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Nakaki A, Denaro E, Crimella M, Castellani R, Vellvé K, Izquierdo N, Basso A, Paules C, Casas R, Benitez L, Casas I, Larroya M, Genero M, Castro-Barquero S, Gomez-Gomez A, Pozo ÓJ, Vieta E, Estruch R, Nadal A, Gratacós E, Crovetto F, Crispi F, Youssef L. Effect of Mediterranean diet or mindfulness-based stress reduction during pregnancy on placental volume and perfusion: A subanalysis of the IMPACT BCN randomized clinical trial. Acta Obstet Gynecol Scand 2024. [PMID: 39037192 DOI: 10.1111/aogs.14874] [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: 01/26/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION The IMPACT BCN trial-a parallel-group randomized clinical trial where 1221 pregnant women at high risk for small-for-gestational age (SGA) newborns were randomly allocated at 19- to 23-week gestation into three groups: Mediterranean diet, Mindfulness-based Stress reduction or non-intervention-has demonstrated a positive effect of Mediterranean diet and Stress reduction in the prevention of SGA. However, the mechanism of action of these interventions remains still unclear. The aim of this study is to investigate the effect of Mediterranean diet and Stress reduction on placental volume and perfusion. MATERIAL AND METHODS Participants in the Mediterranean diet group received monthly individual and group educational sessions, and free provision of extra-virgin olive oil and walnuts. Women in the Stress reduction group underwent an 8-week Stress reduction program adapted for pregnancy, consisting of weekly 2.5-h and one full-day sessions. Non-intervention group was based on usual care. Placental volume and perfusion were assessed in a subgroup of randomly selected women (n = 165) using magnetic resonance (MR) at 36-week gestation. Small placental volume was defined as MR estimated volume <10th centile. Perfusion was assessed by intravoxel incoherent motion. RESULTS While mean MR placental volume was similar among the study groups, both interventions were associated with a lower prevalence of small placental volume (3.9% Mediterranean diet and 5% stress reduction vs. 17% non-intervention; p = 0.03 and p = 0.04, respectively). Logistic regression showed that small placental volume was significantly associated with higher risk of SGA in both study groups (OR 7.48 [1.99-28.09] in Mediterranean diet and 20.44 [5.13-81.4] in Stress reduction). Mediation analysis showed that the effect of Mediterranean diet on SGA can be decomposed by a direct effect and an indirect effect (56.6%) mediated by a small placental volume. Similarly, the effect of Stress reduction on SGA is partially mediated (45.3%) by a small placental volume. Results on placental intravoxel incoherent motion perfusion fraction and diffusion coefficient were similar among the study groups. CONCLUSIONS Structured interventions during pregnancy based on Mediterranean diet or Stress reduction are associated with a lower proportion of small placentas, which is consistent with the previously observed beneficial effects of these interventions on fetal growth.
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Affiliation(s)
- Ayako Nakaki
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Eugenio Denaro
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
| | - Maddalena Crimella
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
| | - Roberta Castellani
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
| | - Kilian Vellvé
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
| | - Nora Izquierdo
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
| | - Annachiara Basso
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Department of Obstetrics and Pediatrics ASST Lecco, A. Manzoni Hospital, Lecco, Italy
| | - Cristina Paules
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Instituto de Investigación Sanitaria Aragón (IISAragon), Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de la Investigación y Fondo Europeo de Desarrollo Regional (FEDER), Zaragoza, Spain
| | - Rosa Casas
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute de Salud Carlos III, Madrid, Spain
- Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), University of Barcelona, Barcelona, Spain
| | - Leticia Benitez
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Irene Casas
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Larroya
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Mariona Genero
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Sara Castro-Barquero
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute de Salud Carlos III, Madrid, Spain
- Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), University of Barcelona, Barcelona, Spain
| | - Alex Gomez-Gomez
- Integrative Pharmacology and Systems Neuroscience Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Óscar J Pozo
- Integrative Pharmacology and Systems Neuroscience Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Ramon Estruch
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Department of Internal Medicine Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute de Salud Carlos III, Madrid, Spain
- Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), University of Barcelona, Barcelona, Spain
| | - Alfons Nadal
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Francesca Crovetto
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin RD21/0012/0003, Instituto de Salud Carlos III, Madrid, Spain
| | - Fàtima Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Lina Youssef
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Josep Carreras Leukaemia Research Institute, Hospital Clinic/University of Barcelona Campus, Barcelona, Spain
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König AM, Pöschke A, Mahnken AH. Health risks for medical personnel due to magnetic fields in magnetic resonance imaging. ROFO-FORTSCHR RONTG 2024. [PMID: 39029511 DOI: 10.1055/a-2296-3860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
The current state of medical and scientific knowledge on the effects of exposure to electromagnetic fields on workers in the field of clinical magnetic resonance imaging (MRI) is summarized here.A systematic literature search was conducted to analyze the health risks to medical personnel from magnetic fields in MRI. A total of 7273 sources were identified, with 7139 being excluded after screening of the title and abstract. After full-text screening, 34 sources remained and were included in this paper.There are a number of scientific publications on the occurrence of short-term sensory effects such as vertigo, metallic taste, phosphenes as well as on the occurrence of neurocognitive and neurobehavioral effects. For example, short-term exposure to clinical magnetic fields has been reported to result in a 4% reduction in speed and precision and a 16% reduction in visual contrast sensitivity at close range. Both eye-hand precision and coordination speed are affected. The long-term studies concern, among other things, the influence of magnetic fields on sleep quality, which could be linked to an increased risk of accidents. The data on the exposure of healthcare workers to magnetic fields during pregnancy is consistently outdated. However, it has been concluded that there are no particular deviations with regard to the duration of pregnancy, premature births, miscarriages, and birth weight. Epidemiological studies are lacking. With a focus on healthcare personnel, there is a considerable need for high-quality data, particularly on the consequences of long-term exposure to electromagnetic fields from clinical MRI and the effects on pregnancy. · Short-term sensory effects such as vertigo, metallic taste, phosphenes as well as neurocognitive and neurological behavioral effects may occur upon exposure to magnetic fields.. · Long-term effects mainly concern quality of sleep, which can be associated with an increased risk of accidents.. · When pregnant women were exposed to magnetic fields, no particular deviations were found with regard to the duration of pregnancy, premature births, miscarriages, and birth weight.. · König AM, Pöschke A, Mahnken AH. Health risks for medical personnel due to magnetic fields in magnetic resonance imaging. Fortschr Röntgenstr 2024; DOI 10.1055/a-2296-3860.
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Affiliation(s)
- Alexander Marc König
- Diagnostic and Interventional Radiology, Philipps University of Marburg, Marburg, Germany
| | - Antje Pöschke
- Diagnostic and Interventional Radiology, Philipps University of Marburg, Marburg, Germany
| | - Andreas H Mahnken
- Diagnostic and Interventional Radiology, Philipps University of Marburg, Marburg, Germany
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Dunn A, Wagner S, Sussman D. Scoping review of magnetic resonance motion imaging phantoms. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01164-9. [PMID: 38739218 DOI: 10.1007/s10334-024-01164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/28/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
To review and analyze the currently available MRI motion phantoms. Publications were collected from the Toronto Metropolitan University Library, PubMed, and IEEE Xplore. Phantoms were categorized based on the motions they generated: linear/cartesian, cardiac-dilative, lung-dilative, rotational, deformation or rolling. Metrics were extracted from each publication to assess the motion mechanisms, construction methods, as well as phantom validation. A total of 60 publications were reviewed, identifying 48 unique motion phantoms. Translational movement was the most common movement (used in 38% of phantoms), followed by cardiac-dilative (27%) movement and rotational movement (23%). The average degrees of freedom for all phantoms were determined to be 1.42. Motion phantom publications lack quantification of their impact on signal-to-noise ratio through standardized testing. At present, there is a lack of phantoms that are designed for multi-role as many currently have few degrees of freedom.
