimore, MD 21287
| | - Catherine Limperopoulos
- Division of Fetal & Transitional Medicine, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Division of Diagnostic Imaging & Radiology, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037,Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037
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Dahdouh S, Andescavage N, Yewale S, Yarish A, Lanham D, Bulas D, du Plessis AJ, Limperopoulos C. In vivo placental MRI shape and textural features predict fetal growth restriction and postnatal outcome. J Magn Reson Imaging 2017; 47:449-458. [PMID: 28734056 DOI: 10.1002/jmri.25806] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/20/2017] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate the ability of three-dimensional (3D) MRI placental shape and textural features to predict fetal growth restriction (FGR) and birth weight (BW) for both healthy and FGR fetuses. MATERIALS AND METHODS We recruited two groups of pregnant volunteers between 18 and 39 weeks of gestation; 46 healthy subjects and 34 FGR. Both groups underwent fetal MR imaging on a 1.5 Tesla GE scanner using an eight-channel receiver coil. We acquired T2-weighted images on either the coronal or the axial plane to obtain MR volumes with a slice thickness of either 4 or 8 mm covering the full placenta. Placental shape features (volume, thickness, elongation) were combined with textural features; first order textural features (mean, variance, kurtosis, and skewness of placental gray levels), as well as, textural features computed on the gray level co-occurrence and run-length matrices characterizing placental homogeneity, symmetry, and coarseness. The features were used in two machine learning frameworks to predict FGR and BW. RESULTS The proposed machine-learning based method using shape and textural features identified FGR pregnancies with 86% accuracy, 77% precision and 86% recall. BW estimations were 0.3 ± 13.4% (mean percentage error ± standard error) for healthy fetuses and -2.6 ± 15.9% for FGR. CONCLUSION The proposed FGR identification and BW estimation methods using in utero placental shape and textural features computed on 3D MR images demonstrated high accuracy in our healthy and high-risk cohorts. Future studies to assess the evolution of each feature with regard to placental development are currently underway. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:449-458.
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Affiliation(s)
- Sonia Dahdouh
- Developing Brain Research Laboratory, Children's National Health System, Washington, DC, USA
| | - Nickie Andescavage
- Developing Brain Research Laboratory, Children's National Health System, Washington, DC, USA.,Division of Neonatology, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| | - Sayali Yewale
- Developing Brain Research Laboratory, Children's National Health System, Washington, DC, USA
| | - Alexa Yarish
- Developing Brain Research Laboratory, Children's National Health System, Washington, DC, USA
| | - Diane Lanham
- Developing Brain Research Laboratory, Children's National Health System, Washington, DC, USA
| | - Dorothy Bulas
- Diagnostic Imaging & Radiology, Children's National Health System, Washington, DC, USA
| | - Adre J du Plessis
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.,Fetal & Transitional Medicine, Children's National Health System, Washington, DC, USA
| | - Catherine Limperopoulos
- Developing Brain Research Laboratory, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.,Diagnostic Imaging & Radiology, Children's National Health System, Washington, DC, USA
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Ahn KH, Lee JH, Cho GJ, Hong SC, Oh MJ, Kim HJ. Placental thickness-to-estimated foetal weight ratios and small-for-gestational-age infants at delivery. J OBSTET GYNAECOL 2017. [PMID: 28631507 DOI: 10.1080/01443615.2017.1312306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to determine the correlation between the placental thickness-to-estimated foetal weight ratio on midterm ultrasonography and small-for-gestational-age (SGA) infants. In this retrospective study, the placental thickness at the umbilical cord insertion site was measured and adjusted for foetal body weight at 18-24 weeks gestation. Investigators compared the data of women who delivered SGA infants (birth weight <10th percentile) with those of women who delivered non-SGA infants. Among the 1281 women in this study, those who delivered SGA infants were younger and less likely to be obese. Women with higher placental thickness-to-estimated foetal weight ratios delivered more SGA infants. In logistic regression analysis, a higher placental thickness-to-estimated foetal weight ratio remained associated with SGA infants. Since the placental thickness-to-estimated foetal weight ratio in midterm pregnancy was associated with infant body weight at delivery, this ratio could be an effective, adjunctive screening marker for predicting SGA status.
