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Jacquier M, Chalouhi G, Marquant F, Bussieres L, Grevent D, Picone O, Mandelbrot L, Mahallati H, Briand N, Elie C, Siauve N, Salomon LJ. Placental T2* and BOLD effect in response to hyperoxia in normal and growth-restricted pregnancies: multicenter cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:472-480. [PMID: 37743665 DOI: 10.1002/uog.27496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Blood-oxygen-level-dependent (BOLD) magnetic resonance imaging (MRI) facilitates the non-invasive in-vivo evaluation of placental oxygenation. The aims of this study were to identify and quantify a relative BOLD effect in response to hyperoxia in the human placenta and to compare it between pregnancies with and those without fetal growth restriction (FGR). METHODS This was a prospective multicenter study (NCT02238301) of 19 pregnancies with FGR (estimated fetal weight (EFW) on ultrasound < 5th centile) and 75 non-FGR pregnancies (controls) recruited at two centers in Paris, France. Using a 1.5-Tesla MRI system, the same multi-echo gradient-recalled echo (GRE) sequences were performed at both centers to obtain placental T2* values at baseline and in hyperoxic conditions. The relative BOLD effect was calculated according to the equation 100 × (hyperoxic T2* - baseline T2*)/baseline T2*. Baseline T2* values and relative BOLD effect were compared according to EFW (FGR vs non-FGR), presence/absence of Doppler anomalies and birth weight (small-for-gestational age (SGA) vs non-SGA). RESULTS We observed a relative BOLD effect in response to hyperoxia in the human placenta (median, 33.8% (interquartile range (IQR), 22.5-48.0%)). The relative BOLD effect did not differ significantly between pregnancies with and those without FGR (median, 34.4% (IQR, 24.1-48.5%) vs 33.7% (22.7-47.4%); P = 0.95). Baseline T2* Z-score adjusted for gestational age at MRI was significantly lower in FGR pregnancies compared with non-FGR pregnancies (median, -1.27 (IQR, -4.87 to -0.10) vs 0.33 (IQR, -0.81 to 1.02); P = 0.001). Baseline T2* Z-score was also significantly lower in those pregnancies that subsequently delivered a SGA neonate (n = 23) compared with those that delivered a non-SGA neonate (n = 62) (median, -0.75 (IQR, -3.48 to 0.29) vs 0.35 (IQR, -0.79 to 1.05); P = 0.01). CONCLUSIONS Our study confirms a BOLD effect in the human placenta and that baseline T2* values are significantly lower in pregnancies with FGR. Further studies are needed to evaluate whether such parameters may detect placental insufficiency before it has a clinical impact on fetal growth. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Jacquier
- Obstetrics and Gynecology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA FETUS 7328 and LUMIERE Unit, Université de Paris-Cité, Paris, France
| | - G Chalouhi
- Obstetrics and Gynecology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA FETUS 7328 and LUMIERE Unit, Université de Paris-Cité, Paris, France
- Centre SFFERe (Spécialistes Fœtus, Femme Enceinte et Reproduction), Boulogne-Billancourt, France
| | - F Marquant
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes University, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - L Bussieres
- Obstetrics and Gynecology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA FETUS 7328 and LUMIERE Unit, Université de Paris-Cité, Paris, France
| | - D Grevent
- EA FETUS 7328 and LUMIERE Unit, Université de Paris-Cité, Paris, France
- Radiology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - O Picone
- Obstetrics and Gynecology Department, Hôpital Louis-Mourier, AP-HP, Colombes, France
- Inserm IAME-U1137, Paris, France
- FHU PREMA, Paris, France
| | - L Mandelbrot
- Obstetrics and Gynecology Department, Hôpital Louis-Mourier, AP-HP, Colombes, France
- Inserm IAME-U1137, Paris, France
- FHU PREMA, Paris, France
| | - H Mahallati
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - N Briand
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes University, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - C Elie
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes University, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - N Siauve
- Radiology Department, Hôpital Louis-Mourier, AP-HP, Colombes, France
- INSERM-U970, Paris Cardiovascular Research Center (PARCC), Sorbonne Paris Cité, Paris, France
| | - L J Salomon
- Obstetrics and Gynecology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA FETUS 7328 and LUMIERE Unit, Université de Paris-Cité, Paris, France
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Rajagopalan V, Truong V, Wang S, Lopez J, Rosas V, Borzage M, Votava-Smith JK, Ponrartana S, Panigrahy A, Detterich J, Wood J. Non-invasive in-utero quantification of vascular reactivity in human placenta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:481-488. [PMID: 37820067 DOI: 10.1002/uog.27512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Placental vascular reactivity (PlVR) indicates the ability of the placental vasculature to match blood supply to fetal demand. Many pregnancy disorders alter the characteristics of PlVR, resulting in suboptimal oxygen delivery, although current understanding is limited by the lack of non-invasive, repeatable methods to measure PlVR in utero. Our objective was to quantify PlVR by measuring the placental response to transient changes in maternal carbon dioxide (CO2) using blood-oxygen-level-dependent (BOLD) magnetic resonance imaging (MRI). We hypothesized that PlVR will increase with gestational age to meet the changing demands of a growing fetus, and that PlVR will be driven by a maternal response to changes in CO2 concentration. METHODS This was a cross-sectional study of 35 women with a healthy singleton pregnancy, of whom 31 were included in the analysis. The median gestational age was 32.6 (range, 22.6-38.4) weeks. Pregnant women were instructed to follow audiovisual breathing cues during a MRI scan. Maternal end-tidal CO2 (EtCO2) was measured concurrently with resting placental BOLD MRI for a total of 7-8 min. Preprocessing of magnetic resonance images consisted of manual delineation of placental anatomy and motion correction. In each placental voxel, vascular reactivity was computed using a coherence-weighted general linear model between MRI signal and EtCO2 stimulus. Global PlVR was computed as the mean of voxel-wise PlVR values across the placenta. RESULTS PlVR, quantified by the placental response to induced, transient changes in maternal CO2, was consistently measured in utero using BOLD MRI. PlVR increased non-linearly with advancing gestational age (P < 0.001) and was higher on the fetal side of the placenta. PlVR was associated positively with fetal brain volume after accounting for gestational age. PlVR did not show any significant associations with maternal characteristics. CONCLUSIONS We present, for the first time, a non-invasive paradigm to quantify PlVR in ongoing human pregnancies without the use of exogenous gases or contrast agents. Our findings suggest that PlVR is driven by a fetal response to changes in maternal CO2. Ease of translation to the clinical setting makes PlVR a promising biomarker for the identification and management of high-risk pregnancies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- V Rajagopalan
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| | - V Truong
- University of Southern California, Los Angeles, CA, USA
| | - S Wang
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| | - J Lopez
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - V Rosas
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - M Borzage
- Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| | - J K Votava-Smith
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| | - S Ponrartana
- University of Southern California, Los Angeles, CA, USA
| | - A Panigrahy
- Pediatric Imaging Research Lab, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - J Detterich
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| | - J Wood
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
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Nichols ES, Al-Saoud S, de Vrijer B, McKenzie CA, Eagleson R, de Ribaupierre S, Duerden EG. T2* Mapping of Placental Oxygenation to Estimate Fetal Cortical and Subcortical Maturation. JAMA Netw Open 2024; 7:e240456. [PMID: 38411965 PMCID: PMC10900962 DOI: 10.1001/jamanetworkopen.2024.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
This cohort study investigates the association between T2* mapping of placental oxygenation and cortical and subcortical fetal brain volumes in typically developing fetuses scanned longitudinally in the third trimester.
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Affiliation(s)
- Emily S Nichols
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Sarah Al-Saoud
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Barbra de Vrijer
- Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute
| | - Charles A McKenzie
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Roy Eagleson
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Electrical and Computer Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute
- Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Electrical and Computer Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
- Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Emma G Duerden
- Applied Psychology, Faculty of Education, Western University, London, Ontario, Canada
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
- Division of Maternal, Fetal and Newborn Health, Children's Health Research Institute
- Biomedical Engineering, Western University, London, Ontario, Canada
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Al Darwish FM, Meijerink L, Coolen BF, Strijkers GJ, Bekker M, Lely T, Terstappen F. From Molecules to Imaging: Assessment of Placental Hypoxia Biomarkers in Placental Insufficiency Syndromes. Cells 2023; 12:2080. [PMID: 37626890 PMCID: PMC10452979 DOI: 10.3390/cells12162080] [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: 07/14/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Placental hypoxia poses significant risks to both the developing fetus and the mother during pregnancy, underscoring the importance of early detection and monitoring. Effectively identifying placental hypoxia and evaluating the deterioration in placental function requires reliable biomarkers. Molecular biomarkers in placental tissue can only be determined post-delivery and while maternal blood biomarkers can be measured over time, they can merely serve as proxies for placental function. Therefore, there is an increasing demand for non-invasive imaging techniques capable of directly assessing the placental condition over time. Recent advancements in imaging technologies, including photoacoustic and magnetic resonance imaging, offer promising tools for detecting and monitoring placental hypoxia. Integrating molecular and imaging biomarkers may revolutionize the detection and monitoring of placental hypoxia, improving pregnancy outcomes and reducing long-term health complications. This review describes current research on molecular and imaging biomarkers of placental hypoxia both in human and animal studies and aims to explore the benefits of an integrated approach throughout gestation.
