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Davidson L, Boland MR. Towards deep phenotyping pregnancy: a systematic review on artificial intelligence and machine learning methods to improve pregnancy outcomes. Brief Bioinform 2021; 22:6065792. [PMID: 33406530 PMCID: PMC8424395 DOI: 10.1093/bib/bbaa369] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/13/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022] Open
Abstract
Objective Development of novel informatics methods focused on improving pregnancy outcomes remains an active area of research. The purpose of this study is to systematically review the ways that artificial intelligence (AI) and machine learning (ML), including deep learning (DL), methodologies can inform patient care during pregnancy and improve outcomes. Materials and methods We searched English articles on EMBASE, PubMed and SCOPUS. Search terms included ML, AI, pregnancy and informatics. We included research articles and book chapters, excluding conference papers, editorials and notes. Results We identified 127 distinct studies from our queries that were relevant to our topic and included in the review. We found that supervised learning methods were more popular (n = 69) than unsupervised methods (n = 9). Popular methods included support vector machines (n = 30), artificial neural networks (n = 22), regression analysis (n = 17) and random forests (n = 16). Methods such as DL are beginning to gain traction (n = 13). Common areas within the pregnancy domain where AI and ML methods were used the most include prenatal care (e.g. fetal anomalies, placental functioning) (n = 73); perinatal care, birth and delivery (n = 20); and preterm birth (n = 13). Efforts to translate AI into clinical care include clinical decision support systems (n = 24) and mobile health applications (n = 9). Conclusions Overall, we found that ML and AI methods are being employed to optimize pregnancy outcomes, including modern DL methods (n = 13). Future research should focus on less-studied pregnancy domain areas, including postnatal and postpartum care (n = 2). Also, more work on clinical adoption of AI methods and the ethical implications of such adoption is needed.
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Affiliation(s)
- Lena Davidson
- MS degree at College of St. Scholastica, Duluth, MN, USA
| | - Mary Regina Boland
- Department of Biostatistics, Epidemiology, and Informatics at the University of Pennsylvania
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Welsh AW, Fowlkes JB, Pinter SZ, Ives KA, Owens GE, Rubin JM, Kripfgans OD, Looney P, Collins SL, Stevenson GN. Three-dimensional US Fractional Moving Blood Volume: Validation of Renal Perfusion Quantification. Radiology 2019; 293:460-468. [PMID: 31573404 PMCID: PMC6800606 DOI: 10.1148/radiol.2019190248] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Three-dimensional (3D) fractional moving blood volume (FMBV) derived from 3D power Doppler US has been proposed for noninvasive approximation of perfusion. However, 3D FMBV has never been applied in animals against a ground truth. Purpose To determine the correlation between 3D FMBV and the reference standard of fluorescent microspheres (FMS) for measurement of renal perfusion in a porcine model. Materials and Methods From February 2017 to September 2017, adult pigs were administered FMS before and after measurement of renal 3D FMBV at baseline (100%) and approximately 75%, 50%, and 25% flow levels by using US machines from two different vendors. The 3D power Doppler US volumes were converted and segmented, and correlations between FMS and 3D FMBV were made with simple linear regression (r2). Similarity and reproducibility of manual segmentation were determined with the Dice similarity coefficient and 3D FMBV reproducibility (intraclass correlation coefficient [ICC]). Results Thirteen pigs were studied with 33 flow measurements. Kidney volume (mean Dice similarity coefficient ± standard deviation, 0.89 ± 0.01) and renal segmentation (coefficient of variation = 12.6%; ICC = 0.86) were consistent. The 3D FMBV calculations had high reproducibility (ICC = 0.97; 95% confidence interval: 0.96, 0.98). The 3D FMBV per-pig correlation showed excellent correlation for US machines from both vendors (mean r2 = 0.96 [range, 0.92-1.0] and 0.93 [range, 0.78-1.0], respectively). The correlation between 3D FMBV and perfusion measured with microspheres was high for both US machines (r2 = 0.80 [P < .001] and 0.70 [P < .001], respectively). Conclusion The strong correlation between three-dimensional (3D) fractional moving blood volume (FMBV) and fluorescent microspheres indicates that 3D FMBV shows excellent correlation to perfusion and good reproducibility. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Morrell et al in this issue.