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Affiliation(s)
- Alexander Dunn
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST) at Toronto Metropolitan University and St. Michael's Hospital, Toronto, Canada
| | - Sophie Wagner
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST) at Toronto Metropolitan University and St. Michael's Hospital, Toronto, Canada
| | - Dafna Sussman
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, Canada.
- Institute for Biomedical Engineering, Science and Technology (iBEST) at Toronto Metropolitan University and St. Michael's Hospital, Toronto, Canada.
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
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Milosevic B, Likic Ladjevic I, Dotlic J, Beleslin A, Mihaljevic O, Pilic I, Kesic V, Gojnic M, Stefanovic A, Stefanovic K. Cancer during pregnancy: Twenty-two years of experience from a tertiary referral center. Acta Obstet Gynecol Scand 2024; 103:716-728. [PMID: 38216215 PMCID: PMC10993340 DOI: 10.1111/aogs.14756] [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: 03/30/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Cancer complicating pregnancy is a rare but potentially life-threatening condition for both the mother and her child. The aim of the present study was to assess the outcomes for mothers and children after pregnancy complicated by malignancy and to investigate which parameters are important for their 1-year survival. MATERIAL AND METHODS The study included 84 pregnant women diagnosed with malignant tumors during pregnancy from 2001 to 2022. The pregnancy course and outcome, as well as parameters that could influence the survival and condition of the mother and child were evaluated. Mothers and children were followed up for 1 year after delivery to assess their condition/complications and overall survival. RESULTS Most malignancies were gynecological (31%) or hematological (23.8%) and were diagnosed and surgically treated in the second trimester. Most children (69%) showed adequate growth and development throughout pregnancy but were delivered before term (53.6%) to allow mothers to receive therapy. Adjuvant therapy during pregnancy mostly caused a transitory deterioration of the child's condition, while surgery did not significantly impact the pregnancy course. Deliveries, on average, occurred during the 33.01 ± 6.16 gestational week (range: 20-40) and mostly by cesarean section (76.2%). For mothers, the pregnancy survival rate was 95.2% and survival after 1 year was 87.5%. However, 37.5% of women were still ill and required additional therapy 1 year postpartum. The pregnancy survival rate for children was 94%, whereas the 1-year survival rate was 76.2%. Most children had a favorable condition (alive, adequately growing and developing, and without complications) at birth (81%) as well as at the 1-year follow-up (63.7%). Regression analysis identified the following predictors of favorable 1-year maternal condition: applying therapy during pregnancy, no progression of the malignancy during pregnancy, and delivery at a later gestational week. Predictors of favorable 1-year condition of children were lower histopathological grade of malignancy, surgery as therapy for malignancy, obtaining higher birthweight, and delivery by cesarean section. CONCLUSIONS If the malignancy is not progressing, pregnancy should be continued as long as possible for the child to obtain adequate birthweight. Both surgery and chemotherapy were safe therapeutic choices, as most pregnancies continued successfully after therapy.
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Affiliation(s)
- Branislav Milosevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Ivana Likic Ladjevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Jelena Dotlic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Aleksandra Beleslin
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Olga Mihaljevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Igor Pilic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Vesna Kesic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Miroslava Gojnic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Aleksandar Stefanovic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Katarina Stefanovic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
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Yetisir F, Abaci Turk E, Adalsteinsson E, Wald LL, Grant PE. Local SAR management strategies to use two-channel RF shimming for fetal MRI at 3 T. Magn Reson Med 2024; 91:1165-1178. [PMID: 37929768 PMCID: PMC10843691 DOI: 10.1002/mrm.29913] [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: 07/12/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE This study evaluates the imaging performance of two-channel RF-shimming for fetal MRI at 3 T using four different local specific absorption rate (SAR) management strategies. METHODS Due to the ambiguity of safe local SAR levels for fetal MRI, local SAR limits for RF shimming were determined based on either each individual's own SAR levels in standard imaging mode (CP mode) or the maximum SAR level observed across seven pregnant body models in CP mode. Local SAR was constrained either indirectly by further constraining the whole-body SAR (wbSAR) or directly by using subject-specific local SAR models. Each strategy was evaluated by the improvement of the transmit field efficiency (average |B1 + |) and nonuniformity (|B1 + | variation) inside the fetus compared with CP mode for the same wbSAR. RESULTS Constraining wbSAR when using RF shimming decreases B1 + efficiency inside the fetus compared with CP mode (by 12%-30% on average), making it inefficient for SAR management. Using subject-specific models with SAR limits based on each individual's own CP mode SAR value, B1 + efficiency and nonuniformity are improved on average by 6% and 13% across seven pregnant models. In contrast, using SAR limits based on maximum CP mode SAR values across seven models, B1 + efficiency and nonuniformity are improved by 13% and 25%, compared with the best achievable improvement without SAR constraints: 15% and 26%. CONCLUSION Two-channel RF-shimming can safely and significantly improve the transmit field inside the fetus when subject-specific models are used with local SAR limits based on maximum CP mode SAR levels in the pregnant population.
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Affiliation(s)
- Filiz Yetisir
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, Boston, MA, USA
| | - Esra Abaci Turk
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Elfar Adalsteinsson
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lawrence L. Wald
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - P. Ellen Grant
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
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Plunkett S, Dobeli K, Prior M, Tusek X. Survey of maternal anxiety and perceptions towards foetal MRI and pre-scan education. J Med Radiat Sci 2024; 71:10-20. [PMID: 37724764 PMCID: PMC10920945 DOI: 10.1002/jmrs.725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/25/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Foetal MRI scans can induce feelings of fear, concern and anxiety in pregnant patients. The aim of this research was to determine if providing patients with an information leaflet reduced maternal anxiety regarding foetal MRI. METHODS A prospective, three-arm comparative pilot study was performed in the MRI department of a quaternary public hospital in Brisbane, Australia. Three groups of 30 participants (total 90 participants) received differing levels of information about foetal MRI: Group A - no foetal-MRI specific information (current practice at the site); Group B - a basic information leaflet; Group C - a comprehensive information leaflet. All participants completed a survey that explored their pre-scan anxiety immediately after their MRI scan. RESULTS Over 50% of participants in each group felt anxious before the MRI. Participants expressed anxiety towards the general process of the MRI, the outcome or results of the scan, and the safety of the modality. The basic and comprehensive leaflets were both efficacious in reducing anxiety for the majority of participants. CONCLUSIONS Whilst not all patients express anxiety regarding MRI scans, emotional distress surrounding the entire process is prevalent. Providing patients with comprehensive information about what the MRI scan entails (including the scan environment and duration, positioning, breath-holding requirements, and foetal safety) reduces anxiety for most patients. These findings can be used to determine ways in which reduction of anxiety improves the patient experience.
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Affiliation(s)
- Stephanie Plunkett
- Department of Medical ImagingRoyal Brisbane & Women's HospitalQueenslandHerstonAustralia
| | - Karen Dobeli
- Department of Medical ImagingRoyal Brisbane & Women's HospitalQueenslandHerstonAustralia
| | - Marita Prior
- Department of Medical ImagingRoyal Brisbane & Women's HospitalQueenslandHerstonAustralia
| | - Xanthe Tusek
- Department of Medical ImagingRoyal Brisbane & Women's HospitalQueenslandHerstonAustralia
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Wang L, Zhang M, Jin J. A Young Pregnant Person With Old Myocardial Infarction. JAMA Intern Med 2024; 184:209-210. [PMID: 38147321 DOI: 10.1001/jamainternmed.2023.5251] [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: 12/27/2023]
Abstract
This case report presents the electrocardiogram findings of a pregnant patient in their 30s with a family history of hypertrophic obstructive cardiomyopathy.