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Affiliation(s)
- Fatimah M. Al Darwish
- Department of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (B.F.C.); (G.J.S.)
| | - Lotte Meijerink
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (L.M.); (M.B.); (T.L.); (F.T.)
| | - Bram F. Coolen
- Department of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (B.F.C.); (G.J.S.)
| | - Gustav J. Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (B.F.C.); (G.J.S.)
| | - Mireille Bekker
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (L.M.); (M.B.); (T.L.); (F.T.)
| | - Titia Lely
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (L.M.); (M.B.); (T.L.); (F.T.)
| | - Fieke Terstappen
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (L.M.); (M.B.); (T.L.); (F.T.)
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Clark A, Flouri D, Mufti N, James J, Clements E, Aughwane R, Aertsen M, David A, Melbourne A. Developments in functional imaging of the placenta. Br J Radiol 2023; 96:20211010. [PMID: 35234516 PMCID: PMC10321248 DOI: 10.1259/bjr.20211010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022] Open
Abstract
The placenta is both the literal and metaphorical black box of pregnancy. Measurement of the function of the placenta has the potential to enhance our understanding of this enigmatic organ and serve to support obstetric decision making. Advanced imaging techniques are key to support these measurements. This review summarises emerging imaging technology being used to measure the function of the placenta and new developments in the computational analysis of these data. We address three important examples where functional imaging is supporting our understanding of these conditions: fetal growth restriction, placenta accreta, and twin-twin transfusion syndrome.
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Affiliation(s)
- Alys Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Joanna James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eleanor Clements
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Rosalind Aughwane
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Anna David
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
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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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Associations between Maternal Risk Factors and Intrinsic Placental and Fetal Brain Functional Properties in Congenital Heart Disease. Int J Mol Sci 2022; 23:ijms232315178. [PMID: 36499505 PMCID: PMC9738149 DOI: 10.3390/ijms232315178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 12/11/2022] Open
Abstract
The relationship between maternal risk factors (MRFs) (particularly pre-gravid obesity, diabetes, and hypertension) and congenital heart disease (CHD) to placental and fetal brain outcomes is poorly understood. Here, we tested the hypothesis that MRF and CHD would be associated with reduced intrinsic placental and fetal brain function using a novel non-invasive technique. Pregnant participants with and without MRF and fetal CHD were prospectively recruited and underwent feto-placental MRI. Using intrinsic properties of blood oxygen level dependent imaging (BOLD) we quantified spatiotemporal variance of placenta and fetal brain. MRFs and CHD were correlated with functional characteristics of the placenta and fetal brain. Co-morbid MRF (hypertension, diabetes, and obesity) reduced spatiotemporal functional variance of placenta and fetal brain (p < 0.05). CHD predicted reduced fetal brain temporal variance compared to non-CHD (p < 0.05). The presence of both MRF and CHD was associated with reduced intrinsic pBOLD temporal variance (p = 0.047). There were no significant interactions of MRFs and CHD status on either temporal or spatial variance of intrinsic brain BOLD. MRF and CHD reduced functional characteristic of placenta and brain in fetuses. MRF modification and management during pregnancy may have the potential to not only provide additional risk stratification but may also improve neurodevelopmental outcomes.
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8
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Dynamics of T2* and deformation in the placenta and myometrium during pre-labour contractions. Sci Rep 2022; 12:18542. [PMID: 36329074 PMCID: PMC9633703 DOI: 10.1038/s41598-022-22008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Pre-labour uterine contractions, occurring throughout pregnancy, are an important phenomenon involving the placenta in addition to the myometrium. They alter the uterine environment and thus potentially the blood supply to the fetus and may thus provide crucial insights into the processes of labour. Assessment in-vivo is however restricted due to their unpredictability and the inaccessible nature of the utero-placental compartment. While clinical cardiotocography (CTG) only allows global, pressure-based assessment, functional magnetic resonance imaging (MRI) provides an opportunity to study contractile activity and its effects on the placenta and the fetus in-vivo. This study aims to provide both descriptive and quantitative structural and functional MR assessments of pre-labour contractions in the human uterus. A total of 226 MRI scans (18-41 weeks gestation) from ongoing research studies were analysed, focusing on free-breathing dynamic quantitative whole uterus dynamic T2* maps. These provide an indirect measure of tissue properties such as oxygenation. 22 contractile events were noted visually and both descriptive and quantitative analysis of the myometrial and placental changes including volumetric and T2* variations were undertaken. Processing and analysis was successfully performed, qualitative analysis shows distinct and highly dynamic contraction related characteristics including; alterations in the thickness of the low T2* in the placental bed and other myometrial areas, high intensity vessel-like structures in the myometrium, low-intensity vessel structures within the placental parenchyma and close to the chorionic plate. Quantitative evaluation shows a significant negative correlation between T2* in both contractile and not-contractile regions with gestational age (p < 0.05) as well as a significant reduction in T2* during contractions. The T2* values in the myometrium were however not correlated to gestational age (p > 0.5). The quantitative and qualitative description of uterine pre-labour contractions including dynamic changes and key characteristics aims to contribute to the sparsely available in-vivo information and to provide an in-vivo tool to study this important phenomenon. Further work is required to analyse the origins of these subclinical contractions, their effects in high-risk pregnancies and their ability to determine the likelihood of a successful labour. Assessing T2* distribution as a marker for placental oxygenation could thus potentially complement clinically used cardiotocography measurements in the future.
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9
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Schabel MC, Roberts VHJ, Gibbins KJ, Rincon M, Gaffney JE, Streblow AD, Wright AM, Lo JO, Park B, Kroenke CD, Szczotka K, Blue NR, Page JM, Harvey K, Varner MW, Silver RM, Frias AE. Quantitative longitudinal T2* mapping for assessing placental function and association with adverse pregnancy outcomes across gestation. PLoS One 2022; 17:e0270360. [PMID: 35853003 PMCID: PMC9295947 DOI: 10.1371/journal.pone.0270360] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Existing methods for evaluating in vivo placental function fail to reliably detect pregnancies at-risk for adverse outcomes prior to maternal and/or fetal morbidity. Here we report the results of a prospective dual-site longitudinal clinical study of quantitative placental T2* as measured by blood oxygen-level dependent magnetic resonance imaging (BOLD-MRI). The objectives of this study were: 1) to quantify placental T2* at multiple time points across gestation, and its consistency across sites, and 2) to investigate the association between placental T2* and adverse outcomes. 797 successful imaging studies, at up to three time points between 11 and 38 weeks of gestation, were completed in 316 pregnancies. Outcomes were stratified into three groups: (UN) uncomplicated/normal pregnancy, (PA) primary adverse pregnancy, which included hypertensive disorders of pregnancy, birthweight <5th percentile, and/or stillbirth or fetal death, and (SA) secondary abnormal pregnancy, which included abnormal prenatal conditions not included in the PA group such as spontaneous preterm birth or fetal anomalies. Of the 316 pregnancies, 198 (62.6%) were UN, 70 (22.2%) PA, and 48 (15.2%) SA outcomes. We found that the evolution of placental T2* across gestation was well described by a sigmoid model, with T2* decreasing continuously from a high plateau level early in gestation, through an inflection point around 30 weeks, and finally approaching a second, lower plateau in late gestation. Model regression revealed significantly lower T2* in the PA group than in UN pregnancies starting at 15 weeks and continuing through 33 weeks. T2* percentiles were computed for individual scans relative to UN group regression, and z-scores and receiver operating characteristic (ROC) curves calculated for association of T2* with pregnancy outcome. Overall, differences between UN and PA groups were statistically significant across gestation, with large effect sizes in mid- and late- pregnancy. The area under the curve (AUC) for placental T2* percentile and PA pregnancy outcome was 0.71, with the strongest predictive power (AUC of 0.76) at the mid-gestation time period (20–30 weeks). Our data demonstrate that placental T2* measurements are strongly associated with pregnancy outcomes often attributed to placental insufficiency. Trial registration: ClinicalTrials.gov: NCT02749851.