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Affiliation(s)
- Ki Hoon Ahn
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
| | - Joo Hak Lee
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
| | - Geum Joon Cho
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
| | - Soon-Cheol Hong
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
| | - Min-Jeong Oh
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
| | - Hai-Joong Kim
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
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Decreased Brain and Placental Perfusion in Omphalopagus Conjoined Twins on Fetal MRI. Radiol Res Pract 2016; 2016:9458540. [PMID: 27034830 PMCID: PMC4791498 DOI: 10.1155/2016/9458540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/10/2016] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to evaluate perfusional changes in brain and placenta of omphalopagus conjoined twins and to compare them with singleton fetuses by using diffusion weighted imaging and apparent diffusion coefficient. Fetal MRIs of 28-week-old omphalopagus conjoined twins with a shared liver with two separate gallbladders and portal and hepatic venous systems and three singleton fetuses with unilateral borderline ventriculomegaly at the same gestational week as control group were enrolled retrospectively. There was a significant decrease in ADC values of brain regions (p = 0.018) and placenta (p = 0.005) of conjoined twins compared to the control group. The decreased ADC values in placenta and brain regions in conjoined twins might be due to decreased placental perfusion compared to singleton pregnancy. Our results would be a keystone for future studies which will compare larger group of monochorionic multiple pregnancies with singleton pregnancies.
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Gonzalez PN, Gasperowicz M, Barbeito-Andrés J, Klenin N, Cross JC, Hallgrímsson B. Chronic Protein Restriction in Mice Impacts Placental Function and Maternal Body Weight before Fetal Growth. PLoS One 2016; 11:e0152227. [PMID: 27018791 PMCID: PMC4809512 DOI: 10.1371/journal.pone.0152227] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/10/2016] [Indexed: 01/08/2023] Open
Abstract
Mechanisms of resource allocation are essential for maternal and fetal survival, particularly when the availability of nutrients is limited. We investigated the responses of feto-placental development to maternal chronic protein malnutrition to test the hypothesis that maternal low protein diet produces differential growth restriction of placental and fetal tissues, and adaptive changes in the placenta that may mitigate impacts on fetal growth. C57BL/6J female mice were fed either a low-protein diet (6% protein) or control isocaloric diet (20% protein). On embryonic days E10.5, 17.5 and 18.5 tissue samples were prepared for morphometric, histological and quantitative RT-PCR analyses, which included markers of trophoblast cell subtypes. Potential endocrine adaptations were assessed by the expression of Prolactin-related hormone genes. In the low protein group, placenta weight was significantly lower at E10.5, followed by reduction of maternal weight at E17.5, while the fetuses became significantly lighter no earlier than at E18.5. Fetal head at E18.5 in the low protein group, though smaller than controls, was larger than expected for body size. The relative size and shape of the cranial vault and the flexion of the cranial base was affected by E17.5 and more severely by E18.5. The junctional zone, a placenta layer rich in endocrine and energy storing glycogen cells, was smaller in low protein placentas as well as the expression of Pcdh12, a marker of glycogen trophoblast cells. Placental hormone gene Prl3a1 was altered in response to low protein diet: expression was elevated at E17.5 when fetuses were still growing normally, but dropped sharply by E18.5 in parallel with the slowing of fetal growth. This model suggests that nutrients are preferentially allocated to sustain fetal and brain growth and suggests the placenta as a nutrient sensor in early gestation with a role in mitigating impacts of poor maternal nutrition on fetal growth.