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Affiliation(s)
- Li Wang
- Department of Electrocardiographic Diagnosis, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Minmin Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jing Jin
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China: Medical Imaging Research Center, Anhui Medical University, Hefei, China
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Tarui T, Gimovsky AC, Madan N. Fetal neuroimaging applications for diagnosis and counseling of brain anomalies: Current practice and future diagnostic strategies. Semin Fetal Neonatal Med 2024; 29:101525. [PMID: 38632010 PMCID: PMC11156536 DOI: 10.1016/j.siny.2024.101525] [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] [Indexed: 04/19/2024]
Abstract
Advances in fetal brain neuroimaging, especially fetal neurosonography and brain magnetic resonance imaging (MRI), allow safe and accurate anatomical assessments of fetal brain structures that serve as a foundation for prenatal diagnosis and counseling regarding fetal brain anomalies. Fetal neurosonography strategically assesses fetal brain anomalies suspected by screening ultrasound. Fetal brain MRI has unique technological features that overcome the anatomical limits of smaller fetal brain size and the unpredictable variable of intrauterine motion artifact. Recent studies of fetal brain MRI provide evidence of improved diagnostic and prognostic accuracy, beginning with prenatal diagnosis. Despite technological advances over the last several decades, the combined use of different qualitative structural biomarkers has limitations in providing an accurate prognosis. Quantitative analyses of fetal brain MRIs offer measurable imaging biomarkers that will more accurately associate with clinical outcomes. First-trimester ultrasound opens new opportunities for risk assessment and fetal brain anomaly diagnosis at the earliest time in pregnancy. This review includes a case vignette to illustrate how fetal brain MRI results interpreted by the fetal neurologist can improve diagnostic perspectives. The strength and limitations of conventional ultrasound and fetal brain MRI will be compared with recent research advances in quantitative methods to better correlate fetal neuroimaging biomarkers of neuropathology to predict functional childhood deficits. Discussion of these fetal sonogram and brain MRI advances will highlight the need for further interdisciplinary collaboration using complementary skills to continue improving clinical decision-making following precision medicine principles.
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Affiliation(s)
- Tomo Tarui
- Pediatric Neurology, Pediatrics, Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Alexis C Gimovsky
- Maternal Fetal Medicine, Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neel Madan
- Neuroradiology, Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Start AO, Ryan GA, Cathcart B, Geraghty J, Adams N, Colleran G, Vavasseur C, Caird J, Murray D, Walsh JM. An unusual case of a giant fetal facial tumour and review of the literature. Ir J Med Sci 2023; 192:2881-2885. [PMID: 36964892 PMCID: PMC10691997 DOI: 10.1007/s11845-023-03344-3] [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: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/26/2023]
Abstract
We present the case of a pregnant 32-year-old woman who presented with a giant fetal facial tumour at 22 weeks. The mass, initially 4 × 3.5 × 3 cm in size, was largely cystic with a small solid component. It subsequently increased to 9 × 9 × 10 cm. Significant compression effects on the fetal orbit, temple and infratemporal fossa, with potential compression of the optic nerve, were noted on ultrasound and MRI. The cyst required drainage twice in the pregnancy: firstly to reduce the compression effects and secondly to facilitate caesarean delivery. Postnatally, the baby had significant compression and displacement of the craniofacial skeleton from the mass effect. Postnatal histology revealed a diagnosis of a teratoma. This case highlights the complexities and challenges surrounding the diagnosis and management of a giant fetal facial tumour.
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Affiliation(s)
- Alex O Start
- Fetal Medicine, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland.
| | - Gillian A Ryan
- Fetal Medicine, National Maternity Hospital, Holles Street, Dublin 2, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | - Barbra Cathcart
- Fetal Medicine, National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Jennifer Geraghty
- Department of Neonatology, National Maternity Hospital, Dublin 2, Ireland
| | - Niamh Adams
- Paediatric Radiology, National Maternity Hospital, Dublin 2, Ireland
| | | | - Claudine Vavasseur
- Department of Neonatology, National Maternity Hospital, Dublin 2, Ireland
| | - John Caird
- Neurosurgery, Children's University Hospital, Dublin 1, Ireland
| | - Dylan Murray
- Plastic Surgery, Children's University Hospital, Dublin 1, Ireland
| | - Jennifer M Walsh
- Fetal Medicine, National Maternity Hospital, Holles Street, Dublin 2, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
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10
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Maralani PJ, Pai V, Ertl-Wagner BB. Safety of Magnetic Resonance Imaging in Pregnancy. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:34-40. [PMID: 37747489 DOI: 10.1007/s00117-023-01207-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
Magnetic resonance imaging is being increasingly used to diagnose and follow up a variety of medical conditions in pregnancy, both for maternal and fetal indications. However, limited data regarding its safe use in pregnancy may be a source of anxiety and avoidance for both patients and their healthcare providers. In this review, we critically discuss the main safety concerns of Magnetic Resonance Imaging (MRI) in pregnancy including energy deposition, acoustic noise, and use of contrast agents, supported by data from animal and human studies. Use of maternal sedatives and concerns related to occupational exposure in pregnant personnel are also addressed. Exposure to gadolinium-based contrast agents and sedation for MRI during pregnancy should be avoided whenever feasible.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Bayview Avenue, Room AG270C, 2075, Toronto, Ontario, Canada.
| | - Vivek Pai
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Birgit B Ertl-Wagner
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
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11
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Fraga Rivas P, de Miguel Criado J, García Del Salto Lorente L, Gutiérrez Velasco L, Quintana Valcarcel P. Patient safety in magnetic resonance imaging. RADIOLOGIA 2023; 65:447-457. [PMID: 37758335 DOI: 10.1016/j.rxeng.2023.01.009] [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: 10/12/2022] [Accepted: 01/29/2023] [Indexed: 10/03/2023]
Abstract
Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging (MRI) study.
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Affiliation(s)
- P Fraga Rivas
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain.
| | - J de Miguel Criado
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - L García Del Salto Lorente
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - L Gutiérrez Velasco
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
| | - P Quintana Valcarcel
- Servicio de Radiodiagnóstico, Hospital Universitario del Henares, Unidad Central de Radiodiagnóstico, Universidad Francisco de Vitoria, Madrid, Spain
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12
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Lother D, Robert M, Elwood E, Smith S, Tunariu N, Johnston SRD, Parton M, Bhaludin B, Millard T, Downey K, Sharma B. Imaging in metastatic breast cancer, CT, PET/CT, MRI, WB-DWI, CCA: review and new perspectives. Cancer Imaging 2023; 23:53. [PMID: 37254225 DOI: 10.1186/s40644-023-00557-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Breast cancer is the most frequent cancer in women and remains the second leading cause of death in Western countries. It represents a heterogeneous group of diseases with diverse tumoral behaviour, treatment responsiveness and prognosis. While major progress in diagnosis and treatment has resulted in a decline in breast cancer-related mortality, some patients will relapse and prognosis in this cohort of patients remains poor. Treatment is determined according to tumor subtype; primarily hormone receptor status and HER2 expression. Menopausal status and site of disease relapse are also important considerations in treatment protocols. MAIN BODY Staging and repeated evaluation of patients with metastatic breast cancer are central to the accurate assessment of disease extent at diagnosis and during treatment; guiding ongoing clinical management. Advances have been made in the diagnostic and therapeutic fields, particularly with new targeted therapies. In parallel, oncological imaging has evolved exponentially with the development of functional and anatomical imaging techniques. Consistent, reproducible and validated methods of assessing response to therapy is critical in effectively managing patients with metastatic breast cancer. CONCLUSION Major progress has been made in oncological imaging over the last few decades. Accurate disease assessment at diagnosis and during treatment is important in the management of metastatic breast cancer. CT (and BS if appropriate) is generally widely available, relatively cheap and sufficient in many cases. However, several additional imaging modalities are emerging and can be used as adjuncts, particularly in pregnancy or other diagnostically challenging cases. Nevertheless, no single imaging technique is without limitation. The authors have evaluated the vast array of imaging techniques - individual, combined parametric and multimodal - that are available or that are emerging in the management of metastatic breast cancer. This includes WB DW-MRI, CCA, novel PET breast cancer-epitope specific radiotracers and radiogenomics.