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Affiliation(s)
- Matthias C. Schabel
- Advanced Imaging Research Center, Oregon Health and Science University (OHSU), Portland, Oregon, United States of America
| | - Victoria H. J. Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center (ONPRC), OHSU, Portland, Oregon, United States of America
- * E-mail:
| | - Karen J. Gibbins
- Department of Obstetrics and Gynecology, OHSU, Portland, Oregon, United States of America
| | - Monica Rincon
- Department of Obstetrics and Gynecology, OHSU, Portland, Oregon, United States of America
| | - Jessica E. Gaffney
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center (ONPRC), OHSU, Portland, Oregon, United States of America
| | - Aaron D. Streblow
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center (ONPRC), OHSU, Portland, Oregon, United States of America
| | - Adam M. Wright
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center (ONPRC), OHSU, Portland, Oregon, United States of America
| | - Jamie O. Lo
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center (ONPRC), OHSU, Portland, Oregon, United States of America
- Department of Obstetrics and Gynecology, OHSU, Portland, Oregon, United States of America
| | - Byung Park
- Biostatistics Shared Resource, Knight Cancer Institute, OHSU, Portland, Oregon, United States of America
| | - Christopher D. Kroenke
- Advanced Imaging Research Center, Oregon Health and Science University (OHSU), Portland, Oregon, United States of America
- Division of Neuroscience, ONPRC, OHSU, Portland, Oregon, United States of America
| | - Kathryn Szczotka
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, United States of America
| | - Nathan R. Blue
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, United States of America
| | - Jessica M. Page
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, United States of America
| | - Kathy Harvey
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, United States of America
| | - Michael W. Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, United States of America
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, United States of America
| | - Antonio E. Frias
- Department of Obstetrics and Gynecology, OHSU, Portland, Oregon, United States of America
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10
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Evaluation of placental oxygenation in fetal growth restriction using blood oxygen level-dependent magnetic resonance imaging. Placenta 2022; 126:40-45. [PMID: 35750000 DOI: 10.1016/j.placenta.2022.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Abnormalities in placental function can lead to fetal growth restriction (FGR), but there is no consensus on their evaluation. Using blood oxygen level-dependent magnetic resonance imaging (BOLD MRI), we compared placental oxygenation between FGR cases and previously reported normal pregnancies. METHODS Eight singleton pregnant women (>32 weeks of gestation) diagnosed with fetal growth failure during pregnancy were recruited. BOLD MRI was consecutively performed under normoxia (21% O2), hyperoxia (100% O2), and normoxia for 4 min each. Each placental time-activity curve was evaluated to calculate the peak score (peakΔR2*) and the time from the start of maternal oxygen administration to the time of peakΔR2* (time to peakΔR2*). In six of the eight FGR cases, placental FGR-related pathological findings were evaluated after delivery. RESULTS The parameter peakΔR2* was significantly decreased in the FGR group (8 ± 3 vs 6 ± 1, p < 0.001), but there was no significant difference in time to peakΔR2* (458 ± 74 s vs 468 ± 57 s, p = 0.750). The findings in the six FGR cases assessed for placental pathologies included chorangiosis in two cases, avascular chorions in two cases, placental infarction in two cases, and syncytial knot formation in one case. DISCUSSION The peakΔR2* values were lower in the FGR group than in the normal pregnancy group. This suggests that oxygenation of the placenta is decreased in the FGR group compared to the normal group, and this may be related to FGR. Placental pathology also revealed findings possibly related to FGR, suggesting that low peakΔR2* values in the FGR group may reflect placental dysfunction.
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11
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Malmberg M, Kragsterman E, Sinding M, Hansen DN, Peters DA, Frøkjær JB, Petersen AC, Sørensen A. Perfusion fraction derived from IVIM analysis of diffusion-weighted MRI in the assessment of placental vascular malperfusion antenatally. Placenta 2022; 119:1-7. [DOI: 10.1016/j.placenta.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 12/16/2022]
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12
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HANSEN DN, SINDING M, PETERSEN A, CHRISTIANSEN OB, ULDBJERG N, PETERS MDA, FRØKJÆR JB, SØRENSEN A. T2* weighted placental MRI: A biomarker of placental dysfunction in small-for-gestational-age pregnancies. Am J Obstet Gynecol MFM 2022; 4:100578. [DOI: 10.1016/j.ajogmf.2022.100578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/12/2022] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
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13
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Andescavage N, Limperopoulos C. Emerging placental biomarkers of health and disease through advanced magnetic resonance imaging (MRI). Exp Neurol 2021; 347:113868. [PMID: 34562472 DOI: 10.1016/j.expneurol.2021.113868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022]
Abstract
Placental dysfunction is a major cause of fetal demise, fetal growth restriction, and preterm birth, as well as significant maternal morbidity and mortality. Infant survivors of placental dysfunction are at elevatedrisk for lifelong neuropsychiatric morbidity. However, despite the significant consequences of placental disease, there are no clinical tools to directly and non-invasively assess and measure placental function in pregnancy. In this work, we will review advanced MRI techniques applied to the study of the in vivo human placenta in order to better detail placental structure, architecture, and function. We will discuss the potential of these measures to serve as optimal biomarkers of placental dysfunction and review the evidence of these tools in the discrimination of health and disease in pregnancy. Efforts to advance our understanding of in vivo placental development are necessary if we are to optimize healthy pregnancy outcomes and prevent brain injury in successive generations. Current management of many high-risk pregnancies cannot address placental maldevelopment or injury, given the standard tools available to clinicians. Once accurate biomarkers of placental development and function are constructed, the subsequent steps will be to introduce maternal and fetal therapeutics targeting at optimizing placental function. Applying these biomarkers in future studies will allow for real-time assessments of safety and efficacy of novel interventions aimed at improving maternal-fetal well-being.
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Affiliation(s)
- Nickie Andescavage
- Developing Brain Institute, Department of Radiology, Children's National, Washington DC, USA; Department of Neonatology, Children's National, Washington DC, USA
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14
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Stout JN, Liao C, Gagoski B, Turk EA, Feldman HA, Bibbo C, Barth WH, Shainker SA, Wald LL, Grant PE, Adalsteinsson E. Quantitative T 1 and T 2 mapping by magnetic resonance fingerprinting (MRF) of the placenta before and after maternal hyperoxia. Placenta 2021; 114:124-132. [PMID: 34537569 DOI: 10.1016/j.placenta.2021.08.058] [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: 01/15/2021] [Revised: 06/16/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION MR relaxometry has been used to assess placental exchange function, but methods to date are not sufficiently fast to be robust to placental motion. Magnetic resonance fingerprinting (MRF) permits rapid, voxel-wise, intrinsically co-registered T1 and T2 mapping. After characterizing measurement error, we scanned pregnant women during air and oxygen breathing to demonstrate MRF's ability to detect placental oxygenation changes. METHODS The accuracy of FISP-based, sliding-window reconstructed MRF was tested on phantoms. MRF scans in 9-s breath holds were acquired at 3T in 31 pregnant women during air and oxygen breathing. A mixed effects model was used to test for changes in placenta relaxation times between physiological states, to assess the dependency on gestational age (GA), and the impact of placental motion. RESULTS MRF estimates of known phantom relaxation times resulted in mean absolute errors for T1 of 92 ms (4.8%), but T2 was less accurate at 16 ms (13.6%). During normoxia, placental T1 = 1825 ± 141 ms (avg ± standard deviation) and T2 = 60 ± 16 ms (gestational age range 24.3-36.7, median 32.6 weeks). In the statistical model, placental T2 rose and T1 remained contant after hyperoxia, and no GA dependency was observed for T1 or T2. DISCUSSION Well-characterized, motion-robust MRF was used to acquire T1 and T2 maps of the placenta. Changes with hyperoxia are consistent with a net increase in oxygen saturation. Toward the goal of whole-placenta quantitative oxygenation imaging over time, we aim to implement 3D MRF with integrated motion correction to improve T2 accuracy.