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Affiliation(s)
- Alec W. Welsh
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia
| | - J. Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen Z. Pinter
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kimberly A Ives
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Gabe E Owens
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jonathan M. Rubin
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver D Kripfgans
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Pádraig Looney
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Sally L. Collins
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Fetal Medicine Unit, Women’s Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Gordon N. Stevenson
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
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Schwartz N, Siegal J, Rourke A, Sehgal CM. Placental Pulsatility: Quantitative Assessment of Placental Bed Vasculature by 2-Dimensional Doppler Cine Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:471-479. [PMID: 30121962 PMCID: PMC6347511 DOI: 10.1002/jum.14720] [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: 02/16/2018] [Revised: 05/17/2018] [Accepted: 05/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Vascular resistance is known to be one of the determinants of pulsatile flow. This study aimed to investigate whether quantitative 2-dimensional Doppler ultrasound can capture and evaluate the pulsatility within the placental bed vasculature. METHODS The placental bed vasculature was imaged by directional power Doppler ultrasound. Ten-second cine clips were recorded by using standardized machine settings. A region of interest with a prominent Doppler signal in the uteroplacental interface was analyzed for the percentage of vascularity to generate a time-vascularity waveform. A vascular pulsatility index representing variation over the cardiac cycle was calculated by the ratio of the systolic-diastolic difference in vascularity to the mean vascularity. The acquisitions were repeated with 6 different pulse repetition frequencies (PRFs) and 3 wall motion filter (WMF) settings to evaluate their impact on the Doppler measurements. RESULTS Ten sets of cine clips were analyzed for this study. The pulsatile nature of the vascularity was readily apparent in each cine clip. The measured time-vascularity waveforms showed uniform cyclic variation in vascularity over the cardiac cycle, with systolic vascularity significantly higher than diastolic vascularity at each combination of PRF and WMF (P < .05). A gradual increase in the vascular pulsatility index was observed with an increasing PRF or WMF. Normalization of systolic-to-diastolic measurement provided a stable vascular assessment across the range of PRFs. CONCLUSIONS Doppler cine clips provide a dynamic representation of the placental bed vasculature and a novel analytic approach to quantitatively evaluating the pulsatility of this critical vascular network. Further work is warranted to explore the reproducibility and clinical potential of this approach.
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Affiliation(s)
- Nadav Schwartz
- Maternal Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Siegal
- Maternal Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Aaron Rourke
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chandra M. Sehgal
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Schindler T, Gilbert Y, Jayatilake S, Stevenson G, Oei JL, Welsh A. Basal ganglia perfusion in the preterm infant during transition. Pediatr Res 2016; 80:573-6. [PMID: 27304098 DOI: 10.1038/pr.2016.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND The preterm brain is susceptible to changes in blood flow. Using power Doppler images, digital imaging techniques have been developed to measure the total amount of blood flow in a defined area, giving the index: fractional moving blood volume (FMBV). The aim of this study was to investigate temporal changes in basal ganglia perfusion during the transitional period after birth. METHODS Twenty-four preterm infants were examined with serial cranial ultrasounds at four time points during the first 48 h of life. FMBV was calculated using power Doppler images at each time point. RESULTS All infants had analyzable data and FMBV was successfully calculated at all time points. Twenty-three of the 24 infants had an increasing trend in FMBV over time. The median FMBV increased from 17% at 6 h to 25% at 48 h. One-way repeated measures ANOVA showed a significant increase in values at P < 0.001 at each of the four time points. CONCLUSION We have demonstrated changes in basal ganglia blood flow as the cerebral circulation adapts to extrauterine life. With further investigation, this technique may be useful in the assessment of preterm circulatory adaptation, either alone or in conjunction with other modes of evaluating cerebral blood flow.
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Affiliation(s)
- Tim Schindler
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, Australia
| | - Yasmin Gilbert
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Sonali Jayatilake
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Gordon Stevenson
- Department of Engineering Science, University of Oxford, Oxford, England
| | - Ju Lee Oei
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, Australia
| | - Alec Welsh
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia
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Duan J, Chabot-Lecoanet AC, Perdriolle-Galet E, Christov C, Hossu G, Cherifi A, Morel O. Utero-placental vascularisation in normal and preeclamptic and intra-uterine growth restriction pregnancies: third trimester quantification using 3D power Doppler with comparison to placental vascular morphology (EVUPA): a prospective controlled study. BMJ Open 2016; 6:e009909. [PMID: 27033959 PMCID: PMC4823389 DOI: 10.1136/bmjopen-2015-009909] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Preeclampsia (PE) and intra-uterine growth restriction (IUGR) are two major pregnancy complications related to chronic utero-placental hypoperfusion. Three-dimensional power Doppler (3DPD) angiography has been used for the evaluation of utero-placental vascularisation and three vascular indices have been calculated: the vascularisation index (VI), flow index (FI) and vascularisation-FI (VFI). However, several technical endpoints hinder the clinical use of 3DPD as physical characteristics and machine settings may affect 3DPD indices, and so its clinical significance is not yet clear. OBJECTIVES The primary objective is to better understand the clinical significance of 3DPD indices by evaluating the relationship between these indices and placental morphometry. Secondary objectives are (i) to determine the impact of machine settings and physical characteristics on 3DPD indices, and (ii) to evaluate physio-pathological placental vascularisation patterns. METHODS AND ANALYSIS This is a prospective controlled study. We expect to include 112 women: 84 with normal pregnancies and 28 with PE and/or IUGR (based on our former cohort study on 3DPD indices for PE and/or IUGR prediction (unpublished data)). Within 72 h before planned or semi-urgent caesarean section, utero-placental 3DPD images with five different machine settings will be acquired. Placentas will be collected and examined after surgery and stereological indices (volume density, surface density, length density) calculated. The 3DPD indices (VI, FI and VFI) of the placenta and adjacent myometrium will be calculated. Correlation between Doppler and morphological indices will be evaluated by Pearson or Spearman tests. Agreement between 3DPD indices and morphological indices will be assessed by Bland and Altman plots. The impact of Doppler settings and maternal characteristics on 3DPD indices will be evaluated with a multivariate linear regression model. ETHICS The study and related consent forms have been approved by the French Ethics Committee (CPP, Comité de Protection des Personnes) Est III on 4 March 2014.