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Affiliation(s)
| | - Marie Robert
- Institut de Cancérologie de l'Ouest, St Herblain, France
| | | | - Sam Smith
- The Royal Marsden Hospital, London & Sutton, UK
| | - Nina Tunariu
- The Royal Marsden Hospital, London & Sutton, UK
- The Institute of Cancer Research (ICR), London & Sutton, UK
| | - Stephen R D Johnston
- The Royal Marsden Hospital, London & Sutton, UK
- The Institute of Cancer Research (ICR), London & Sutton, UK
| | | | | | | | - Kate Downey
- The Royal Marsden Hospital, London & Sutton, UK
- The Institute of Cancer Research (ICR), London & Sutton, UK
| | - Bhupinder Sharma
- The Royal Marsden Hospital, London & Sutton, UK.
- The Institute of Cancer Research (ICR), London & Sutton, UK.
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13
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Hadjidekov G, Haynatzki G, Chaveeva P, Nikolov M, Masselli G, Rossi A. Concordance between US and MRI Two-Dimensional Measurement and Volumetric Segmentation in Fetal Ventriculomegaly. Diagnostics (Basel) 2023; 13:diagnostics13061183. [PMID: 36980491 PMCID: PMC10047855 DOI: 10.3390/diagnostics13061183] [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: 01/01/2023] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
We provide a study comparison between two-dimensional measurement and volumetric (3D) segmentation of the lateral ventricles and brain structures in fetuses with isolated and non-isolated ventriculomegaly with 3D virtual organ computer-aided analysis (VOCAL) ultrasonography vs. magnetic resonance imaging (MRI) analyzed with 3D-Slicer software. In this cross-sectional study, 40 fetuses between 20 and 38 gestational weeks with various degrees of ventriculomegaly were included. A total of 71 ventricles were measured with ultrasound (US) and with MRI. A total of 64 sonographic ventricular volumes, 80 ventricular and 40 fetal brain MR volumes were segmented and analyzed using both imaging modalities by three observers. Sizes and volumes of the ventricles and brain parenchyma were independently analyzed by two radiologists, and interobserver correlation of the results with 3D fetal ultrasound data was performed. The semiautomated rotational multiplanar 3D VOCAL technique was performed for ultrasound volumetric measurements. Results were compared to manually extracted ventricular and total brain volumes in 3D-Slicer. Segmentation of fetal brain structures (cerebral and cerebellar hemispheres, brainstem, ventricles) performed independently by two radiologists showed high interobserver agreement. An excellent agreement between VOCAL and MRI volumetric and two-dimensional measurements was established, taking into account the intraclass correlation coefficients (ICC), and a Bland-Altman plot was established. US and MRI are valuable tools for performing fetal brain and ventricular volumetry for clinical prognosis and patient counseling. Our datasets could provide the backbone for further construction of quantitative normative trajectories of fetal intracranial structures and support earlier detection of abnormal brain development and ventriculomegaly, its timing and progression during gestation.
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Affiliation(s)
- George Hadjidekov
- Department of Radiology, University Hospital Lozenetz, Koziak 1 Str., 1407 Sofia, Bulgaria
- Department of Physics, Biophysics and Radiology, Faculty of Medicine, Sofia University "St Kliment Ohridski", 1504 Sofia, Bulgaria
| | - Gleb Haynatzki
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Petya Chaveeva
- Department of Fetal Medicine, Shterev Hospital, 1330 Sofia, Bulgaria
| | - Miroslav Nikolov
- Department of Theoretical Electrical Engineering, Technical University, 1156 Sofia, Bulgaria
| | - Gabriele Masselli
- Radiology Department, Umberto 1 Hospital Sapienza University, 00161 Rome, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
- Department of Health Sciences, University of Genoa, 16126 Genoa, Italy
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14
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Hong Y, Ning L, Sun Y, Qian H, Ji Y. The growth and shape of the eyeball and crystalline lens in utero documented by fetal MR imaging. Heliyon 2023; 9:e12885. [PMID: 36685428 PMCID: PMC9851875 DOI: 10.1016/j.heliyon.2023.e12885] [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: 10/13/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Purpose To study the growth model, shape, and developmental relationship of lens and eyeball, we used two-dimensional Magnetic Resonance (MR) imaging to investigate gestationally age-related changes in the selected ocular parameters in vivo. Materials and methods We retrospectively reviewed the MR images from 126 fetuses ranging from 21 to 39 weeks' gestation. Ocular parameters on MR imaging of transverse plane were measured including lens diameter (LD), anteroposterior lens diameter (APLD), lens surface area (LS), globe diameter (GD), anteroposterior globe diameter (APGD), globe surface area (GS). The growth model of each biometric against gestational age (GA), aspect ratio of lens and globe (LD/APLD and GD/APGD), and growing relationship between the ratio of lens and globe surface area (LS/GS) were studied by statistical analysis. Results The growth model of most biometry for gestational age is logarithmic, except for the diameter of the ocular globe (GD and APGD) showing a quadratic growth pattern. Our study showed that the lens was consistently larger in the transverse than the anteroposterior diameters during 21-39 weeks(P < 0.001). Besides, the ratio of surface area (LS/GS) was not significantly changing with GA(P = 0.4908), while the increase of LS was significantly accorded with that of GS(P < 0.001). Conclusion The lens shape throughout fetal life may take part in the process, shape changing from vertical ellipsoid, spherical to transversal ellipsoid, based on the logarithmically increased ratio of lens transverse and anteroposterior diameters. In the meanwhile, the aspect ratio of eyeball in late fetal life may imply a gradually spherical shape during gestation. Nomogram data from this study may provide appropriate information about morphological changes in the fetal lens and the synchronous relationship between lens and eyeball.
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Key Words
- AIC, Akaike Information Criterion
- APGD, anteroposterior globe diameter
- APLD, anteroposterior lens diameter
- CC, correlation coefficient
- CI, confidence intervals
- Eye biometry
- Fetus
- GA, gestational age
- GD, globe diameter
- GS, globe surface area
- LD, lens diameter
- LS, lens surface area
- Lens growth
- Lens shape
- MR imaging
- MR, Magnetic Resonance
- OLS, ordinary least square
- Ocular globe growth
- SD, standard deviation
- SNR, signal-to noise ratio
- T2W, T2 weighted
- US, ultrasound
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Affiliation(s)
- Yingying Hong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Li Ning
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Yang Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Huijun Qian
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China,Corresponding author. Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, No. 419 Fangxie Rd. Shanghai, 200011, China.
| | - Yinghong Ji
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China,Corresponding author. Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai Key Laboratory of Visual Impairment and Restoration, No. 83 Fenyang Road, Shanghai, 200031, China.