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Affiliation(s)
- Paula N. Gonzalez
- Instituto de Genética Veterinaria, CCT-CONICET, La Plata, Argentina
- de Ciencias Naturales y Museo, UNLP, La Plata, Argentina
| | - Malgorzata Gasperowicz
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, and the Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jimena Barbeito-Andrés
- Instituto de Genética Veterinaria, CCT-CONICET, La Plata, Argentina
- de Ciencias Naturales y Museo, UNLP, La Plata, Argentina
| | - Natasha Klenin
- Department Biochemistry & Molecular Biology, University of Calgary, Calgary, Alberta, Canada
| | - James C. Cross
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, and the Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department Biochemistry & Molecular Biology, University of Calgary, Calgary, Alberta, Canada
- * E-mail: (BH); (JC)
| | - Benedikt Hallgrímsson
- Department of Cell Biology and Anatomy, Alberta Children’s Hospital Research Institute, and McCaig Institute for Bone and Joint Health. University of Calgary, Calgary, Alberta, Canada
- * E-mail: (BH); (JC)
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The hemodynamics of late-onset intrauterine growth restriction by MRI. Am J Obstet Gynecol 2016; 214:367.e1-367.e17. [PMID: 26475425 DOI: 10.1016/j.ajog.2015.10.004] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/24/2015] [Accepted: 10/06/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Late-onset intrauterine growth restriction (IUGR) results from a failure of the placenta to supply adequate nutrients and oxygen to the rapidly growing late-gestation fetus. Limitations in current monitoring methods present the need for additional techniques for more accurate diagnosis of IUGR in utero. New magnetic resonance imaging (MRI) technology now provides a noninvasive technique for fetal hemodynamic assessment, which could provide additional information over conventional Doppler methods. OBJECTIVE The objective of the study was to use new MRI techniques to measure hemodynamic parameters and brain growth in late-onset IUGR fetuses. STUDY DESIGN This was a prospective observational case control study to compare the flow and T2 of blood in the major fetal vessels and brain imaging findings using MRI. Indexed fetal oxygen delivery and consumption were calculated. Middle cerebral artery and umbilical artery pulsatility indexes and cerebroplacental ratio were acquired using ultrasound. A score of ≥ 2 of the 4 following parameters defined IUGR: (1) birthweight the third centile or less or 20% or greater drop in the centile in estimated fetal weight; (2) lowest cerebroplacental ratio after 30 weeks less than the fifth centile; (3) ponderal index < 2.2; and (4) placental histology meets predefined criteria for placental underperfusion. Measurements were compared between the 2 groups (Student t test) and correlations between parameters were analyzed (Pearson's correlation). MRI measurements were compared with Doppler parameters for identifying IUGR defined by postnatal criteria (birthweight, placental histology, ponderal index) using receiver-operating characteristic curves. RESULTS We studied 14 IUGR and 26 non-IUGR fetuses at 35 weeks' gestation. IUGR fetuses had lower umbilical vein (P = .004) and pulmonary blood flow (P = .01) and higher superior vena caval flow (P < .0001) by MRI. IUGR fetuses had asymmetric growth but smaller brains than normal fetuses (P < .0001). Newborns with IUGR also had smaller brains with otherwise essentially normal findings on MRI. Vessel T2s, oxygen delivery, oxygen consumption, middle cerebral artery pulsatility index, and cerebroplacental ratio were all significantly lower in IUGR fetuses, whereas there was no significant difference in umbilical artery pulsatility index. IUGR score correlated positively with superior vena caval flow and inversely with oxygen delivery, oxygen consumption, umbilical vein T2, and cerebroplacental ratio. Receiver-operating characteristic curves revealed equivalent performance of MRI and Doppler techniques in identifying IUGR that was defined based on postnatal parameters with superior vena caval flow area under the curve of 0.94 (95% confidence interval, 0.87-1.00) vs a cerebroplacental ratio area under the curve of 0.80 (95% confidence interval, 0.64-0.97). CONCLUSION MRI revealed the expected circulatory redistribution in response to hypoxia in IUGR fetuses. The reduced oxygen delivery in IUGR fetuses indicated impaired placental oxygen transport, whereas reduced oxygen consumption presumably reflected metabolic adaptation to diminished substrate delivery, resulting in slower fetal growth. Despite brain sparing, placental insufficiency limits fetal brain growth. Superior vena caval flow and umbilical vein T2 by MRI may be useful new markers of late-onset IUGR.
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Himoto Y, Kido A, Mogami H, Moribata Y, Minamiguchi S, Shitano F, Kiguchi K, Kurata Y, Konishi I, Togashi K. Placental function assessed visually using half-Fourier acquisition single-shot turbo spin-echo (HASTE) magnetic resonance imaging. Placenta 2016; 39:55-60. [PMID: 26992675 DOI: 10.1016/j.placenta.2016.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/15/2015] [Accepted: 01/08/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To investigate a simple visual assessment method of placental function using half-Fourier acquisition single-shot turbo spin-echo (HASTE) magnetic resonance imaging (MRI). METHODS The institutional review board approved this retrospective study of fetal MRI in 48 singleton pregnant women for whom placentas had undergone clinical pathological examinations. Two readers independently assessed the placentas using the HASTE scoring system, particularly emphasizing the visualization of the regular two-tone pattern inside and signal intensity (SI) of placental parenchyma referring to SI of the fetal kidney and liver. After categorization using the HASTE scoring system, the associations between the scores and the presence of pathologically proven placental insufficiency or of low birth weight less than the tenth percentile were examined using chi-square tests. The associations between the HASTE scores and the MRI findings previously reported to suggest placental insufficiency, such as placental thickness and placenta to amniotic fluid SI ratio, were also examined using Student t-tests. RESULTS The HASTE scores were associated significantly with the presence of pathologically proven placental insufficiency (P = .003 for reader 1; P = .04 reader 2) and birth weight less than the tenth percentile (P = .005 for reader 1; P = .003 for reader 2). The HASTE scores were associated significantly with the placenta thickness (P < .0001 for both readers) and the placenta to the amniotic fluid SI ratio (P < .0001 for both readers). DISCUSSION The HASTE scoring system is feasible for use in clinical assessment of placental function and for diagnosing placental insufficiency.
