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Bartin R, Melbourne A, Bobet L, Gauchard G, Menneglier A, Grevent D, Bussieres L, Siauve N, Salomon LJ. Static and dynamic responses to hyperoxia of normal placenta across gestation with T2*-weighted MRI sequences. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:236-244. [PMID: 38348601 DOI: 10.1002/uog.27609] [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: 09/22/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 08/03/2024]
Abstract
OBJECTIVES T2*-weighted magnetic resonance imaging (MRI) sequences have been identified as non-invasive tools with which to study placental oxygenation in vivo. This study aimed to use these to investigate both static and dynamic responses to hyperoxia of the normal placenta across gestation. METHODS We conducted a single-center prospective study including 52 uncomplicated pregnancies. Two T2*-weighted sequences (T2* relaxometry) were performed, one before and one after maternal hyperoxia. The distribution of placental T2* values was modeled by fitting a gamma probability density function (T2* ~ Γ α β ), describing the structure of the histogram using the mean T2* value, the shape parameter (α) and the rate (β). A dynamic acquisition (blood-oxygen-level-dependent (BOLD) MRI) was also performed before and during maternal oxygen supply, until placental oxygen saturation had been achieved. The signal change over time was modeled using a sigmoid function, to determine the intensity of enhancement (ΔBOLD (% with respect to baseline)), a temporal variation coefficient (λ (min-1), controlling the slope of the curve) and the maximum steepness (Vmax (% of placental enhancement/min)). RESULTS The histogram analysis of the T2* values in normoxia showed a whole-placenta variation, with a decreasing linear trend in the mean T2* value (Pearson's correlation coefficient (R) = -0.83 (95% CI, -0.9 to -0.71), P < 0.001), along with an increasingly peaked and narrower distribution of T2* values with advancing gestation. After maternal hyperoxia, the mean T2* ratios (mean T2*hyperoxia/mean T2*baseline) were positively correlated with gestational age, while the other histogram parameters remained stable, suggesting a translation of the histogram towards higher values with a similar appearance after maternal hyperoxia. ΔBOLD showed a non-linear increase across gestation. Conversely, λ showed an inverted trend across gestation, with a weaker correlation (R = -0.33 (95% CI, -0.58 to -0.02), P = 0.04, R2 = 0.1). As a combination of ΔBOLD and λ, the changes in Vmax throughout gestation were influenced mainly by the changes in ΔBOLD and showed a positive non-linear correlation with gestational age. CONCLUSIONS Our results suggest that the decrease in the T2* placental signal as gestation progresses does not reflect placental dysfunction. The BOLD dynamic signal change is representative of a free-diffusion model of oxygenation and highlights the increasing differences in oxygen saturation between mother and fetus as gestation progresses (ΔBOLD) and in the placental permeability to oxygen (λ). © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Bartin
- Department of Fetal Medicine, Surgery and Imaging, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
- Plateforme LUMIERE, Hôpital Universitaire Necker-Enfants Malades, URP 7328 and PACT, affiliated to Imagine Institut, Université de Paris, Faculté de Médecine, Paris, France
| | - A Melbourne
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- School of Biomedical Engineering & Imaging Sciences, Kings College London, London, UK
| | - L Bobet
- Plateforme LUMIERE, Hôpital Universitaire Necker-Enfants Malades, URP 7328 and PACT, affiliated to Imagine Institut, Université de Paris, Faculté de Médecine, Paris, France
| | - G Gauchard
- Plateforme LUMIERE, Hôpital Universitaire Necker-Enfants Malades, URP 7328 and PACT, affiliated to Imagine Institut, Université de Paris, Faculté de Médecine, Paris, France
| | - A Menneglier
- Plateforme LUMIERE, Hôpital Universitaire Necker-Enfants Malades, URP 7328 and PACT, affiliated to Imagine Institut, Université de Paris, Faculté de Médecine, Paris, France
| | - D Grevent
- Plateforme LUMIERE, Hôpital Universitaire Necker-Enfants Malades, URP 7328 and PACT, affiliated to Imagine Institut, Université de Paris, Faculté de Médecine, Paris, France
- Department of Pediatric Radiology, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - L Bussieres
- Department of Fetal Medicine, Surgery and Imaging, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
- Plateforme LUMIERE, Hôpital Universitaire Necker-Enfants Malades, URP 7328 and PACT, affiliated to Imagine Institut, Université de Paris, Faculté de Médecine, Paris, France
| | - N Siauve
- Department of Radiology, Hôpital Louis Mourier, AP-HP, Colombes, France
| | - L J Salomon
- Department of Fetal Medicine, Surgery and Imaging, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
- Plateforme LUMIERE, Hôpital Universitaire Necker-Enfants Malades, URP 7328 and PACT, affiliated to Imagine Institut, Université de Paris, Faculté de Médecine, Paris, France