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Affiliation(s)
- Jeffrey N Stout
- Fetal and Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, 02115, USA.
| | - Congyu Liao
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Borjan Gagoski
- Fetal and Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Esra Abaci Turk
- Fetal and Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Henry A Feldman
- Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Carolina Bibbo
- Brigham and Women's Hospital, Division of Maternal-Fetal Medicine, Boston, MA, 02115, USA
| | - William H Barth
- Maternal-Fetal Medicine, Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Scott A Shainker
- Maternal-Fetal Medicine, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Lawrence L Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, 02129, USA
| | - P Ellen Grant
- Fetal and Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Elfar Adalsteinsson
- Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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15
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Sinding M, Sørensen A, Hansen DN, Peters DA, Frøkjær JB, Petersen AC. T2* weighted placental MRI in relation to placental histology and birth weight. Placenta 2021; 114:52-55. [PMID: 34461455 DOI: 10.1016/j.placenta.2021.07.304] [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: 12/16/2020] [Revised: 06/22/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Placental dysfunction may be found among normal birth weight (BW) pregnancies, as indicated by abnormal histological findings in postnatal placental examination in some of these pregnancies. T2* weighted placental MRI provides non-invasive information on placental oxygenation and thereby placental function. The aim of this study was to investigate the correlation between placental T2*, BW and placental histology. METHODS A total of 63 pregnant women underwent T2* weighted placental MRI at 15-40 week's gestation and a standardized placental histological examination (PHE). Abnormal PHE was defined by vascular malperfusion according to the Amsterdam workshop consensus. The correlation between PHE, BW z-score and T2* z-score was analyzed by logistic regression. RESULTS Abnormal PHE was revealed in 28 pregnancies. Multiple logistic regression revealed a significant correlation between abnormal PHE and T2* z-score (OR = 0.34, p = 0.008), whereas BW z-score did not add significantly to the correlation of placental histology (OR = 0.52, p = 0.115). In BW z-score≥0, PHE was normal in 100% of pregnancies. In BW z-score ≤ -2, PHE was abnormal in 89% of pregnancies. In intermediate BW (z-score between -2 and 0), PPE was abnormal in 35% of pregnancies. In this intermediate group, placental T2* z-score was reduced (-1.52 ± 1.22 (mean SD)) when compared to normal PHE pregnancies (-0.28 ± 1.17), p = 0.006. DISCUSSION This study demonstrates a correlation between abnormal placental histology and low placental T2* value regardless of fetal size. This indicates that T2* provides information of placental function in vivo even when fetal size is normal. This finding highlights that fetal size alone is not a valid marker of placental dysfunction.
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Affiliation(s)
- Marianne Sinding
- Department of Clinical Medicine, Aalborg University, Denmark Sdr. Skovvej 15, 9000 Aalborg, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Denmark Reberbansgade 15, 9000 Aalborg, Denmark.
| | - Anne Sørensen
- Department of Clinical Medicine, Aalborg University, Denmark Sdr. Skovvej 15, 9000 Aalborg, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Denmark Reberbansgade 15, 9000 Aalborg, Denmark.
| | - Ditte N Hansen
- Department of Clinical Medicine, Aalborg University, Denmark Sdr. Skovvej 15, 9000 Aalborg, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Denmark Reberbansgade 15, 9000 Aalborg, Denmark.
| | - David A Peters
- Department of Clinical Engineering, Central Denmark Region, Aarhus, Denmark Nørrebrogade 44, 8000 Aarhus C, Denmark.
| | - Jens B Frøkjær
- Department of Clinical Medicine, Aalborg University, Denmark Sdr. Skovvej 15, 9000 Aalborg, Denmark; Department of Radiology, Aalborg University Hospital, Denmark Hobrovej 18-22, 9100 Aalborg, Denmark.
| | - Astrid C Petersen
- Department of Pathology, Aalborg University Hospital, Denmark Reberbansgade 15, 9000 Aalborg, Denmark.
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Pietsch M, Ho A, Bardanzellu A, Zeidan AMA, Chappell LC, Hajnal JV, Rutherford M, Hutter J. APPLAUSE: Automatic Prediction of PLAcental health via U-net Segmentation and statistical Evaluation. Med Image Anal 2021; 72:102145. [PMID: 34229190 PMCID: PMC8350147 DOI: 10.1016/j.media.2021.102145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/26/2021] [Accepted: 06/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Artificial-intelligence population-based automated quantification of placental maturation and health from a rapid functional Magnetic Resonance scan. The placenta plays a crucial role for any successful human pregnancy. Deviations from the normal dynamic maturation throughout gestation are closely linked to major pregnancy complications. Antenatal assessment in-vivo using T2* relaxometry has shown great promise to inform management and possible interventions but clinical translation is hampered by time consuming manual segmentation and analysis techniques based on comparison against normative curves over gestation. METHODS This study proposes a fully automatic pipeline to predict the biological age and health of the placenta based on a free-breathing rapid (sub-30 second) T2* scan in two steps: Automatic segmentation using a U-Net and a Gaussian process regression model to characterize placental maturation and health. These are trained and evaluated on 108 3T MRI placental data sets, the evaluation included 20 high-risk pregnancies diagnosed with pre-eclampsia and/or fetal growth restriction. An independent cohort imaged at 1.5 T is used to assess the generalization of the training and evaluation pipeline. RESULTS Across low- and high-risk groups, automatic segmentation performs worse than inter-rater performance (mean Dice coefficients of 0.58 and 0.68, respectively) but is sufficient for estimating placental mean T2* (0.986 Pearson Correlation Coefficient). The placental health prediction achieves an excellent ability to differentiate cases of placental insufficiency between 27 and 33 weeks. High abnormality scores correlate with low birth weight, premature birth and histopathological findings. Retrospective application on a different cohort imaged at 1.5 T illustrates the ability for direct clinical translation. CONCLUSION The presented automatic pipeline facilitates a fast, robust and reliable prediction of placental maturation. It yields human-interpretable and verifiable intermediate results and quantifies uncertainties on the cohort-level and for individual predictions. The proposed machine-learning pipeline runs in close to real-time and, deployed in clinical settings, has the potential to become a cornerstone of diagnosis and intervention of placental insufficiency. APPLAUSE generalizes to an independent cohort imaged at 1.5 T, demonstrating robustness to different operational and clinical environments.
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Affiliation(s)
- Maximilian Pietsch
- Centre for Medical Engineering, King's College London, London, UK; Centre for the Developing Brain, King's College London, London, UK.
| | - Alison Ho
- Department of Women and Children's Health, King's College London, London, UK
| | - Alessia Bardanzellu
- Centre for Medical Engineering, King's College London, London, UK; Centre for the Developing Brain, King's College London, London, UK
| | - Aya Mutaz Ahmad Zeidan
- Centre for Medical Engineering, King's College London, London, UK; Centre for the Developing Brain, King's College London, London, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for Medical Engineering, King's College London, London, UK; Centre for the Developing Brain, King's College London, London, UK
| | - Mary Rutherford
- Centre for Medical Engineering, King's College London, London, UK; Centre for the Developing Brain, King's College London, London, UK
| | - Jana Hutter
- Centre for Medical Engineering, King's College London, London, UK; Centre for the Developing Brain, King's College London, London, UK
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17
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He J, Chen Z, Chen C, Liu P. Comparative study of placental T2* and intravoxel incoherent motion in the prediction of fetal growth restriction. Placenta 2021; 111:47-53. [PMID: 34157440 DOI: 10.1016/j.placenta.2021.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/30/2021] [Accepted: 06/13/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Both transverse relaxation time (T2*) and intravoxel incoherent motion (IVIM) on magnetic resonance imaging (MRI) are promising for discriminating fetal growth restriction (FGR). We aimed to compare the utility of these two parameters and their combination in the same cohort. METHODS Twenty-seven FGR and 24 control pregnancies after 28 weeks of gestation in which both T2* and IVIM scans were performed on a 3.0 T MRI were recruited. We compared the T2* Z-score, perfusion fraction (f), diffusion coefficient (D) and pseudodiffusion coefficient (D*) between groups. Binary logistic regression analysis and areas under the curve (AUCs) with receiver operating characteristic (ROC) curve were used to evaluate the diagnostic efficacy of these parameters and their combination. RESULTS Compared with normal pregnancies, T2* Z-score (0.036 ± 0.95 vs. -2.479 ± 1.56, p < 0.001), f (0.2753 ± 0.035 vs. 0.3304 ± 0.035, p < 0.001), D* (48279.82 ± 7497.36 μm2/s vs. 56167.92 ± 8549.87 μm2/s, p = 0.001) and D (1664.32 ± 288.53 μm2/s vs. 1887.15 ± 204.08 μm2/s, p = 0.002) were significantly decreased in FGR pregnancies. However, only AUC(T2* Z-score) (0.903) and AUC(f) (0.873) were good predictors of FGR. The AUC(T2* Z-score-IVIM) (0.937), calculated with the combination of T2* Z-score and f, was similar to AUC(T2* Z-score) and ACU(f). DISCUSSION Both T2* and f were effective in discriminating FGR. However, the combination of the two parameters did not further improve diagnostic efficacy. We suggest that T2* might be more suitable for evaluating placental dysfunction, as it is fast to obtain and easy to measure.