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15
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Popescu AD, Carsote M, Valea A, Nicola AG, Dascălu IT, Tircă T, Abdul-Razzak J, Țuculină MJ. Approach of Acromegaly during Pregnancy. Diagnostics (Basel) 2022; 12:diagnostics12112669. [PMID: 36359512 PMCID: PMC9689290 DOI: 10.3390/diagnostics12112669] [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: 10/06/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Acromegaly-related sub/infertility, tidily related to suboptimal disease control (1/2 of cases), correlates with hyperprolactinemia (1/3 of patients), hypogonadotropic hypogonadism—mostly affecting the pituitary axis in hypopituitarism (10−80%), and negative effects of glucose profile (GP) anomalies (10−70%); thus, pregnancy is an exceptional event. Placental GH (Growth Hormone) increases from weeks 5−15 with a peak at week 37, stimulating liver IGF1 and inhibiting pituitary GH secreted by normal hypophysis, not by somatotropinoma. However, estrogens induce a GH resistance status, protecting the fetus form GH excess; thus a full-term, healthy pregnancy may be possible. This is a narrative review of acromegaly that approaches cardio-metabolic features (CMFs), somatotropinoma expansion (STE), management adjustment (MNA) and maternal-fetal outcomes (MFOs) during pregnancy. Based on our method (original, in extenso, English—published articles on PubMed, between January 2012 and September 2022), we identified 24 original papers—13 studies (3 to 141 acromegalic pregnancies per study), and 11 single cases reports (a total of 344 pregnancies and an additional prior unpublished report). With respect to maternal acromegaly, pregnancies are spontaneous or due to therapy for infertility (clomiphene, gonadotropins or GnRH) and, lately, assisted reproduction techniques (ARTs); there are no consistent data on pregnancies with paternal acromegaly. CMFs are the most important complications (7.7−50%), especially concerning worsening of HBP (including pre/eclampsia) and GP anomalies, including gestational diabetes mellitus (DM); the best predictor is the level of disease control at conception (IGF1), and, probably, family history of 2DM, and body mass index. STE occurs rarely (a rate of 0 to 9%); some of it symptoms are headache and visual field anomalies; it is treated with somatostatin analogues (SSAs) or alternatively dopamine agonists (DAs); lately, second trimester selective hypophysectomy has been used less, since pharmaco-therapy (PT) has proven safe. MNA: PT that, theoretically, needs to be stopped before conception—continued if there was STE or an inoperable tumor (no clear period of exposure, preferably, only first trimester). Most data are on octreotide > lanreotide, followed by DAs and pegvisomant, and there are none on pasireotide. Further follow-up is required: a prompt postpartum re-assessment of the mother’s disease; we only have a few data confirming the safety of SSAs during lactation and long-term normal growth and developmental of the newborn (a maximum of 15 years). MFO seem similar between PT + ve and PT − ve, regardless of PT duration; the additional risk is actually due to CMF. One study showed a 2-year median between hypophysectomy and pregnancy. Conclusion: Close surveillance of disease burden is required, particularly, concerning CMF; a personalized approach is useful; the level of statistical evidence is expected to expand due to recent progress in MNA and ART.
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Affiliation(s)
- Alexandru Dan Popescu
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, 011683 Bucharest, Romania
- Correspondence: (M.C.); (A.V.); Tel.: +40-744851934 (M.C.)
| | - Ana Valea
- Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy & Clinical County Hospital, 400012 Cluj-Napoca, Romania
- Correspondence: (M.C.); (A.V.); Tel.: +40-744851934 (M.C.)
| | - Andreea Gabriela Nicola
- Department of Oro-Dental Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ionela Teodora Dascălu
- Department of Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Tiberiu Tircă
- Department of Oro-Dental Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Jaqueline Abdul-Razzak
- Department of Infant Care–Pediatrics–Neonatology, Romania & Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Jana Țuculină
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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16
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Sethi S, Friesen-Waldner LJ, Wade TP, Courchesne M, Nygard K, Sarr O, Sutherland B, Regnault TRH, McKenzie CA. Feasibility of MRI Quantification of Myelin Water Fraction in the Fetal Guinea Pig Brain. J Magn Reson Imaging 2022; 57:1856-1864. [PMID: 36239714 DOI: 10.1002/jmri.28482] [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: 07/25/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fetal myelination assessment is important for understanding neurodevelopment and neurodegeneration. Myelin water imaging (MWI) quantifies myelin water fraction (MWF), a validated marker for myelin content, and has been used to assess brain myelin in children and neonates. PURPOSE To demonstrate that MWI can quantify MWF in fetal guinea pigs (GPs). STUDY TYPE Animal model. ANIMAL MODEL Nine pregnant, Dunkin-Hartley GPs with 31 fetuses (mean ± standard deviation = 60 ± 1.5 days gestation). FIELD STRENGTH/SEQUENCE 3D spoiled gradient echo and balanced steady-state free precession sequences at 3.0 T. ASSESSMENT MWF maps were reconstructed for maternal and fetal GP brains using the multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT) approach. Myelin basic protein (MBP) stain provided histological validation of the MWF. Regions of interest were placed in the maternal corpus callosum (CC), maternal fornix (FOR), fetal CC, and fetal FOR in MWF maps and MBP stains. STATISTICAL TESTS Linear regression between MWF and MBP stain intensity (SI) of all four regions (coefficient of determination, R2 ). A paired t-test compared the MWF of maternal and mean fetal CC, MBP SI of maternal and mean fetal CC, MWF of maternal and mean fetal FOR, MBP SI of maternal and mean fetal FOR. A paired t-test with a linear mixed model compared the MWF of fetal CC and fetal FOR, and MBP SI of fetal CC and fetal FOR. A P value < 0.0083 was considered statistically significant. RESULTS The mean MWF of the analyzed regions are as follows (mean ± standard deviation): 0.338 + 0.016 (maternal CC), 0.340 ± 0.017 (maternal FOR), 0.214 ± 0.016 (fetal CC), and 0.305 ± 0.025 (fetal FOR). MWF correlated with MBP SI in all regions (R2 = 0.81). Significant differences were found between MWF and MBP SI of maternal and fetal CC, and MWF and MBP SI of fetal CC and fetal FOR. DATA CONCLUSION This study demonstrated the feasibility of MWI in assessing fetal brain myelin content. EVIDENCE LEVEL 2 Technical Efficacy: Stage 1.