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Affiliation(s)
- Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Japan.
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Japan
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Japan
| | - Sachiko Minamiguchi
- Department of Pathology, Kyoto University Graduate School of Medicine, Japan
| | - Fuki Shitano
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Japan
| | - Kayo Kiguchi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Japan
| | - Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Japan
| | - Ikuo Konishi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Japan
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Ohgiya Y, Nobusawa H, Seino N, Miyagami O, Yagi N, Hiroto S, Munechika J, Hirose M, Takeyama N, Ohike N, Matsuoka R, Sekizawa A, Gokan T. MR Imaging of Fetuses to Evaluate Placental Insufficiency. Magn Reson Med Sci 2015; 15:212-9. [PMID: 26607809 PMCID: PMC5600058 DOI: 10.2463/mrms.mp.2015-0051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose: To evaluate morphological and signal intensity (SI) changes of placental insufficiency on magnetic resonance imaging (MRI) and to assess morphological changes and decreased flow voids (FVs) on T2-weighted rapid acquisition with relaxation enhancement (RARE) images for diagnosing placental insufficiency. Methods: Fifty singleton fetuses underwent MRI using a 1.5-T MR scanner. Placental thickness, area, volume, SI, amniotic fluid SI, and size of FVs between the uterus and the placenta were measured on MR images. Two radiologists reviewed T2-weighted RARE images for globular appearance of the placenta and FVs between the uterus and the placenta. Data were analyzed using t-tests, McNemar’s tests, and areas under the receiver operating characteristic curve (AUCs) at 5% level of significance. Results: Twenty-five of the 50 pregnancies were categorized as having an insufficient placenta. Significant differences were observed between insufficient and normal placentas in mean placental thickness, area, volume, placenta to amniotic fluid SI ratio, and size of FVs (49.0 mm vs. 36.9 mm, 1.62 × 104 mm2 vs. 2.67 × 104 mm2, 5.13 × 105 mm3 vs. 6.56 × 105 mm3, 0.549 vs. 0.685, and 3.4 mm vs. 4.3 mm, respectively). The sensitivity and accuracy using globular appearance plus decreased FVs were greater than those using decreased FVs (P < 0.01). There was no significant difference among AUCs using globular appearance and decreased FVs, and globular appearance plus decreased FVs. Conclusions: Placental insufficiency was associated with placental thickness, area, volume, placenta to amniotic fluid SI ratio, and size of FVs. Evaluating FVs on T2-weighted RARE images can be useful for detecting placental insufficiency, particularly in placentas without globular appearance on MR images.