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Affiliation(s)
- Jie Duan
- IADI, Inserm U947, University of Lorraine, Nancy, France
- Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France
| | - Anne-Claire Chabot-Lecoanet
- IADI, Inserm U947, University of Lorraine, Nancy, France
- Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France
| | - Estelle Perdriolle-Galet
- IADI, Inserm U947, University of Lorraine, Nancy, France
- Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France
| | - Christophe Christov
- Service Commun de Microscopie, Faculté de Médecine, University of Lorraine, Vandoeuvre-Lès-Nancy, France
- Laboratory of Fetal and Placental Pathology, CHRU Nancy, Nancy, France
| | | | | | - Olivier Morel
- IADI, Inserm U947, University of Lorraine, Nancy, France
- Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France
- PremUp Foundation, Paris, France
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Three-Dimensional Power Doppler Ultrasonography for Diagnosing Abnormally Invasive Placenta and Quantifying the Risk. Obstet Gynecol 2015. [PMID: 26214694 DOI: 10.1097/aog.0000000000000962] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test an objective ultrasound marker for diagnosing the presence and severity of abnormally invasive placenta. METHODS Women at risk of abnormally invasive placenta underwent a three-dimensional power Doppler ultrasound scan. The volumes were examined offline by a blinded observer. The largest area of confluent three-dimensional power Doppler signal (Area of Confluence [Acon], cm) at the uteroplacental interface was measured and compared in women subsequently diagnosed with abnormally invasive placenta and women in a control group who did not have abnormally invasive placenta. Receiver operating characteristic curves were plotted for prediction of abnormally invasive placenta and abnormally invasive placenta requiring cesarean hysterectomy. RESULTS Ninety-three women were recruited. Results were available for 89. Abnormally invasive placenta was clinically diagnosed in 42 women; 36 required hysterectomy and had abnormally invasive placenta confirmed histopathologically. Median and interquartile range for Acon was greater for abnormally invasive placenta (44.2 [31.4-61.7] cm) compared with women in the control group (4.5 cm [2.9-6.6], P<.001) and even greater in the 36 requiring hysterectomy (46.6 cm [37.2-72.6], P<.001). Acon rose with histopathologic diagnosis: focal accreta (32.2 cm [17.2-57.3]), accreta (59.6 cm [40.1-89.9]), and percreta (46.6 cm [37.5-71.5]; P<.001 analysis of variance for linear trend). Receiver operating characteristic analysis for prediction of abnormally invasive placenta revealed that with an Acon of 12.4 cm or greater, 100% sensitivity (95% confidence interval [CI] 91.6-100) could be obtained with 92% specificity (95% CI 79.6-97.6); area under the curve is 0.99 (95% CI 0.94-1.0). For prediction of abnormally invasive placenta requiring hysterectomy, 100% sensitivity (95% CI 90.3-100) can be obtained with an Acon of 17.4 cm or greater with 87% specificity (95% CI 74.7-94.5; area under the curve 0.98 [0.93-1.0]). CONCLUSION The marker Acon provides a quantitative means for diagnosing abnormally invasive placenta and assessing severity. If further validated, subjectivity could be eliminated from the diagnosis of abnormally invasive placenta. LEVEL OF EVIDENCE II.
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[Placental 3D Doppler angiography: current and upcoming applications]. ACTA ACUST UNITED AC 2014; 44:107-18. [PMID: 25307617 DOI: 10.1016/j.jgyn.2014.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/03/2014] [Accepted: 09/10/2014] [Indexed: 11/20/2022]
Abstract
The placental dysfunction, which seems to be caused by a defect of trophoblastic invasion and impaired uterine vascular remodeling since the first trimester, is responsible in a non-exclusive way for the chronic placental hypoxia, resulting secondarily in the intra-uterine growth restriction (IUGR) and/or pre-eclampsia (PE). The quality of utero-placental vasculature is essential for a proper fetal development and a successful progress of pregnancy. However, the in vivo assessment of placental vascularization with non-invasive methods is complicated by the small size of placental terminal vessel and its complex architecture. Moreover, imaging with contrast agent is not recommended to pregnant women. Until recently, the fetal and maternal vascularization could only be evaluated through pulse Doppler of uterine arteries during pregnancy, which has little clinical value for utero-placental vascularization defects assessment. Recently, a non-invasive study, without use of contrast agent for vasculature evaluation of an organ of interest has become possible by the development of 3D Doppler angiography technique. The objective of this review was to make an inventory of its current and future applications for utero-placental vasculature quantification. The main findings of the literature on the assessment of utero-placental vascularization in physiological situation and major placental vascular dysfunction pathologies such as PE and IUGR were widely discussed.
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