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Affiliation(s)
- Junshen He
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zhao Chen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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18
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Slator PJ, Hutter J, Marinescu RV, Palombo M, Jackson LH, Ho A, Chappell LC, Rutherford M, Hajnal JV, Alexander DC. Data-Driven multi-Contrast spectral microstructure imaging with InSpect: INtegrated SPECTral component estimation and mapping. Med Image Anal 2021; 71:102045. [PMID: 33934005 PMCID: PMC8543043 DOI: 10.1016/j.media.2021.102045] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 11/19/2022]
Abstract
Unsupervised learning technique for spectroscopic analysis of quantitative MRI. Shares information across voxels to improve estimation of multi-dimensional or single-dimensional spectra. Spectral maps are dramatically improved compared to existing approaches. Can potentially identify and map tissue environments; in placental diffusion-relaxometry MRI we demonstrate that it identifies components that correspond to distinct tissue types.
We introduce and demonstrate an unsupervised machine learning technique for spectroscopic analysis of quantitative MRI experiments. Our algorithm supports estimation of one-dimensional spectra from single-contrast data, and multidimensional correlation spectra from simultaneous multi-contrast data. These spectrum-based approaches allow model-free investigation of tissue properties, but require regularised inversion of a Laplace transform or Fredholm integral, which is an ill-posed calculation. Here we present a method that addresses this limitation in a data-driven way. The algorithm simultaneously estimates a canonical basis of spectral components and voxelwise maps of their weightings, thereby pooling information across whole images to regularise the ill-posed problem. We show in simulations that our algorithm substantially outperforms current voxelwise spectral approaches. We demonstrate the method on multi-contrast diffusion-relaxometry placental MRI scans, revealing anatomically-relevant sub-structures, and identifying dysfunctional placentas. Our algorithm vastly reduces the data required to reliably estimate spectra, opening up the possibility of quantitative MRI spectroscopy in a wide range of new applications. Our InSpect code is available at github.com/paddyslator/inspect.
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Affiliation(s)
- Paddy J Slator
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK.
| | - Jana Hutter
- Centre for the Developing Brain, Kings College London, London, UK; Biomedical Engineering Department, Kings College London, London, UK
| | - Razvan V Marinescu
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK
| | - Marco Palombo
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK
| | - Laurence H Jackson
- Centre for the Developing Brain, Kings College London, London, UK; Biomedical Engineering Department, Kings College London, London, UK
| | - Alison Ho
- Women's Health Department, King's College London, London, UK
| | - Lucy C Chappell
- Women's Health Department, King's College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, Kings College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, Kings College London, London, UK; Biomedical Engineering Department, Kings College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK
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19
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Steinweg JK, Hui GTY, Pietsch M, Ho A, van Poppel MP, Lloyd D, Colford K, Simpson JM, Razavi R, Pushparajah K, Rutherford M, Hutter J. T2* placental MRI in pregnancies complicated with fetal congenital heart disease. Placenta 2021; 108:23-31. [PMID: 33798991 DOI: 10.1016/j.placenta.2021.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is one of the most important and common group of congenital malformations in humans. Concurrent development and close functional links between the fetal heart and placenta emphasise the importance of understanding placental function and its influence in pregnancy outcomes. The aim of this study was to evaluate placental oxygenation by relaxometry (T2*) to assess differences in placental phenotype and function in CHD. METHODS In this prospective cross-sectional observational study, 69 women with a fetus affected with CHD and 37 controls, whole placental T2* was acquired using a 1.5-Tesla MRI scanner. Gaussian Process Regression was used to assess differences in placental phenotype in CHD cohorts compared to our controls. RESULTS Placental T2* maps demonstrated significant differences in CHD compared to controls at equivalent gestational age. Mean T2* values over the entire placental volume were lowest compared to predicted normal in right sided obstructive lesions (RSOL) (Z-Score 2.30). This cohort also showed highest lacunarity indices (Z-score -1.7), as a marker of lobule size. Distribution patterns of T2* values over the entire placental volume were positively skewed in RSOL (Z-score -4.69) and suspected, not confirmed coarctation of the aorta (CoA-) (Z-score -3.83). Deviations were also reflected in positive kurtosis in RSOL (Z-score -3.47) and CoA- (Z-score -2.86). CONCLUSION Placental structure and function appear to deviate from normal development in pregnancies with fetal CHD. Specific patterns of altered placental function assessed by T2* deliver crucial complementary information to antenatal assessments in the presence of fetal CHD.
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Affiliation(s)
- Johannes K Steinweg
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom.
| | - Grace Tin Yan Hui
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Maximilian Pietsch
- Centre for the Developing Brain, King's College London, London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
| | - Alison Ho
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Milou Pm van Poppel
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
| | - David Lloyd
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Kathleen Colford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - John M Simpson
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Reza Razavi
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Kuberan Pushparajah
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
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20
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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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Couper S, Clark A, Thompson JMD, Flouri D, Aughwane R, David AL, Melbourne A, Mirjalili A, Stone PR. The effects of maternal position, in late gestation pregnancy, on placental blood flow and oxygenation: an MRI study. J Physiol 2021; 599:1901-1915. [PMID: 33369732 DOI: 10.1113/jp280569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/10/2020] [Indexed: 01/07/2023] Open
Abstract
KEY POINTS Maternal supine sleep position in late pregnancy is associated with an increased risk of stillbirth. Maternal supine position in late pregnancy reduces maternal cardiac output and uterine blood flow. Using MRI, this study shows that compared to the left lateral position, maternal supine position in late pregnancy is associated with reduced utero-placental blood flow and oxygen transfer across the placenta with an average 6.2% reduction in oxygen delivery to the fetus and an average 11% reduction in fetal umbilical venous blood flow. ABSTRACT Maternal sleep position in late gestation is associated with an increased risk of stillbirth, though the pathophysiological reasons for this are unclear. Studies using magnetic resonance imaging (MRI) have shown that compared with lateral positions, lying supine causes a reduction in cardiac output, reduced abdominal aortic blood flow and reduced vena caval flow which is only partially compensated for by increased flow in the azygos venous system. Using functional MRI techniques, including an acquisition termed diffusion-relaxation combined imaging of the placenta (DECIDE), which combines diffusion weighted imaging and T2 relaxometry, blood flow and oxygen transfer were estimated in the maternal, fetal and placental compartments when subjects were scanned both supine and in left lateral positions. In late gestation pregnancy, lying supine caused a 23.7% (P < 0.0001) reduction in total internal iliac arterial blood flow to the uterus. In addition, lying in the supine position caused a 6.2% (P = 0.038) reduction in oxygen movement across the placenta. The reductions in oxygen transfer to the fetus, termed delivery flux, of 11.2% (P = 0.0597) and in fetal oxygen saturation of 4.4% (P = 0.0793) did not reach statistical significance. It is concluded that even in healthy late gestation pregnancy, maternal position significantly affects oxygen transfer across the placenta and may in part provide an explanation for late stillbirth in vulnerable fetuses.
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Affiliation(s)
- Sophie Couper
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Alys Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.,Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Dimitra Flouri
- School of Biomedical Engineering and Imaging, Kings College London, London, UK
| | - Rosalind Aughwane
- Elizabeth Garrett Anderson Institute for Women's Health, University College, Huntley Street, London, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College, Huntley Street, London, UK
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging, Kings College London, London, UK
| | - Ali Mirjalili
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Peter R Stone
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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22
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Anderson KB, Andersen AS, Hansen DN, Sinding M, Peters DA, Frøkjaer JB, Sørensen A. Placental transverse relaxation time (T2) estimated by MRI: Normal values and the correlation with birthweight. Acta Obstet Gynecol Scand 2020; 100:934-940. [PMID: 33258106 DOI: 10.1111/aogs.14057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Placental transverse relaxation time (T2) assessed by MRI may have the potential to improve the antenatal identification of small for gestational age. The aims of this study were to provide normal values of placental T2 in relation to gestational age at the time of MRI and to explore the correlation between placental T2 and birthweight. MATERIAL AND METHODS A mixed cohort of 112 singleton pregnancies was retrieved from our placental MRI research database. MRI was performed at 23.6-41.3 weeks of gestation in a 1.5T system (TE (8): 50-440 ms, TR: 4000 ms). Normal pregnancies were defined by uncomplicated pregnancies with normal obstetric outcome and birthweight deviation within ±1 SD of the expected for gestational age. The correlation between placental T2 and birthweight was investigated using the following outcomes; small for gestational age (birthweight ≤-2 SD of the expected for gestational age) and birthweight deviation (birthweight Z-scores). RESULTS In normal pregnancies (n = 27), placenta T2 showed a significant negative linear correlation with gestational age (r = -.91, P = .0001) being 184 ms ± 15.94 ms (mean ± SD) at 20 weeks of gestation and 89 ms ± 15.94 ms at 40 weeks of gestation. Placental T2 was significantly reduced among small-for-gestational-age pregnancies (mean Z-score -1.95, P < .001). Moreover, we found a significant positive correlation between placenta T2 deviation (Z-score) and birthweight deviation (Z-score) (R2 = .26, P = .0001). CONCLUSIONS This study provides normal values of placental T2 to be used in future studies on placental MRI. Placental T2 is closely related to birthweight and may improve the antenatal identification of small-for-gestational-age pregnancies.