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Siauve N, Chalouhi GE, Deloison B, Alison M, Clement O, Ville Y, Salomon LJ. Functional imaging of the human placenta with magnetic resonance. Am J Obstet Gynecol 2015; 213:S103-14. [PMID: 26428488 DOI: 10.1016/j.ajog.2015.06.045] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/29/2022]
Abstract
Abnormal placentation is responsible for most failures in pregnancy; however, an understanding of placental functions remains largely concealed from noninvasive, in vivo investigations. Magnetic resonance imaging (MRI) is safe in pregnancy for magnetic fields of up to 3 Tesla and is being used increasingly to improve the accuracy of prenatal imaging. Functional MRI (fMRI) of the placenta has not yet been validated in a clinical setting, and most data are derived from animal studies. FMRI could be used to further explore placental functions that are related to vascularization, oxygenation, and metabolism in human pregnancies by the use of various enhancement processes. Dynamic contrast-enhanced MRI is best able to quantify placental perfusion, permeability, and blood volume fractions. However, the transplacental passage of Gadolinium-based contrast agents represents a significant safety concern for this procedure in humans. There are alternative contrast agents that may be safer in pregnancy or that do not cross the placenta. Arterial spin labeling MRI relies on magnetically labeled water to quantify the blood flows within the placenta. A disadvantage of this technique is a poorer signal-to-noise ratio. Based on arterial spin labeling, placental perfusion in normal pregnancy is 176 ± 91 mL × min(-1) × 100 g(-1) and decreases in cases with intrauterine growth restriction. Blood oxygen level-dependent and oxygen-enhanced MRIs do not assess perfusion but measure the response of the placenta to changes in oxygen levels with the use of hemoglobin as an endogenous contrast agent. Diffusion-weighted imaging and intravoxel incoherent motion MRI do not require exogenous contrast agents, instead they use the movement of water molecules within tissues. The apparent diffusion coefficient and perfusion fraction are significantly lower in placentas of growth-restricted fetuses when compared with normal pregnancies. Magnetic resonance spectroscopy has the ability to extract information regarding metabolites from the placenta noninvasively and in vivo. There are marked differences in all 3 metabolites N-acetyl aspartate/choline levels, inositol/choline ratio between small, and adequately grown fetuses. Current research is focused on the ability of each fMRI technique to make a timely diagnosis of abnormal placentation that would allow for appropriate planning of follow-up examinations and optimal scheduling of delivery. These research programs will benefit from the use of well-defined sequences, standardized imaging protocols, and robust computational methods.
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Affiliation(s)
- Nathalie Siauve
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | - Gihad E Chalouhi
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Benjamin Deloison
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Marianne Alison
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France
| | - Olivier Clement
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | - Yves Ville
- EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Laurent J Salomon
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France.
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Quibel T, Deloison B, Chammings F, Chalouhi GE, Siauve N, Alison M, Bessières B, Gennisson JL, Clément O, Salomon LJ. Placental elastography in a murine intrauterine growth restriction model. Prenat Diagn 2015; 35:1106-11. [PMID: 26193351 DOI: 10.1002/pd.4654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare placental elasticity in normal versus intrauterine growth restriction (IUGR) murine pregnancies using shear wave elastography (SWE). METHODS Intrauterine growth restriction was created by ligation of the left uterine artery of Sprague-Dawley rats on E17. Ultrasonography (US) and elastography were performed 2 days later on exteriorized horns after laparotomy. Biparietal diameter (BPD) and abdominal diameter (AD) were measured and compared in each horn. Placental elasticity of each placenta was compared in the right and left horns, respectively, using the Young's modulus, which increases with increasing stiffness of the tissue. RESULTS Two hundred seventeen feto-placental units from 18 rats were included. Fetuses in the left ligated horn had smaller biometric measurements than those in the right horn (6.7 vs 7.2 mm, p < 0.001, and 9.2 vs 11.2 mm, p < 0.001 for BPD and AD, respectively). Mean fetal weight was lower in the pups from the left than the right horn (1.65 vs 2.11 g; p < 0.001). Mean (SD) Young's modulus was higher for placentas from the left than the right horn (11.7 ± 1.5 kPa vs 8.01 ± 3.8 kPa, respectively; p < 0.001), indicating increased stiffness in placentas from the left than the right horn. There was an inverse relationship between fetal weight and placental elasticity (r = 0.42; p < 0.001). CONCLUSION Shear wave elastography may be used to provide quantitative elasticity measurements of the placenta. In our model, placentas from IUGR fetuses demonstrated greater stiffness, which correlated with the degree of fetal growth restriction.