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Bhattacharya S, Price AN, Uus A, Sousa HS, Marenzana M, Colford K, Murkin P, Lee M, Cordero-Grande L, Teixeira RPAG, Malik SJ, Deprez M. In vivo T2 measurements of the fetal brain using single-shot fast spin echo sequences. Magn Reson Med 2024; 92:715-729. [PMID: 38623934 DOI: 10.1002/mrm.30094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/18/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE We propose a quantitative framework for motion-corrected T2 fetal brain measurements in vivo and validate the single-shot fast spin echo (SS-FSE) sequence to perform these measurements. METHODS Stacks of two-dimensional SS-FSE slices are acquired with different echo times (TE) and motion-corrected with slice-to-volume reconstruction (SVR). The quantitative T2 maps are obtained by a fit to a dictionary of simulated signals. The sequence is selected using simulated experiments on a numerical phantom and validated on a physical phantom scanned on a 1.5T system. In vivo quantitative T2 maps are obtained for five fetuses with gestational ages (GA) 21-35 weeks on the same 1.5T system. RESULTS The simulated experiments suggested that a TE of 400 ms combined with the clinically utilized TEs of 80 and 180 ms were most suitable for T2 measurements in the fetal brain. The validation on the physical phantom confirmed that the SS-FSE T2 measurements match the gold standard multi-echo spin echo measurements. We measured average T2s of around 200 and 280 ms in the fetal brain grey and white matter, respectively. This was slightly higher than fetal T2* and the neonatal T2 obtained from previous studies. CONCLUSION The motion-corrected SS-FSE acquisitions with varying TEs offer a promising practical framework for quantitative T2 measurements of the moving fetus.
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Affiliation(s)
- Suryava Bhattacharya
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Anthony N Price
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Alena Uus
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Helena S Sousa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Kathleen Colford
- Centre for the Developing Brain, King's College London, London, UK
| | - Peter Murkin
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Maggie Lee
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Lucilio Cordero-Grande
- Biomedical Image Technologies, ETSI Telecomunicración, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Rui Pedro A G Teixeira
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Shaihan J Malik
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Maria Deprez
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
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Cromb D, Steinweg J, Aviles Verdera J, van Poppel MPM, Bonthrone AF, Lloyd DFA, Pushparajah K, Simpson J, Razavi R, Rutherford M, Counsell SJ, Hutter J. T2*-Relaxometry MRI to Assess Third Trimester Placental and Fetal Brain Oxygenation and Placental Characteristics in Healthy Fetuses and Fetuses With Congenital Heart Disease. J Magn Reson Imaging 2024. [PMID: 38994701 DOI: 10.1002/jmri.29498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Congenital heart disease (CHD) has been linked to impaired placental and fetal brain development. Assessing the placenta and fetal brain in parallel may help further our understanding of the relationship between development of these organs. HYPOTHESIS 1) Placental and fetal brain oxygenation are correlated, 2) oxygenation in these organs is reduced in CHD compared to healthy controls, and 3) placental structure is altered in CHD. STUDY TYPE Retrospective case-control. POPULATION Fifty-one human fetuses with CHD (32 male; median [IQR] gestational age [GA] = 32.0 [30.9-32.9] weeks) and 30 from uncomplicated pregnancies with normal birth outcomes (18 male; median [IQR] GA = 34.5 [31.9-36.7] weeks). FIELD STRENGTH/SEQUENCE 1.5 T single-shot multi-echo-gradient-echo echo-planar imaging. ASSESSMENT Masking was performed using an automated nnUnet model. Mean brain and placental T2* and quantitative measures of placental texture, volume, and morphology were calculated. STATISTICAL TESTS Spearman's correlation coefficient for determining the association between brain and placental T2*, and between brain and placental characteristics with GA. P-values for comparing brain T2*, placenta T2*, and placental characteristics between groups derived from ANOVA. Significance level P < 0.05. RESULTS There was a significant positive association between placental and fetal brain T2* (⍴ = 0.46). Placental and fetal brain T2* showed a significant negative correlation with GA (placental T2* ⍴ = -0.65; fetal brain T2* ⍴ = -0.32). Both placental and fetal brain T2* values were significantly reduced in CHD, after adjusting for GA (placental T2*: control = 97 [±24] msec, CHD = 83 [±23] msec; brain T2*: control = 218 [±26] msec, CHD = 202 [±25] msec). Placental texture and morphology were also significantly altered in CHD (Texture: control = 0.84 [0.83-0.87], CHD = 0.80 [0.78-0.84]; Morphology: control = 9.9 [±2.2], CHD = 10.8 [±2.0]). For all fetuses, there was a significant positive association between placental T2* and placental texture (⍴ = 0.46). CONCLUSION Placental and fetal brain T2* values are associated in healthy fetuses and those with CHD. Placental and fetal brain oxygenation are reduced in CHD. Placental appearance is significantly altered in CHD and shows associations with placental oxygenation, suggesting altered placental development and function may be related. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