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Affiliation(s)
- Simran Sethi
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | | | - Trevor P Wade
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada
| | - Marc Courchesne
- Biotron Experimental Climate Change Research Centre, Western University, London, Ontario, Canada
| | - Karen Nygard
- Biotron Experimental Climate Change Research Centre, Western University, London, Ontario, Canada
| | - Ousseynou Sarr
- Department of Physiology & Pharmacology, Western University, London, Ontario, Canada
| | - Brian Sutherland
- Department of Physiology & Pharmacology, Western University, London, Ontario, Canada
| | - Timothy R H Regnault
- Department of Physiology & Pharmacology, Western University, London, Ontario, Canada.,Department of Obstetrics & Gynaecology, Western University, London, Ontario, Canada.,Division of Maternal, Fetal, and Newborn Health, Children's Health Research Institute, Lawson Health Research Institute, Western University, London, Ontario, Canada
| | - Charles A McKenzie
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Division of Maternal, Fetal, and Newborn Health, Children's Health Research Institute, Lawson Health Research Institute, Western University, London, Ontario, Canada
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17
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Surgery in Pregnancy. Am J Gastroenterol 2022; 117:53-59. [PMID: 36194034 DOI: 10.14309/ajg.0000000000001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/23/2022] [Indexed: 12/11/2022]
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18
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Jalan S, Anjankar A, Deshpande S. Effective Treatment of Diabetes Mellitus by Resonance Medicine. Cureus 2022; 14:e29535. [PMID: 36312660 PMCID: PMC9595267 DOI: 10.7759/cureus.29535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/24/2022] [Indexed: 12/04/2022] Open
Abstract
The metabolic disorder known as diabetes mellitus (DM) has several different causes, distinguished by recurring hyperglycemia due to inadequate insulin secretion, insulin action, or both. T-lymphocytes target such cells for destruction, which include beta cells. Transplants of the pancreas, islets of Langerhans, and individual beta cells are all effective treatments for DM. Additionally, treating DM using stem cells is popular currently. The basis of stem cell therapy for DM is the replacement of beta cells, or dead pancreatic cells, with stem cells. After attaching to the tissues of the pancreas, the stem cells differentiate into active cells. An X-ray scanner is used to place a catheter into the pancreatic artery in DM, and the process lasts 90 minutes. The use of stem cells to replace dead pancreatic beta cells forms the cornerstone of stem cell treatment for DM. Transplants of the pancreas, islets of Langerhans, and individual beta cells are all effective treatments for insulin-dependent DM. In contrast to prior studies, where we only used low potencies of nosodes and organopreparations, our research used both high and low potencies of these substances. Choosing the strength of the nosode stomach cancer in the computer-connected device selector so that it will resonate with the nosode that is tested in the patient's device is the doctor's responsibility when using the bioresonance therapy method. The initial nosode, which is in the computer programme of the device for bioresonance therapy, is no longer tested when the stomach cancer nosode is tested in a patient along with the chosen potency of this nosode. The initial nosode in the bioresonance therapy device itself is still being studied in case the chosen nosode's potency is inadequate (the frequency of oscillations of the nosode is lower than the frequency of oscillations of the tumour).
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19
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Kidney morphology in pregnancy using T2-weighted MRI. Clin Radiol 2022; 77:548-552. [PMID: 35570156 PMCID: PMC7614115 DOI: 10.1016/j.crad.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/25/2022] [Indexed: 02/01/2023]
Abstract
AIM To report the morphology of maternal kidneys captured on fetal magnetic resonance imaging (MRI) including kidney length, volume, renal pelvis diameter, and corticomedullary differentiation in pregnancy. MATERIALS AND METHODS A retrospective study of maternal kidney morphology captured incidentally on fetal MRI. Women without chronic kidney disease, with a complete view of both kidneys and a singleton pregnancy were included. Kidney length, maximal renal pelvis diameter, kidney volume, and corticomedullary differentiation ratio were measured independently in duplicate. Associations with maternal and pregnancy variables were explored using linear regression. RESULTS MRI images from 42 women were performed at 22-32 weeks' gestation. Serum creatinine concentrations are not checked routinely during pregnancy and were available for 15 (36%) women, with a median creatinine of 57 μmol/l (IQR: 50-63 μmol/l). Mean interpolar lengths were 10.9 and 10.4 cm for the left and right kidneys and varied with height. Mean maximal renal pelvis diameters were 9 mm and 12 mm, with upper reference intervals of 17 and 25 mm for the left and right kidneys, respectively. Renal volume in pregnancy was within the non-pregnant reference interval and varied with height and gestation. CONCLUSIONS Maternal kidney length and volume in pregnancy are within the normal reference intervals for non-pregnant women. Renal pelvis diameter in pregnancy measured using MRI is substantially higher than described previously by ultrasound, with implications for routine reporting.
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20
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Hall M, Hutter J, Suff N, Zampieri CA, Tribe RM, Shennan A, Rutherford M, Story L. Antenatal diagnosis of chorioamnionitis: A review of the potential role of fetal and placental imaging. Prenat Diagn 2022; 42:1049-1058. [PMID: 35670265 PMCID: PMC9543023 DOI: 10.1002/pd.6188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 11/12/2022]
Abstract
Chorioamnionitis is present in up to 70% of spontaneous preterm births. It is defined as an acute inflammation of the chorion, with or without involvement of the amnion, and is evidence of a maternal immunological response to infection. A fetal inflammatory response can coexist and is diagnosed on placental histopathology postnatally. Fetal inflammatory response syndrome (FIRS) is associated with poorer fetal and neonatal outcomes. The only antenatal diagnostic test is amniocentesis which carries risks of miscarriage or preterm birth. Imaging of the fetal immune system, in particular the thymus and the spleen, and the placenta may give valuable information antenatally regarding the diagnosis of fetal inflammatory response. While ultrasound is largely limited to structural information, MRI can complement this with functional information that may provide insight into the metabolic activities of the fetal immune system and placenta. This review discusses fetal and placental imaging in pregnancies complicated by chorioamnionitis and their potential future use in achieving non-invasive antenatal diagnosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Megan Hall
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK.,Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK
| | - Natalie Suff
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
| | - Carla Avena Zampieri
- Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK
| | - Rachel M Tribe
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK
| | - Lisa Story
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK.,Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK
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21
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How Could Nanomedicine Improve the Safety of Contrast Agents for MRI during Pregnancy? SCI 2022. [DOI: 10.3390/sci4010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pregnancy is a delicate state, during which timely investigation of possible physiological anomalies is essential to reduce the risk of maternal and fetal complications. Medical imaging encompasses different technologies to image the human body for the diagnosis, course of treatment management, and follow-up of diseases. Ultrasound (US) is currently the imaging system of choice for pregnant patients. However, sonographic evaluations can be non-effective or give ambiguous results. Therefore, magnetic resonance imaging (MRI), due to its excellent tissue penetration, the possibility of acquisition of three-dimensional anatomical information, and its high spatial resolution, is considered a valid diagnostical alternative. Nevertheless, currently employed contrast agents to improve the MRI image quality are harmful to the fetus. Because of their ability to cross the placenta, their use on pregnant patients is avoided. This review will firstly recapitulate the most common non-obstetrical, obstetrical, and fetal indications for magnetic resonance imaging on pregnant women. Fetal safety risks, due to the use of strong magnetic fields and exogenous contrast agents, will be presented. Then, possible advantages of nanostructured contrast agents compared to current molecular ones are explored. Nanosystems’ characteristics affecting contrast efficiency, and their potential for improving contrast-enhanced MRI’s safety in pregnant women, are discussed. Lastly, promising examples of nanoparticles as safer alternatives to current MRI contrast agents in pregnancy are discussed.
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22
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Michalet M, Dejean C, Schick U, Durdux C, Fourquet A, Kirova Y. Radiotherapy and pregnancy. Cancer Radiother 2021; 26:417-423. [PMID: 34953688 DOI: 10.1016/j.canrad.2021.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We present the updated recommendations of the French society for radiation oncology on radiotherapy and pregnancy. The occurrence of cancer during pregnancy is a rare event (approximately 1 in 1000 pregnancies). The risks for the embryo or the foetus depend on the gestational age at the time of irradiation. The main risks are malformations with microcephaly and mental retardation. There is also a risk of radiation-induced cancer in the unborn child. In the case of only supradiaphragmatic irradiation, radiotherapy can be performed most often in pregnant women without risk to the foetus. On the other hand, in the case of an indication for subdiaphragmatic irradiation, therapeutic termination of the pregnancy should be proposed. In all cases, when radiotherapy is chosen, a phantom estimation of the dose delivered to the foetus, confirmed by in vivo measurement, is recommended. Conformational radiotherapy is the preferred technique because of the lower dose delivered to the foetus (except in tumour locations where other techniques such as IMRT are recommended).