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Affiliation(s)
- Kristi B Anderson
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Anna S Andersen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Ditte N Hansen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Sinding
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - David A Peters
- Department of Clinical Engineering, Central Denmark Region, Aarhus, Denmark
| | - Jens B Frøkjaer
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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23
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The application of in utero magnetic resonance imaging in the study of the metabolic and cardiovascular consequences of the developmental origins of health and disease. J Dev Orig Health Dis 2020; 12:193-202. [PMID: 33308364 PMCID: PMC8162788 DOI: 10.1017/s2040174420001154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Observing fetal development in utero is vital to further the understanding of later-life diseases. Magnetic resonance imaging (MRI) offers a tool for obtaining a wealth of information about fetal growth, development, and programming not previously available using other methods. This review provides an overview of MRI techniques used to investigate the metabolic and cardiovascular consequences of the developmental origins of health and disease (DOHaD) hypothesis. These methods add to the understanding of the developing fetus by examining fetal growth and organ development, adipose tissue and body composition, fetal oximetry, placental microstructure, diffusion, perfusion, flow, and metabolism. MRI assessment of fetal growth, organ development, metabolism, and the amount of fetal adipose tissue could give early indicators of abnormal fetal development. Noninvasive fetal oximetry can accurately measure placental and fetal oxygenation, which improves current knowledge on placental function. Additionally, measuring deficiencies in the placenta’s transport of nutrients and oxygen is critical for optimizing treatment. Overall, the detailed structural and functional information provided by MRI is valuable in guiding future investigations of DOHaD.
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24
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Benjamini D, Basser PJ. Multidimensional correlation MRI. NMR IN BIOMEDICINE 2020; 33:e4226. [PMID: 31909516 PMCID: PMC11062766 DOI: 10.1002/nbm.4226] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 05/23/2023]
Abstract
Multidimensional correlation spectroscopy is emerging as a novel MRI modality that is well suited for microstructure and microdynamic imaging studies, especially of biological specimens. Conventional MRI methods only provide voxel-averaged and mostly macroscopically averaged information; these methods cannot disentangle intra-voxel heterogeneity on the basis of both water mobility and local chemical interactions. By correlating multiple MR contrast mechanisms and processing the data in an integrated manner, correlation spectroscopy is able to resolve the distribution of water populations according to their chemical and physical interactions with the environment. The use of a non-parametric, phenomenological representation of the multidimensional MR signal makes no assumptions about tissue structure, thereby allowing the study of microscopic structure and composition of complex heterogeneous biological systems. However, until recently, vast data requirements have confined these types of measurement to non-localized NMR applications and prevented them from being widely and successfully used in conjunction with imaging. Recent groundbreaking advancements have allowed this powerful NMR methodology to be migrated to MRI, initiating its emergence as a promising imaging approach. This review is not intended to cover the entire field of multidimensional MR; instead, it focuses on pioneering imaging applications and the challenges involved. In addition, the background and motivation that have led to multidimensional correlation MR development are discussed, along with the basic underlying mathematical concepts. The goal of the present work is to provide the reader with a fundamental understanding of the techniques developed and their potential benefits, and to provide guidance to help refine future applications of this technology.
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Affiliation(s)
- Dan Benjamini
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Peter J. Basser
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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25
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Sørensen A, Sinding M. Placental Magnetic Resonance Imaging: A Method to Evaluate Placental Function In Vivo. Obstet Gynecol Clin North Am 2020; 47:197-213. [PMID: 32008669 DOI: 10.1016/j.ogc.2019.10.009] [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: 10/25/2022]
Abstract
This article describes the use of placental magnetic resonance imaging (MRI) relaxation times in the in vivo assessment of placental function. It focuses on T2*-weighted placental MRI, the main area of the authors' research over the past decade. The rationale behind T2*-weighted placental MRI, the main findings reported in the literature, and directions for future research and clinical applications of this method are discussed. The article concludes that placental T2* relaxation time is an easily obtained and robust measurement, which can discriminate between normal and dysfunctional placenta. Placenta T2* is a promising tool for in vivo assessment of placental function.
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Affiliation(s)
- Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, Aalborg 9000, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg 9000, Denmark.
| | - Marianne Sinding
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, Aalborg 9000, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg 9000, Denmark
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26
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Chirchiglia D, Chirchiglia P, Latorre D. An update of the imaging and diagnostic techniques in use for the preservation of eloquent areas in brain tumor surgery – An opinion paper. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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27
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Harteveld AA, Hutter J, Franklin SL, Jackson LH, Rutherford M, Hajnal JV, van Osch MJP, Bos C, De Vita E. Systematic evaluation of velocity-selective arterial spin labeling settings for placental perfusion measurement. Magn Reson Med 2020; 84:1828-1843. [PMID: 32141655 PMCID: PMC7384055 DOI: 10.1002/mrm.28240] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 01/15/2023]
Abstract
Purpose Placental function is key for successful human pregnancies. Perfusion may be a sensitive marker for the in vivo assessment of placental function. Arterial spin labeling (ASL) MRI enables noninvasive measurement of tissue perfusion and it was recently suggested that ASL with velocity‐selective (VS) labeling could be advantageous in the placenta. We systematically evaluated essential VS‐ASL sequence parameters to determine optimal settings for efficient placental perfusion measurements. Methods Eleven pregnant women were scanned at 3T using VS‐ASL with 2D multislice echo planar imaging (EPI)‐readout. One reference VS‐ASL scan was acquired in all subjects; within subgroups the following parameters were systematically varied: cutoff velocity, velocity encoding direction, and inflow time. Visual evaluation and region of interest analyses were performed to compare perfusion signal differences between acquisitions. Results In all subjects, a perfusion pattern with clear hyperintense focal regions was observed. Perfusion signal decreased with inflow time and cutoff velocity. Subject‐specific dependence on velocity encoding direction was observed. High temporal signal‐to‐noise ratios with high contrast on the perfusion images between the hyperintense regions and placental tissue were seen at ~1.6 cm/s cutoff velocity and ~1000 ms inflow time. Evaluation of measurements at multiple inflow times revealed differences in blood flow dynamics between placental regions. Conclusion Placental perfusion measurements are feasible at 3T using VS‐ASL with 2D multislice EPI‐readout. A clear dependence of perfusion signal on VS labeling parameters and inflow time was demonstrated. Whereas multiple parameter combinations may advance the interpretation of placental circulation dynamics, this study provides a basis to select an effective set of parameters for the observation of placenta perfusion natural history and its potential pathological changes.
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Affiliation(s)
- Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jana Hutter
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Suzanne L Franklin
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,C.J. Gorter Center for high field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Laurence H Jackson
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Mary Rutherford
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Matthias J P van Osch
- C.J. Gorter Center for high field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Clemens Bos
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Enrico De Vita
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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28
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Sørensen A, Hutter J, Seed M, Grant PE, Gowland P. T2*-weighted placental MRI: basic research tool or emerging clinical test for placental dysfunction? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:293-302. [PMID: 31452271 DOI: 10.1002/uog.20855] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Affiliation(s)
- A Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - J Hutter
- Center for Medical Engineering, King's College London, London, UK
| | - M Seed
- Department of Cardiology, The Hospital for Sick Children, Toronto, Canada
| | - P E Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - P Gowland
- Sir Peter Mansfield Imaging Centre, Nottingham University, Nottingham, UK
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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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Shapiro J, Ginosar Y, Gielchinsky Y, Elchalal U, Bromberg Z, Corchia-Nachmanson N, Abramovitch R. BOLD-MRI demonstrates acute placental and fetal organ hypoperfusion with fetal brain sparing in response to phenylephrine but not ephedrine. Placenta 2019; 90:52-57. [PMID: 32056552 DOI: 10.1016/j.placenta.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 11/15/2019] [Accepted: 11/28/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We previously reported blood oxygen level dependent MRI (BOLD-MRI) for monitoring placental and fetal hemodynamic changes in mice following maternal hypercapnia. Here we use BOLD-MRI to compare the placental and fetal hemodynamic effects of different maternal vasopressors in mice. METHODS Pregnant ICR mice (n = 16; E17.5) anesthetized with pentobarbital (80 mg/kg i.p.) were placed supine in a 4.7-T Bruker Biospec MRI. Following baseline images, equipotential doses of ephedrine (10 mg/kg) or phenylephrine (10mcg/kg) were administered intravenously. Changes in placental and fetal signal were analyzed from T2*-weighted gradient echo MR images (TR/TE = 147/10 ms). Different regions of interest (placenta, fetal heart, fetal liver and fetal brain) were identified. Percentage change of BOLD-MRI signal intensity (SI) were presented as time curves. RESULTS Ephedrine and phenylephrine elicited markedly different effects. Phenylephrine caused an approximate 50% reduction in placental, fetal heart and fetal liver BOLD-MRI-SI, but fetal brain BOLD-MRI-SI was unchanged (statistically different from placenta and other fetal organs; p < 0.001), and the fetal brain/liver BOLD-MRI-SI ratio was markedly increased versus baseline (p < 0.001). Following ephedrine, placental BOLD-MRI-SI increased 30% and fetal heart BOLD-MRI-SI was reduced 26%; other fetal organs were unchanged. Blood gases were unchanged. DISCUSSION Phenylephrine induced BOLD-MRI-SI changes suggestive of placental and fetal hypoperfusion with brain sparing. Ephedrine induced BOLD-MRI-SI changes suggestive of increased cardiac output; we speculate that reduced fetal heart BOLD-MRI-SI may be due to increased fetal myocardial oxygen extraction or metabolic acidosis. The result demonstrates the potential of BOLD-MRI as a non-invasive hemodynamic tool for assessing pharmacodynamics effects in the placental and fetus.