| | - Johannes Steinweg
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, UK
| | - Jordina Aviles Verdera
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Milou P M van Poppel
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, UK
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
| | - David F A Lloyd
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, UK
| | - Kuberan Pushparajah
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, UK
| | - John Simpson
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, UK
| | - Reza Razavi
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Smart Imaging Lab, Radiological Institute, University Hospital Erlangen, Erlangen, Germany
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Leon RL, Bitar L, Rajagopalan V, Spong CY. Interdependence of placenta and fetal cardiac development. Prenat Diagn 2024; 44:846-855. [PMID: 38676696 PMCID: PMC11269166 DOI: 10.1002/pd.6572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/02/2024] [Accepted: 03/22/2024] [Indexed: 04/29/2024]
Abstract
The placenta and fetal heart undergo development concurrently during early pregnancy, and, while human studies have reported associations between placental abnormalities and congenital heart disease (CHD), the nature of this relationship remains incompletely understood. Evidence from animal studies suggests a plausible cause and effect connection between placental abnormalities and fetal CHD. Biomechanical models demonstrate the influence of mechanical forces on cardiac development, whereas genetic models highlight the role of confined placental mutations that can cause some forms of CHD. Similar definitive studies in humans are lacking; however, placental pathologies such as maternal and fetal vascular malperfusion and chronic deciduitis are frequently observed in pregnancies complicated by CHD. Moreover, maternal conditions such as diabetes and pre-eclampsia, which affect placental function, are associated with increased risk of CHD in offspring. Bridging the gap between animal models and human studies is crucial to understanding how placental abnormalities may contribute to human fetal CHD. The next steps will require new methodologies and multidisciplinary approaches combining innovative imaging modalities, comprehensive genomic testing, and histopathology. These studies may eventually lead to preventative strategies for some forms of CHD by targeting placental influences on fetal heart development.
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Affiliation(s)
- Rachel L. Leon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lynn Bitar
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vidya Rajagopalan
- Department of Pediatrics, Children’s Hospital of Los Angeles and Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Catherine Y. Spong
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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5
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Cromb D, Slator PJ, Hall M, Price A, Alexander DC, Counsell SJ, Hutter J. Advanced magnetic resonance imaging detects altered placental development in pregnancies affected by congenital heart disease. Sci Rep 2024; 14:12357. [PMID: 38811636 PMCID: PMC11136986 DOI: 10.1038/s41598-024-63087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/24/2024] [Indexed: 05/31/2024] Open
Abstract
Congenital heart disease (CHD) is the most common congenital malformation and is associated with adverse neurodevelopmental outcomes. The placenta is crucial for healthy fetal development and placental development is altered in pregnancy when the fetus has CHD. This study utilized advanced combined diffusion-relaxation MRI and a data-driven analysis technique to test the hypothesis that placental microstructure and perfusion are altered in CHD-affected pregnancies. 48 participants (36 controls, 12 CHD) underwent 67 MRI scans (50 control, 17 CHD). Significant differences in the weighting of two independent placental and uterine-wall tissue components were identified between the CHD and control groups (both pFDR < 0.001), with changes most evident after 30 weeks gestation. A significant trend over gestation in weighting for a third independent tissue component was also observed in the CHD cohort (R = 0.50, pFDR = 0.04), but not in controls. These findings add to existing evidence that placental development is altered in CHD. The results may reflect alterations in placental perfusion or the changes in fetal-placental flow, villous structure and maturation that occur in CHD. Further research is needed to validate and better understand these findings and to understand the relationship between placental development, CHD, and its neurodevelopmental implications.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Paddy J Slator
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Megan Hall
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Anthony Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.
- Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Smart Imaging Lab, Radiological Institute, University Hospital Erlangen, Erlangen, Germany
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Cromb D, Slator P, Hall M, Price A, Alexander D, Counsell S, Hutter J. Advanced magnetic resonance imaging detects altered placental development in pregnancies affected by congenital heart disease. RESEARCH SQUARE 2024:rs.3.rs-3873412. [PMID: 38343847 PMCID: PMC10854304 DOI: 10.21203/rs.3.rs-3873412/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Congenital heart disease (CHD) is the most common congenital malformation and is associated with adverse neurodevelopmental outcomes. The placenta is crucial for healthy fetal development and placental development is altered in pregnancy when the fetus has CHD. This study utilized advanced combined diffusion-relaxation MRI and a data-driven analysis technique to test the hypothesis that placental microstructure and perfusion are altered in CHD-affected pregnancies. 48 participants (36 controls, 12 CHD) underwent 67 MRI scans (50 control, 17 CHD). Significant differences in the weighting of two independent placental and uterine-wall tissue components were identified between the CHD and control groups (both pFDR<0.001), with changes most evident after 30 weeks gestation. A Significant trend over gestation in weighting for a third independent tissue component was also observed in the CHD cohort (R = 0.50, pFDR=0.04), but not in controls. These findings add to existing evidence that placental development is altered in CHD. The results may reflect alterations in placental perfusion or the changes in fetal-placental flow, villous structure and maturation that occur in CHD. Further research is needed to validate and better understand these findings and to understand the relationship between placental development, CHD, and its neurodevelopmental implications.
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Neves Silva S, Aviles Verdera J, Tomi‐Tricot R, Neji R, Uus A, Grigorescu I, Wilkinson T, Ozenne V, Lewin A, Story L, De Vita E, Rutherford M, Pushparajah K, Hajnal J, Hutter J. Real-time fetal brain tracking for functional fetal MRI. Magn Reson Med 2023; 90:2306-2320. [PMID: 37465882 PMCID: PMC10952752 DOI: 10.1002/mrm.29803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To improve motion robustness of functional fetal MRI scans by developing an intrinsic real-time motion correction method. MRI provides an ideal tool to characterize fetal brain development and growth. It is, however, a relatively slow imaging technique and therefore extremely susceptible to subject motion, particularly in functional MRI experiments acquiring multiple Echo-Planar-Imaging-based repetitions, for example, diffusion MRI or blood-oxygen-level-dependency MRI. METHODS A 3D UNet was trained on 125 fetal datasets to track the fetal brain position in each repetition of the scan in real time. This tracking, inserted into a Gadgetron pipeline on a clinical scanner, allows updating the position of the field of view in a modified echo-planar imaging sequence. The method was evaluated in real-time in controlled-motion phantom experiments and ten fetal MR studies (17 + 4-34 + 3 gestational weeks) at 3T. The localization network was additionally tested retrospectively on 29 low-field (0.55T) datasets. RESULTS Our method achieved real-time fetal head tracking and prospective correction of the acquisition geometry. Localization performance achieved Dice scores of 84.4% and 82.3%, respectively for both the unseen 1.5T/3T and 0.55T fetal data, with values higher for cephalic fetuses and increasing with gestational age. CONCLUSIONS Our technique was able to follow the fetal brain even for fetuses under 18 weeks GA in real-time at 3T and was successfully applied "offline" to new cohorts on 0.55T. Next, it will be deployed to other modalities such as fetal diffusion MRI and to cohorts of pregnant participants diagnosed with pregnancy complications, for example, pre-eclampsia and congenital heart disease.