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Affiliation(s)
- M Michalet
- Institut du cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France.
| | - C Dejean
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06100 Nice, France
| | - U Schick
- CHRU de Brest, 2, avenue Foch, 29200 Brest, France
| | - C Durdux
- Hôpital européen Georges-Pompidou, APHP, 20, rue Leblanc, 75015 Paris, France
| | - A Fourquet
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
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23
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Abstract
Diagnosis of a fetal anomaly in pregnancy increases the risk for perinatal mental health difficulties, including anxiety, depression, and traumatic stress among expectant parents. Common emotional challenges include uncertainty about the diagnosis/prognosis, anticipated neonatal course, fears of fetal or neonatal demise, loss of a typical, uncomplicated pregnancy and postpartum course, and disruption of family roles due to medical care-related activities and restrictions. Psychologists in multidisciplinary fetal care centers are uniquely positioned to assess mental health risks and address the needs of expectant parents. Psychologists bring additional expertise in screening and assessment, clinical interventions to promote coping and symptom reduction while preparing for birth and a complicated neonatal course, consultation and effective communication, and programmatic development. This review paper provides an overview of the challenges and behavioral health risks for expectant parents carrying a fetus with a birth defect and the unique role psychologists play to support patients and families within fetal care settings.
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24
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Yetisir F, Abaci Turk E, Guerin B, Gagoski BA, Grant PE, Adalsteinsson E, Wald LL. Safety and imaging performance of two-channel RF shimming for fetal MRI at 3T. Magn Reson Med 2021; 86:2810-2821. [PMID: 34240759 DOI: 10.1002/mrm.28895] [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: 04/23/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE This study investigates whether two-channel radiofrequency (RF) shimming can improve imaging without increasing specific absorption rate (SAR) for fetal MRI at 3T. METHODS Transmit field ( B 1 + ) average and variation in the fetus was simulated in seven numerical pregnant body models. Safety was quantified by maternal and fetal peak local SAR and fetal average SAR. The shim parameter space was divided into improved B 1 + (magnitude and homogeneity) and improved SAR regions, and an overlap where RF shimming improved both classes of metrics compared with birdcage mode was assessed. Additionally, the effect of fetal position, tissue detail, and dielectric properties on transmit field and SAR was studied. RESULTS A region of subject-specific RF shim parameter space improving both B 1 + and SAR metrics was found for five of the seven models. Optimizing only B 1 + metrics improved B 1 + efficiency across models by 15% on average and 28% for the best-case model. B 1 + variation improved by 26% on average and 49% for the best case. However, for these shim settings, fetal SAR increased by up to 106%. The overlap region, where both B 1 + and SAR metrics improve, showed an average B 1 + efficiency improvement of 6% on average across models and 19% for the best-case model. B 1 + variation improved by 13% on average and 40% for the best case. RFS could also decrease maternal/fetal SAR by up to 49%/58%. CONCLUSION RF shimming can improve imaging compared with birdcage mode without increasing fetal and maternal SAR when a patient-specific SAR model is incorporated into the shimming procedure.
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Affiliation(s)
- Filiz Yetisir
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Esra Abaci Turk
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Bastien Guerin
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Borjan A Gagoski
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Elfar Adalsteinsson
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Lawrence L Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA
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25
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Wattjes MP, Ciccarelli O, Reich DS, Banwell B, de Stefano N, Enzinger C, Fazekas F, Filippi M, Frederiksen J, Gasperini C, Hacohen Y, Kappos L, Li DKB, Mankad K, Montalban X, Newsome SD, Oh J, Palace J, Rocca MA, Sastre-Garriga J, Tintoré M, Traboulsee A, Vrenken H, Yousry T, Barkhof F, Rovira À. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol 2021; 20:653-670. [PMID: 34139157 DOI: 10.1016/s1474-4422(21)00095-8] [Citation(s) in RCA: 292] [Impact Index Per Article: 97.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/15/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
The 2015 Magnetic Resonance Imaging in Multiple Sclerosis and 2016 Consortium of Multiple Sclerosis Centres guidelines on the use of MRI in diagnosis and monitoring of multiple sclerosis made an important step towards appropriate use of MRI in routine clinical practice. Since their promulgation, there have been substantial relevant advances in knowledge, including the 2017 revisions of the McDonald diagnostic criteria, renewed safety concerns regarding intravenous gadolinium-based contrast agents, and the value of spinal cord MRI for diagnostic, prognostic, and monitoring purposes. These developments suggest a changing role of MRI for the management of patients with multiple sclerosis. This 2021 revision of the previous guidelines on MRI use for patients with multiple sclerosis merges recommendations from the Magnetic Resonance Imaging in Multiple Sclerosis study group, Consortium of Multiple Sclerosis Centres, and North American Imaging in Multiple Sclerosis Cooperative, and translates research findings into clinical practice to improve the use of MRI for diagnosis, prognosis, and monitoring of individuals with multiple sclerosis. We recommend changes in MRI acquisition protocols, such as emphasising the value of three dimensional-fluid-attenuated inversion recovery as the core brain pulse sequence to improve diagnostic accuracy and ability to identify new lesions to monitor treatment effectiveness, and we provide recommendations for the judicious use of gadolinium-based contrast agents for specific clinical purposes. Additionally, we extend the recommendations to the use of MRI in patients with multiple sclerosis in childhood, during pregnancy, and in the post-partum period. Finally, we discuss promising MRI approaches that might deserve introduction into clinical practice in the near future.
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Affiliation(s)
- Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany; Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Olga Ciccarelli
- Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Brenda Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicola de Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria; Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jette Frederiksen
- Department of Neurology, Rigshospitalet Glostrup, University Hospital of Copenhagen, Glostrup, Denmark
| | - Claudio Gasperini
- Department of Neurology, San Camillo-Forlanini Hospital, Roma, Italy
| | - Yael Hacohen
- Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Ludwig Kappos
- Department of Neurology and Research Center for Clinical Neuroimmunology and Neuroscience, University Hospital of Basel and University of Basel, Basel, Switzerland
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children, London, UK
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jiwon Oh
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anthony Traboulsee
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, London, UK; Neuroradiological Academic Unit, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands; Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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26
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Jabehdar Maralani P, Kapadia A, Liu G, Moretti F, Ghandehari H, Clarke SE, Wiebe S, Garel J, Ertl-Wagner B, Hurrell C, Schieda N. Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy. Can Assoc Radiol J 2021; 73:56-67. [PMID: 34000852 DOI: 10.1177/08465371211015657] [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] [Indexed: 12/18/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) during pregnancy is associated with concerns among patients and health professionals with regards to fetal safety. In this work, the Canadian Association of Radiologists (CAR) Working Group on MRI in Pregnancy presents recommendations for the use of MRI in pregnancy, derived from literature review as well as expert panel opinions and discussions. The working group, which consists of academic subspecialty radiologists and obstetrician-gynaecologists, aimed to provide updated, evidence-based recommendations addressing safety domains related to energy deposition, acoustic noise, and gadolinium-based contrast agent use based on magnetic field strength (1.5T and 3T) and trimester scanned, in addition to the effects of sedative use and occupational exposure.