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Affiliation(s)
- Joel Shapiro
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
| | - Yehuda Ginosar
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel; Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA; Wohl Institute of Translational Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Yuval Gielchinsky
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
| | - Zohar Bromberg
- The Goldyne Savad Institute of Gene Therapy and MRI Laboratory, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
| | - Nathalie Corchia-Nachmanson
- Wohl Institute of Translational Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel; The Goldyne Savad Institute of Gene Therapy and MRI Laboratory, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
| | - Rinat Abramovitch
- Wohl Institute of Translational Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel; The Goldyne Savad Institute of Gene Therapy and MRI Laboratory, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
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Hutter J, Jackson L, Ho A, Pietsch M, Story L, Chappell LC, Hajnal JV, Rutherford M. T2* relaxometry to characterize normal placental development over gestation in-vivo at 3T. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15451.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: T2* relaxometry has been identified as a non-invasive way to study the placenta in-vivo with good potential to identify placental insufficiency. Typical interpretation links T2* values to oxygen concentrations. This study aimed to comprehensively assess T2* maps as a marker of placental oxygenation in-vivo. Methods: A multi-echo gradient echo echo planar imaging sequence is used in a cohort of 84 healthy pregnant women. Special emphasis is put on spatial analysis: histogram measures, Histogram Asymmetry Measure (HAM) and lacunarity. Influences of maternal, fetal and placental factors and experimental parameters on the proposed measures are evaluated. Results: T2* maps were obtained from each placenta in less than 30sec. The previously reported decreasing trend in mean T2* with gestation was confirmed (3.45 ms decline per week). Factors such as maternal age, BMI, fetal sex, parity, mode of delivery and placental location were shown to be uncorrelated with T2* once corrected for gestational age. Robustness of the obtained values with regard to variation in segmentation and voxel-size were established. The proposed spatially resolved measures reveal a change in T2* in late gestation. Conclusions: T2* mapping is a robust and quick technique allowing quantification of both whole volume and spatial quantification largely independent of confounding factors.
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Turk EA, Stout JN, Ha C, Luo J, Gagoski B, Yetisir F, Golland P, Wald LL, Adalsteinsson E, Robinson JN, Roberts DJ, Barth WH, Grant PE. Placental MRI: Developing Accurate Quantitative Measures of Oxygenation. Top Magn Reson Imaging 2019; 28:285-297. [PMID: 31592995 PMCID: PMC7323862 DOI: 10.1097/rmr.0000000000000221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The Human Placenta Project has focused attention on the need for noninvasive magnetic resonance imaging (MRI)-based techniques to diagnose and monitor placental function throughout pregnancy. The hope is that the management of placenta-related pathologies would be improved if physicians had more direct, real-time measures of placental health to guide clinical decision making. As oxygen alters signal intensity on MRI and oxygen transport is a key function of the placenta, many of the MRI methods under development are focused on quantifying oxygen transport or oxygen content of the placenta. For example, measurements from blood oxygen level-dependent imaging of the placenta during maternal hyperoxia correspond to outcomes in twin pregnancies, suggesting that some aspects of placental oxygen transport can be monitored by MRI. Additional methods are being developed to accurately quantify baseline placental oxygenation by MRI relaxometry. However, direct validation of placental MRI methods is challenging and therefore animal studies and ex vivo studies of human placentas are needed. Here we provide an overview of the current state of the art of oxygen transport and quantification with MRI. We suggest that as these techniques are being developed, increased focus be placed on ensuring they are robust and reliable across individuals and standardized to enable predictive diagnostic models to be generated from the data. The field is still several years away from establishing the clinical benefit of monitoring placental function in real time with MRI, but the promise of individual personalized diagnosis and monitoring of placental disease in real time continues to motivate this effort.
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Affiliation(s)
- Esra Abaci Turk
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
| | - Jeffrey N. Stout
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
| | - Christopher Ha
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
| | - Jie Luo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Borjan Gagoski
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
| | - Filiz Yetisir
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
| | - Polina Golland
- Computer Science and Artificial Intelligence Laboratory (CSAIL), Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Electrical Engineering and Computer Science Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Lawrence L. Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Elfar Adalsteinsson
- Department of Electrical Engineering and Computer Science Massachusetts Institute of Technology, Cambridge, MA, United States
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Julian N. Robinson
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA
| | | | - William H. Barth
- Maternal-Fetal Medicine, Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - P. Ellen Grant
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
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Roberts VH, Gaffney JE, Lewandowski KS, Schabel MC, Morgan TK, Frias AE. A standardized method for collection of human placenta samples in the age of functional magnetic resonance imaging. Biotechniques 2019; 67:45-49. [PMID: 31184493 PMCID: PMC7027198 DOI: 10.2144/btn-2019-0029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Current methods for placental tissue collection assess a delivered organ without direct functional correlates; therefore, the four-quadrant biopsy protocol utilized by many researchers may provide reasonable representation of tissue across a large organ, and offer a snapshot for molecular analysis of the placenta. However, the recent impetus to understand the placenta in real time, and the use of functional imaging to comprehend placental biology, warrants a different sampling approach. Here we present a method to standardize placental tissue collection in a format designed to facilitate correlation of in vivo function with ex vivo assessments. Additionally, we draw comparisons to the quadrant biopsy regimen, and highlight a pathological case of placental infarction detected by in utero imaging.
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Affiliation(s)
- Victoria Hj Roberts
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Jessica E Gaffney
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Katherine S Lewandowski
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Matthias C Schabel
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR 97239, USA
| | - Terry K Morgan
- Department of Pathology, Oregon Health & Science University, Portland, OR 97239, USA.,Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Antonio E Frias
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA.,Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, USA
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Affiliation(s)
- Sarosh Rana
- From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago, IL (S.R.)
| | - Elizabeth Lemoine
- Harvard Medical School, Boston, MA (E.L.)
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.L., S.A.K.)
| | - Joey P. Granger
- Department of Physiology, University of Mississippi Medical Center, Jackson (J.P.G.)
| | - S. Ananth Karumanchi
- Departments of Medicine, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (S.A.K.)
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.L., S.A.K.)
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Slator PJ, Hutter J, Palombo M, Jackson LH, Ho A, Panagiotaki E, Chappell LC, Rutherford MA, Hajnal JV, Alexander DC. Combined diffusion-relaxometry MRI to identify dysfunction in the human placenta. Magn Reson Med 2019; 82:95-106. [PMID: 30883915 PMCID: PMC6519240 DOI: 10.1002/mrm.27733] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/04/2019] [Accepted: 01/27/2019] [Indexed: 12/25/2022]
Abstract
Purpose A combined diffusion‐relaxometry MR acquisition and analysis pipeline for in vivo human placenta, which allows for exploration of coupling between T2* and apparent diffusion coefficient (ADC) measurements in a sub 10‐minute scan time. Methods We present a novel acquisition combining a diffusion prepared spin echo with subsequent gradient echoes. The placentas of 17 pregnant women were scanned in vivo, including both healthy controls and participants with various pregnancy complications. We estimate the joint T2*‐ADC spectra using an inverse Laplace transform. Results T2*‐ADC spectra demonstrate clear quantitative separation between normal and dysfunctional placentas. Conclusions Combined T2*‐diffusivity MRI is promising for assessing fetal and maternal health during pregnancy. The T2*‐ADC spectrum potentially provides additional information on tissue microstructure, compared to measuring these two contrasts separately. The presented method is immediately applicable to the study of other organs.