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Affiliation(s)
- Sara Neves Silva
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Jordina Aviles Verdera
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Raphael Tomi‐Tricot
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- MR Research CollaborationsSiemens Healthcare LimitedCamberleyUK
| | - Radhouene Neji
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- MR Research CollaborationsSiemens Healthcare LimitedCamberleyUK
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Irina Grigorescu
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Thomas Wilkinson
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Valery Ozenne
- CNRS, CRMSB, UMR 5536, IHU LirycUniversité de BordeauxBordeauxFrance
| | - Alexander Lewin
- Institute of Neuroscience and Medicine 11, INM‐11Forschungszentrum JülichJülichGermany
- RWTHAachen UniversityAachenGermany
| | - Lisa Story
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Department of Women & Children's HealthKing's College LondonLondonUK
| | - Enrico De Vita
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- MRI Physics GroupGreat Ormond Street HospitalLondonUK
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Kuberan Pushparajah
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Jo Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
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Herrera CL, Kim MJ, Do QN, Owen DM, Fei B, Twickler DM, Spong CY. The human placenta project: Funded studies, imaging technologies, and future directions. Placenta 2023; 142:27-35. [PMID: 37634371 PMCID: PMC11257151 DOI: 10.1016/j.placenta.2023.08.067] [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: 03/13/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
The placenta plays a critical role in fetal development. It serves as a multi-functional organ that protects and nurtures the fetus during pregnancy. However, despite its importance, the intricacies of placental structure and function in normal and diseased states have remained largely unexplored. Thus, in 2014, the National Institute of Child Health and Human Development launched the Human Placenta Project (HPP). As of May 2023, the HPP has awarded over $101 million in research funds, resulting in 41 funded studies and 459 publications. We conducted a comprehensive review of these studies and publications to identify areas of funded research, advances in those areas, limitations of current research, and continued areas of need. This paper will specifically review the funded studies by the HPP, followed by an in-depth discussion on advances and gaps within placental-focused imaging. We highlight the progress within magnetic reasonance imaging and ultrasound, including development of tools for the assessment of placental function and structure.
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Affiliation(s)
- Christina L Herrera
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, and Parkland Health Dallas, Texas, USA; Green Center for Reproductive Biology Sciences, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Meredith J Kim
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Quyen N Do
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - David M Owen
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, and Parkland Health Dallas, Texas, USA; Green Center for Reproductive Biology Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Baowei Fei
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA; Department of Bioengineering, University of Texas at Dallas, Dallas, TX, USA
| | - Diane M Twickler
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, and Parkland Health Dallas, Texas, USA; Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Catherine Y Spong
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, and Parkland Health Dallas, Texas, USA
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Aviles Verdera J, Story L, Hall M, Finck T, Egloff A, Seed PT, Malik SJ, Rutherford MA, Hajnal JV, Tomi-Tricot R, Hutter J. Reliability and Feasibility of Low-Field-Strength Fetal MRI at 0.55 T during Pregnancy. Radiology 2023; 309:e223050. [PMID: 37847139 PMCID: PMC10623193 DOI: 10.1148/radiol.223050] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/20/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
Abstract
Background The benefits of using low-field-strength fetal MRI to evaluate antenatal development include reduced image artifacts, increased comfort, larger bore size, and potentially reduced costs, but studies about fetal low-field-strength MRI are lacking. Purpose To evaluate the reliability and feasibility of low-field-strength fetal MRI to assess anatomic and functional measures in pregnant participants using a commercially available 0.55-T MRI scanner and a comprehensive 20-minute protocol. Materials and Methods This prospective study was performed at a large teaching hospital (St Thomas' Hospital; London, England) from May to November 2022 in healthy pregnant participants and participants with pregnancy-related abnormalities using a commercially available 0.55-T MRI scanner. A 20-minute protocol was acquired including anatomic T2-weighted fast-spin-echo, quantitative T2*, and diffusion sequences. Key measures like biparietal diameter, transcerebellar diameter, lung volume, and cervical length were evaluated by two radiologists and an MRI-experienced obstetrician. Functional organ-specific mean values were given. Comparison was performed with existing published values and higher-field MRI using linear regression, interobserver correlation, and Bland-Altman plots. Results A total of 79 fetal MRI examinations were performed (mean gestational age, 29.4 weeks ± 5.5 [SD] [age range, 17.6-39.3 weeks]; maternal age, 34.4 years ± 5.3 [age range, 18.4-45.5 years]) in 47 healthy pregnant participants (control participants) and in 32 participants with pregnancy-related abnormalities. The key anatomic two-dimensional measures for the 47 healthy participants agreed with large cross-sectional 1.5-T and 3-T control studies. The interobserver correlations for the biparietal diameter in the first 40 consecutive scans were 0.96 (95% CI: 0.7, 0.99; P = .002) for abnormalities and 0.93 (95% CI: 0.86, 0.97; P < .001) for control participants. Functional features, including placental and brain T2* and placental apparent diffusion coefficient values, strongly correlated with gestational age (mean placental T2* in the control participants: 5.2 msec of decay per week; R2 = 0.66; mean T2* at 30 weeks, 176.6 msec; P < .001). Conclusion The 20-minute low-field-strength fetal MRI examination protocol was capable of producing reliable structural and functional measures of the fetus and placenta in pregnancy. Clinical trial registration no. REC 21/LO/0742 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Gowland in this issue.