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Affiliation(s)
- T Quibel
- Departments of Obstetrics and Gynecology, CHI Poissy Saint Germain, 10 rue Champ, Gaillard, Poissy, BP 3082, France.,INSERM UMR 970, PARCC, Paris, France.,EA FETUS 7328, Université Paris Descartes, Paris, France
| | - B Deloison
- INSERM UMR 970, PARCC, Paris, France.,EA FETUS 7328, Université Paris Descartes, Paris, France.,Maternité Necker-Enfants Malade, Assistance Publique Hopitaux de Paris, Faculté de Médecine, Univeristé Paris Descartes, Paris, France
| | | | - G E Chalouhi
- INSERM UMR 970, PARCC, Paris, France.,Maternité Necker-Enfants Malade, Assistance Publique Hopitaux de Paris, Faculté de Médecine, Univeristé Paris Descartes, Paris, France
| | - N Siauve
- INSERM UMR 970, PARCC, Paris, France
| | - M Alison
- INSERM UMR 970, PARCC, Paris, France
| | - B Bessières
- Département de Génétique Histologie-Embryologie-Cytogénétique, Hopital Necker-Enfant Malades, AP-HP, Paris, France
| | - J L Gennisson
- Institut Langevin Ondes et Images, ESPCI ParisTech, Paris, France
| | - O Clément
- INSERM UMR 970, PARCC, Paris, France
| | - L J Salomon
- INSERM UMR 970, PARCC, Paris, France.,EA FETUS 7328, Université Paris Descartes, Paris, France.,Maternité Necker-Enfants Malade, Assistance Publique Hopitaux de Paris, Faculté de Médecine, Univeristé Paris Descartes, Paris, France
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Himoto Y, Kido A, Minamiguchi S, Mogami H, Konishi I, Togashi K. Visualization of placental hypocirculation with typical patterns using conventional magnetic resonance imaging: Two case reports. J Obstet Gynaecol Res 2014; 41:794-8. [PMID: 25511628 DOI: 10.1111/jog.12632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/06/2014] [Indexed: 12/01/2022]
Abstract
We report two cases of clinically suspected placental hypocirculation, as per evidenced by specific half-Fourier acquisition single-shot turbo spin-echo (HASTE) magnetic resonance findings of the whole placenta. Patient 1 was a case of fetal growth restriction caused by pregnancy-induced hypertension, while patient 2 experienced a discordant dichorionic diamniotic twin pregnancy with fetal growth restriction complication with a velamentous insertion of the umbilical cord in the smaller twin. In both cases, HASTE images showed noticeably decreased signal intensity with high-intensity signal spots present in the central region of the placenta. In the twin pregnancy case, the low-intensity signal area in the placenta of the smaller twin was much lower compared to that of the larger twin. Pathological findings failed to support or explain these observations. HASTE images might reflect compensatory alternation of the distribution of maternal blood and villus caused by hypocirculation. In conclusion, our results suggest that HASTE imaging might be a useful approach for the visualization of placental hypocirculation.
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Affiliation(s)
- Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Gholipour A, Estroff JA, Barnewolt CE, Robertson RL, Grant PE, Gagoski B, Warfield SK, Afacan O, Connolly SA, Neil JJ, Wolfberg A, Mulkern RV. Fetal MRI: A Technical Update with Educational Aspirations. CONCEPTS IN MAGNETIC RESONANCE. PART A, BRIDGING EDUCATION AND RESEARCH 2014; 43:237-266. [PMID: 26225129 PMCID: PMC4515352 DOI: 10.1002/cmr.a.21321] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Fetal magnetic resonance imaging (MRI) examinations have become well-established procedures at many institutions and can serve as useful adjuncts to ultrasound (US) exams when diagnostic doubts remain after US. Due to fetal motion, however, fetal MRI exams are challenging and require the MR scanner to be used in a somewhat different mode than that employed for more routine clinical studies. Herein we review the techniques most commonly used, and those that are available, for fetal MRI with an emphasis on the physics of the techniques and how to deploy them to improve success rates for fetal MRI exams. By far the most common technique employed is single-shot T2-weighted imaging due to its excellent tissue contrast and relative immunity to fetal motion. Despite the significant challenges involved, however, many of the other techniques commonly employed in conventional neuro- and body MRI such as T1 and T2*-weighted imaging, diffusion and perfusion weighted imaging, as well as spectroscopic methods remain of interest for fetal MR applications. An effort to understand the strengths and limitations of these basic methods within the context of fetal MRI is made in order to optimize their use and facilitate implementation of technical improvements for the further development of fetal MR imaging, both in acquisition and post-processing strategies.
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Affiliation(s)
- Ali Gholipour
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Judith A Estroff
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard L Robertson
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - P Ellen Grant
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Borjan Gagoski
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Onur Afacan
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Susan A Connolly
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jeffrey J Neil
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adam Wolfberg
- Boston Maternal Fetal Medicine, Boston, Massachusetts, USA
| | - Robert V Mulkern
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
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