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Affiliation(s)
- Paddy J Slator
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Jana Hutter
- Biomedical Engineering Department, King's College London, London, United Kingdom.,Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Marco Palombo
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Laurence H Jackson
- Biomedical Engineering Department, King's College London, London, United Kingdom.,Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Alison Ho
- Women's Health Department, King's College London, London, United Kingdom
| | - Eleftheria Panagiotaki
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Lucy C Chappell
- Women's Health Department, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Biomedical Engineering Department, King's College London, London, United Kingdom.,Centre for the Developing Brain, 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
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Poulsen SS, Sinding M, Hansen DN, Peters DA, Frøkjær JB, Sørensen A. Placental T2* estimated by magnetic resonance imaging and fetal weight estimated by ultrasound in the prediction of birthweight differences in dichorionic twin pairs. Placenta 2019; 78:18-22. [PMID: 30955706 DOI: 10.1016/j.placenta.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Intertwin birthweight (BW) difference is associated with an increased risk of adverse outcome. Ultrasound estimated fetal weight (EFW) is the current method to predict intertwin BW difference, however, the sensitivity is poor. Therefore, new methods are needed. Placental T2* estimated by magnetic resonance imaging (MRI) provides non-invasive information about the placental function. This study aimed to investigate placental T2* difference as a new predictor of BW difference, and to compare it to the EFW. METHODS We included 25 dichorionic twin pairs at 19-38 weeks' gestation. Placental T2* was obtained by MRI and EFW by ultrasound. Correlations between each predictor and BW difference were examined by simple linear regression, and the combined model was analyzed by multiple linear regression and likelihood ratio test. RESULTS Strong positive correlations were demonstrated between intertwin differences in placental T2* and BW (r = 0.80, p < 0.005), and EFW and BW (r = 0.64, p < 0.005). Placental T2* difference was a strong independent predictor of BW difference (p < 0.001), and the combined model performed better than each predictor alone (p < 0.0001). DISCUSSION This pilot study demonstrates that placental T2* difference may be a predictor of intertwin BW difference irrespectively of fetal size. The clinical potential of this method deserves further investigation in a larger clinical study.
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Affiliation(s)
- Sofie Sondrup Poulsen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark
| | - Marianne Sinding
- Department of Obstetrics and Gynecology, Viborg Regional Hospital, Heibergs Alle 4, 8800, Viborg, Denmark.
| | - Ditte Nymark Hansen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - David A Peters
- Department of Clinical Engineering, Central Denmark Region, Olof Palmes Alle 13, 8200, Aarhus N, Denmark
| | - Jens B Frøkjær
- Department of Clinical Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark; Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
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37
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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: 52] [Impact Index Per Article: 10.4] [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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Melbourne A, Aughwane R, Sokolska M, Owen D, Kendall G, Flouri D, Bainbridge A, Atkinson D, Deprest J, Vercauteren T, David A, Ourselin S. Separating fetal and maternal placenta circulations using multiparametric MRI. Magn Reson Med 2018; 81:350-361. [PMID: 30239036 PMCID: PMC6282748 DOI: 10.1002/mrm.27406] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE The placenta is a vital organ for the exchange of oxygen, nutrients, and waste products between fetus and mother. The placenta may suffer from several pathologies, which affect this fetal-maternal exchange, thus the flow properties of the placenta are of interest in determining the course of pregnancy. In this work, we propose a new multiparametric model for placental tissue signal in MRI. METHODS We describe a method that separates fetal and maternal flow characteristics of the placenta using a 3-compartment model comprising fast and slowly circulating fluid pools, and a tissue pool is fitted to overlapping multiecho T2 relaxometry and diffusion MRI with low b-values. We implemented the combined model and acquisition on a standard 1.5 Tesla clinical system with acquisition taking less than 20 minutes. RESULTS We apply this combined acquisition in 6 control singleton placentas. Mean myometrial T2 relaxation time was 123.63 (±6.71) ms. Mean T2 relaxation time of maternal blood was 202.17 (±92.98) ms. In the placenta, mean T2 relaxation time of the fetal blood component was 144.89 (±54.42) ms. Mean ratio of maternal to fetal blood volume was 1.16 (±0.6), and mean fetal blood saturation was 72.93 (±20.11)% across all 6 cases. CONCLUSION The novel acquisition in this work allows the measurement of histologically relevant physical parameters, such as the relative proportions of vascular spaces. In the placenta, this may help us to better understand the physiological properties of the tissue in disease.
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Affiliation(s)
- Andrew Melbourne
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging, Kings College London, London, United Kingdom
| | - Rosalind Aughwane
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,Institute for Women's Health, University College Hospital,London, London, United Kingdom
| | | | - David Owen
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging, Kings College London, London, United Kingdom
| | - Giles Kendall
- Institute for Women's Health, University College Hospital,London, London, United Kingdom
| | - Dimitra Flouri
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging, Kings College London, London, United Kingdom
| | - Alan Bainbridge
- Medical Physics, University College Hospital, London, United Kingdom
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Jan Deprest
- Institute for Women's Health, University College Hospital,London, London, United Kingdom.,University Hospital KU Leuven, Leuven, Belgium
| | - Tom Vercauteren
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging, Kings College London, London, United Kingdom
| | - Anna David
- Institute for Women's Health, University College Hospital,London, London, United Kingdom.,University Hospital KU Leuven, Leuven, Belgium.,NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Sebastien Ourselin
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging, Kings College London, London, United Kingdom
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Armstrong T, Liu D, Martin T, Masamed R, Janzen C, Wong C, Chanlaw T, Devaskar SU, Sung K, Wu HH. 3D R 2 * mapping of the placenta during early gestation using free-breathing multiecho stack-of-radial MRI at 3T. J Magn Reson Imaging 2018; 49:291-303. [PMID: 30142239 DOI: 10.1002/jmri.26203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/08/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Multiecho gradient-echo Cartesian MRI characterizes placental oxygenation by quantifying R 2 * . Previous research was performed at 1.5T using breath-held 2D imaging during later gestational age (GA). PURPOSE To evaluate the accuracy and repeatability of a free-breathing (FB) 3D multiecho gradient-echo stack-of-radial technique (radial) for placental R 2 * mapping at 3T and report placental R 2 * during early GA. STUDY TYPE Prospective. POPULATION Thirty subjects with normal pregnancies and three subjects with ischemic placental disease (IPD) were scanned twice: between 14-18 and 19-23 weeks GA. FIELD STRENGTH 3T. SEQUENCE FB radial. ASSESSMENT Linear correlation (concordance coefficient, ρc ) and Bland-Altman analyses (mean difference, MD) were performed to evaluate radial R 2 * mapping accuracy compared to Cartesian in a phantom. Radial R 2 * mapping repeatability was characterized using the coefficient of repeatability (CR) between back-to-back scans. The mean and spatial coefficient of variation (CV) of R 2 * was determined for all subjects, and separately for anterior and posterior placentas, at each GA range. STATISTICAL TESTS ρc was tested for significance. Differences in mean R 2 * and CV were tested using Wilcoxon Signed-Rank and Rank-Sum tests. P < 0.05 was considered significant. Z-scores for the IPD subjects were determined. RESULTS FB radial demonstrated accurate (ρc ≥0.996; P < 0.001; |MD|<0.2s-1 ) and repeatable (CR<4s-1 ) R 2 * mapping in a phantom, and repeatable (CR≤4.6s-1 ) R 2 * mapping in normal subjects. At 3T, placental R 2 * mean ± standard deviation was 12.9s-1 ± 2.7s-1 for 14-18 and 13.2s-1 ± 1.9s-1 for 19-23 weeks GA. The CV was significantly greater (P = 0.043) at 14-18 (0.63 ± 0.12) than 19-23 (0.58 ± 0.13) weeks GA. At 19-23 weeks, the CV was significantly lower (P < 0.001) for anterior (0.49 ± 0.08) than posterior (0.67 ± 0.11) placentas. One IPD subject had a lower mean R 2 * than normal subjects at both GA ranges (Z<-2). DATA CONCLUSION FB radial provides accurate and repeatable 3D R 2 * mapping for the entire placenta at 3T during early GA. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:291-303.
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Affiliation(s)
- Tess Armstrong
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Dapeng Liu
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Thomas Martin
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Rinat Masamed
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Cass Wong
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Teresa Chanlaw
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Holden H Wu
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, University of California Los Angeles, Los Angeles, California, USA
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