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Affiliation(s)
- Jordina Aviles Verdera
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Lisa Story
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Megan Hall
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Tom Finck
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Alexia Egloff
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Paul T. Seed
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Shaihan J. Malik
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Mary A. Rutherford
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Joseph V. Hajnal
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Raphaël Tomi-Tricot
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Jana Hutter
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
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10
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Josowitz R, Linn R, Rychik J. The Placenta in Congenital Heart Disease: Form, Function and Outcomes. Neoreviews 2023; 24:e569-e582. [PMID: 37653088 DOI: 10.1542/neo.24-9-e569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The maternal-fetal environment, controlled and modulated by the placenta, plays a critical role in the development and well-being of the fetus, with long-term impact through programming of lifelong health. The fetal cardiovascular system and placenta emerge at the same time embryologically, and thus placental form and function are altered in the presence of congenital heart disease (CHD). In this review, we report on what is known about the placenta from a structural and functional perspective when there is CHD. We describe the various unique pathologic findings as well as the diagnostic imaging tools used to characterize placental function in utero. With growing interest in the placenta, a standardized approach to characterizing placental pathology has emerged. Furthermore, application of ultrasonography techniques and magnetic resonance imaging now allow for insights into placental blood flow and functionality in vivo. An improved understanding of the intriguing relationship between the placenta and the fetal cardiovascular system will provide opportunities to develop novel ways to optimize outcomes. Once better understood, therapeutic modulation of placental function offered during the vulnerable period of fetal plasticity may be one of the most impactful ways to alter the course of CHD and its complications.
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Affiliation(s)
- Rebecca Josowitz
- Division of Cardiology, Fetal Heart Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rebecca Linn
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Jack Rychik
- Division of Cardiology, Fetal Heart Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
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11
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Cromb D, Slator PJ, De La Fuente M, Price AN, Rutherford M, Egloff A, Counsell SJ, Hutter J. Assessing within-subject rates of change of placental MRI diffusion metrics in normal pregnancy. Magn Reson Med 2023; 90:1137-1150. [PMID: 37183839 PMCID: PMC10962570 DOI: 10.1002/mrm.29665] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Studying placental development informs when development is abnormal. Most placental MRI studies are cross-sectional and do not study the extent of individual variability throughout pregnancy. We aimed to explore how diffusion MRI measures of placental function and microstructure vary in individual healthy pregnancies throughout gestation. METHODS Seventy-nine pregnant, low-risk participants (17 scanned twice and 62 scanned once) were included. T2 -weighted anatomical imaging and a combined multi-echo spin-echo diffusion-weighted sequence were acquired at 3 T. Combined diffusion-relaxometry models were performed using both aT 2 * $$ {\mathrm{T}}_2^{\ast } $$ -ADC and a bicompartmentalT 2 * $$ {\mathrm{T}}_2^{\ast } $$ -intravoxel-incoherent-motion (T 2 * IVIM $$ {\mathrm{T}}_2^{\ast}\;\mathrm{IVIM} $$ ) model fit. RESULTS There was a significant decline in placentalT 2 * $$ {\mathrm{T}}_2^{\ast } $$ and ADC (both P < 0.01) over gestation. These declines are consistent in individuals forT 2 * $$ {\mathrm{T}}_2^{\ast } $$ (covariance = -0.47), but not ADC (covariance = -1.04). TheT 2 * IVIM $$ {\mathrm{T}}_2^{\ast}\;\mathrm{IVIM} $$ model identified a consistent decline in individuals over gestation inT 2 * $$ {\mathrm{T}}_2^{\ast } $$ from both the perfusing and diffusing placental compartments, but not in ADC values from either. The placental perfusing compartment fraction increased over gestation (P = 0.0017), but this increase was not consistent in individuals (covariance = 2.57). CONCLUSION Whole placentalT 2 * $$ {\mathrm{T}}_2^{\ast } $$ and ADC values decrease over gestation, although onlyT 2 * $$ {\mathrm{T}}_2^{\ast } $$ values showed consistent trends within subjects. There was minimal individual variation in rates of change ofT 2 * $$ {\mathrm{T}}_2^{\ast } $$ values from perfusing and diffusing placental compartments, whereas trends in ADC values from these compartments were less consistent. These findings probably relate to the increased complexity of the bicompartmentalT 2 * IVIM $$ {\mathrm{T}}_2^{\ast}\;\mathrm{IVIM} $$ model, and differences in how different placental regions evolve at a microstructural level. These placental MRI metrics from low-risk pregnancies provide a useful benchmark for clinical cohorts.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Paddy J. Slator
- Centre for Medical Image Computing, Department of Computer ScienceUniversity College LondonLondonUK
| | - Miguel De La Fuente
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Anthony N. Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Centre for Medical EngineeringSchool of Biomedical Engineering and Imaging Sciences, King's College LondonLondonUK
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- MRC Centre for Neurodevelopmental DisordersKing's College LondonLondonUK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Serena J. Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Centre for Medical EngineeringSchool of Biomedical Engineering and Imaging Sciences, King's College LondonLondonUK
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12
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Moerdijk AS, Claessens NH, van Ooijen IM, van Ooij P, Alderliesten T, Grotenhuis HB, Benders MJNL, Bohte AE, Breur JMPJ, Charisopoulou D, Clur SA, Cornette JMJ, Fejzic Z, Franssen MTM, Frerich S, Geerdink LM, Go ATJI, Gommers S, Helbing WA, Hirsch A, Holtackers RJ, Klein WM, Krings GJ, Lamb HJ, Nijman M, Pajkrt E, Planken RN, Schrauben EM, Steenhuis TJ, ter Heide H, Vanagt WYR, van Beynum IM, van Gaalen MD, van Iperen GG, van Schuppen J, Willems TP, Witters I. Fetal MRI of the heart and brain in congenital heart disease. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:59-68. [PMID: 36343660 DOI: 10.1016/s2352-4642(22)00249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
Antenatal assessment of congenital heart disease and associated anomalies by ultrasound has improved perinatal care. Fetal cardiovascular MRI and fetal brain MRI are rapidly evolving for fetal diagnostic testing of congenital heart disease. We give an overview on the use of fetal cardiovascular MRI and fetal brain MRI in congenital heart disease, focusing on the current applications and diagnostic yield of structural and functional imaging during pregnancy. Fetal cardiovascular MRI in congenital heart disease is a promising supplementary imaging method to echocardiography for the diagnosis of antenatal congenital heart disease in weeks 30-40 of pregnancy. Concomitant fetal brain MRI is superior to brain ultrasound to show the complex relationship between fetal haemodynamics in congenital heart disease and brain development.
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Affiliation(s)
- Anouk S Moerdijk
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nathalie Hp Claessens
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inge M van Ooijen
- Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pim van Ooij
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Thomas Alderliesten
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
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13
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Rajagopalan V, Schmithorst V, El-Ali A, Reynolds W, Lee V, Wallace J, Weinberg J, Johnson J, Votava-Smith J, Adibi J, Panigrahy A. Associations between Maternal Risk Factors and Intrinsic Placental and Fetal Brain Functional Properties in Congenital Heart Disease. Int J Mol Sci 2022; 23:15178. [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] [MESH Headings] [Grants] [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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Affiliation(s)
- Vidya Rajagopalan
- Department of Radiology, Children’s Hospital Los Angeles, 4650 Sunset Blvd., MS #32, Los Angeles, CA 90027, USA
- Keck School of Medicine of University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Vanessa Schmithorst
- Pediatric Imaging Research Center, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
- Department of Radiology, University of Pittsburgh School of Medicine, PUH Suite E204, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Alexander El-Ali
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
| | - William Reynolds
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Blvd., Pittsburgh, PA 15206, USA
| | - Vincent Lee
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
| | - Julia Wallace
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
| | - Jacqueline Weinberg
- Department of Cardiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 3, Pittsburgh, PA 15224, USA
| | - Jennifer Johnson
- Department of Cardiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 3, Pittsburgh, PA 15224, USA
| | - Jodie Votava-Smith
- Keck School of Medicine of University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
- Department of Pediatrics, Childrens Hospital Los Angeles, 4650 Sunset Blvd., MS #71, Los Angeles, CA 90027, USA
| | - Jennifer Adibi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Ashok Panigrahy
- Pediatric Imaging Research Center, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
- Department of Radiology, University of Pittsburgh School of Medicine, PUH Suite E204, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave Floor 2, Pittsburgh, PA 15224, USA
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14
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Liu K, Zhu M, Dong SZ. Prenatal diagnosis of fetal ectopia cordis by fetal cardiovascular magnetic resonance imaging. Prenat Diagn 2022; 42:1636-1642. [PMID: 36307940 DOI: 10.1002/pd.6254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/22/2022] [Accepted: 10/23/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to report our cases of fetal ectopia cordis (EC) and to evaluate the utility of fetal cardiovascular magnetic resonance imaging (MRI) for the diagnosis of this rare anomaly. METHOD This retrospective study included 11 fetuses with EC. The multiplane steady-state free precession (SSFP) sequence, single-shot turbo spin-echo sequence and non-gated SSFP cine cardiovascular magnetic resonance were used to evaluate the fetal heart and abdomen. RESULTS The 11 fetal cases with EC were examined by fetal cardiovascular MRI and confirmed by postnatal or post-mortem findings. Of these 11 cases, two were isolated thoracic EC, six had pentalogy of Cantrell, and three had an omphalocele and EC. Among all 11 fetuses, nine were associated with congenital heart defects. In four cases, fetal MRI added additional information compared to fetal ultrasound, however, in two cases, fetal MRI missed the diagnosis of a ventricular septal defect noted by echocardiography. CONCLUSION Fetal MRI combined with prenatal echocardiography can improve the accuracy of the prenatal diagnosis of EC.
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Affiliation(s)
- Ke Liu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Zhu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Su-Zhen Dong
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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15
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Mizutani T, Kotani T, Kato N, Imai K, Ushida T, Nakano-Kobayashi T, Kinoshita Y, Ito M, Kinoshita F, Yamamuro O, Kajiyama H. Assessment of placental abruption with diffusion-weighted imaging. J Obstet Gynaecol Res 2022; 48:930-937. [PMID: 35194877 DOI: 10.1111/jog.15183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/28/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether placental abruption without fetal distress could be assessed by apparent diffusion coefficient (ADC) values in magnetic resonance imaging (MRI). METHODS We conducted a retrospective case-control study at a single center. ADC values at the lesions of placental abruption in the abruption group (n = 8) were compared to those in the control group (n = 32). In the abruption group, ADC values at the sites of abruption were also compared to those at the nonabruption sites within the same placenta. RESULTS The ADC values in the placental area above the abruption site in the abruption group showed lower values than those in the control group when the slice containing the umbilical cord insertion site was set as the reference, and those values were compared in each corresponding slice. Compared with average ADC values, those above the abruption site in the abruption group were also significantly lower than those in the control group (p < 0.001). Furthermore, ADC values at the area above abruption were lower than those at the nonabruption area of all planes in the abruption group. CONCLUSIONS ADC values at the lesions above the placental abruption site were reduced compared to those in the normal placenta and those in the nonabruption area. Thus, it would be helpful to understand the pathophysiology of placental abruption in expectant management, although further investigations would be needed.
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Affiliation(s)
- Teruyuki Mizutani
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Obstetrics and Gynaecology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Noriko Kato
- Department of Obstetrics and Gynaecology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano-Kobayashi
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshimi Kinoshita
- Diagnostic Radiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Masato Ito
- Diagnostic Radiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Fumie Kinoshita
- Data Science Division, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Osamu Yamamuro
- Department of Obstetrics and Gynaecology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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16
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Limperopoulos C, Wessel DL, du Plessis AJ. Understanding the Maternal-Fetal Environment and the Birth of Prenatal Pediatrics. J Am Heart Assoc 2022; 11:e023807. [PMID: 35014863 PMCID: PMC9238530 DOI: 10.1161/jaha.121.023807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Catherine Limperopoulos
- Division of Diagnostic Imaging and Radiology Developing Brain Institute Children's National Hospital Washington DC.,Department of Pediatrics The George Washington University School of Medicine and Health Sciences Washington DC.,Division of Fetal and Transitional Medicine Prenatal Pediatrics Institute Children's National Hospital Washington DC
| | - David L Wessel
- Department of Pediatrics The George Washington University School of Medicine and Health Sciences Washington DC.,Division of Cardiology Children's National Hospital Washington DC.,Division of Critical Care Medicine Children's National Hospital Washington DC
| | - Adre J du Plessis
- Department of Pediatrics The George Washington University School of Medicine and Health Sciences Washington DC.,Division of Fetal and Transitional Medicine Prenatal Pediatrics Institute Children's National Hospital Washington DC
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17
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Wang S, Celebi ME, Zhang YD, Yu X, Lu S, Yao X, Zhou Q, Miguel MG, Tian Y, Gorriz JM, Tyukin I. Advances in Data Preprocessing for Biomedical Data Fusion: An Overview of the Methods, Challenges, and Prospects. INFORMATION FUSION 2021; 76:376-421. [DOI: 10.1016/j.inffus.2021.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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