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Affiliation(s)
| | - Anish Kapadia
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Grace Liu
- Department of Obstetrics and Gynecology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Felipe Moretti
- Department of Obstetrics and Gynecology, 12365University of Ottawa, Ottawa, Ontario, Canada
| | - Hournaz Ghandehari
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheldon Wiebe
- Department of Medical Imaging, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juliette Garel
- Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal, Montréal, Québec, Canada
| | - Birgit Ertl-Wagner
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Casey Hurrell
- Research and Policy Development - Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Radiology, 12365University of Ottawa, Ottawa, Ontario, Canada
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A Sparse Volume Reconstruction Method for Fetal Brain MRI Using Adaptive Kernel Regression. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6685943. [PMID: 33748279 PMCID: PMC7960018 DOI: 10.1155/2021/6685943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 11/18/2022]
Abstract
Slice-to-volume reconstruction (SVR) method can deal well with motion artifacts and provide high-quality 3D image data for fetal brain MRI. However, the problem of sparse sampling is not well addressed in the SVR method. In this paper, we mainly focus on the sparse volume reconstruction of fetal brain MRI from multiple stacks corrupted with motion artifacts. Based on the SVR framework, our approach includes the slice-to-volume 2D/3D registration, the point spread function- (PSF-) based volume update, and the adaptive kernel regression-based volume update. The adaptive kernel regression can deal well with the sparse sampling data and enhance the detailed preservation by capturing the local structure through covariance matrix. Experimental results performed on clinical data show that kernel regression results in statistical improvement of image quality for sparse sampling data with the parameter setting of the structure sensitivity 0.4, the steering kernel size of 7 × 7 × 7 and steering smoothing bandwidth of 0.5. The computational performance of the proposed GPU-based method can be over 90 times faster than that on CPU.
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28
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Ami O, Maran JC, Musset D, Dubray C, Mage G, Boyer L. Human Birth Imaging Using MRI demonstrates fetal head moldability and brain compression : Prospective cohort study (Preprint). JMIR Form Res 2021; 6:e27421. [DOI: 10.2196/27421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/14/2021] [Accepted: 11/02/2022] [Indexed: 11/05/2022] Open
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29
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Gentle Touch: Noninvasive Approaches to Improve Patient Comfort and Cooperation for Pediatric Imaging. Top Magn Reson Imaging 2021; 29:187-195. [PMID: 32541256 DOI: 10.1097/rmr.0000000000000245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pediatric imaging presents unique challenges related to patient anxiety, cooperation, and safety. Techniques to reduce anxiety and patient motion in adults must often be augmented in pediatrics, because it is always mentioned in the field of pediatrics, children are not miniature adults. This article will review methods that can be considered to improve patient experience and cooperation in imaging studies. Such techniques can range from modifications to the scanner suite, different ways of preparing and interacting with children, collaborating with parents for improved patient care, and technical advances such as accelerated acquisition and motion correction to reduce artifact. Special considerations for specific populations including transgender patients, neonates, and pregnant women undergoing fetal imaging will be described. The unique risks of sedation in children will also be briefly reviewed.
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30
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Lok C, Frijstein M, van Trommel N. Clinical presentation and diagnosis of Gestational Trophoblastic Disease. Best Pract Res Clin Obstet Gynaecol 2020; 74:42-52. [PMID: 33422446 DOI: 10.1016/j.bpobgyn.2020.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/05/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022]
Abstract
Gestational trophoblastic disease (GTD) is a heterogeneous group of pregnancy-related disorders characterized by abnormal proliferation of trophoblastic tissue. It encompasses the premalignant partial and complete hydatidiform mole but also the malignant invasive mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelioid trophoblastic tumor. The clinical presentation changed to earlier detection after the introduction of first trimester ultrasounds. Patients are often asymptomatic, but vaginal bleeding continues to be the most common presenting symptom. Other symptoms can develop in the case of metastatic disease. Ultrasound, serum human chorionic gonadotrophin, and sometimes additional imaging such as CT, MRI, or PET can confirm the diagnosis and stage of disease. Familiarity with the pathogenesis, classification, imaging features, and treatment of GTD facilitates diagnosis and appropriate management.
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Affiliation(s)
- Christianne Lok
- Department of Gynaecologic Oncology, Center of Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
| | - Minke Frijstein
- Department of Gynaecologic Oncology, Center of Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
| | - Nienke van Trommel
- Department of Gynaecologic Oncology, Center of Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
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31
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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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32
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Contrast-Enhanced Ultrasound for Assessing Abdominal Conditions in Pregnancy. ACTA ACUST UNITED AC 2020; 56:medicina56120675. [PMID: 33302381 PMCID: PMC7762549 DOI: 10.3390/medicina56120675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
Background and objectives: Native ultrasound is the most common imaging modality in obstetrics. The use of contrast-enhanced ultrasound (CEUS) during pregnancy has not been officially approved by leading societies for obstetrics and ultrasound. The present study aims to monitor the safety and diagnostic performance of CEUS for assessing abdominal issues in five pregnant women. Materials and Methods: Five pregnant patients who underwent a total of 11 CEUS examinations between June 2020 and October 2020 were included (mean age: 34 years; mean time of pregnancy: 21 weeks). All CEUS scans were interpreted by one experienced consultant radiologist (EFSUMB Level 3). Results: Upon contrast application, no maternal nor fetal adverse effects were observed. Moreover, no fetal contrast enhancement was observed in any patient. CEUS helped to diagnose renal angiomyolipoma, pyelonephritis, necrotic uterine fibroid, gallbladder polyp, and superior mesenteric vein thrombosis. Conclusions: In our study, off-label use of CEUS showed an excellent safety profile allowing the avoidance of ionizing radiation exposure as well as contrast agents in case of CT or use of gadolinium-based contrast agents in case of MRI. CEUS is a promising diagnostic instrument for facilitating clinical decision-making and improving the management of pregnant women.
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33
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Coblentz AC, Teixeira SR, Mirsky DM, Johnson AM, Feygin T, Victoria T. How to read a fetal magnetic resonance image 101. Pediatr Radiol 2020; 50:1810-1829. [PMID: 33252751 DOI: 10.1007/s00247-020-04768-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/22/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022]
Abstract
Accurate antenatal diagnosis is essential for planning appropriate pregnancy management and improving perinatal outcomes. The provision of information vital for prognostication is a crucial component of prenatal imaging, and this can be enhanced by the use of fetal MRI. Image acquisition, interpretation and reporting of a fetal MR study can be daunting to the individual who has encountered few or none of these examinations. This article provides the radiology trainee with a general approach to interpreting a fetal MRI. The authors review the added value of prenatal MRI in the overall assessment of fetal wellbeing, discuss MRI protocols and techniques, and review the normal appearance of maternal and fetal anatomy. The paper concludes with a sample template for structured reporting, to serve as a checklist and guideline for reporting radiologists.
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Affiliation(s)
- Ailish C Coblentz
- Radiology Department, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 10104, USA
| | - Sara R Teixeira
- Radiology Department, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 10104, USA
| | - David M Mirsky
- Neuroradiology Department, Children's Hospital of Colorado, Aurora, CO, USA
| | - Ann M Johnson
- Radiology Department, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 10104, USA
| | - Tamara Feygin
- Radiology Department, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 10104, USA
| | - Teresa Victoria
- Radiology Department, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 10104, USA.
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34
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Jiao J, Namburete AIL, Papageorghiou AT, Noble JA. Self-Supervised Ultrasound to MRI Fetal Brain Image Synthesis. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:4413-4424. [PMID: 32833630 DOI: 10.1109/tmi.2020.3018560] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Fetal brain magnetic resonance imaging (MRI) offers exquisite images of the developing brain but is not suitable for second-trimester anomaly screening, for which ultrasound (US) is employed. Although expert sonographers are adept at reading US images, MR images which closely resemble anatomical images are much easier for non-experts to interpret. Thus in this article we propose to generate MR-like images directly from clinical US images. In medical image analysis such a capability is potentially useful as well, for instance for automatic US-MRI registration and fusion. The proposed model is end-to-end trainable and self-supervised without any external annotations. Specifically, based on an assumption that the US and MRI data share a similar anatomical latent space, we first utilise a network to extract the shared latent features, which are then used for MRI synthesis. Since paired data is unavailable for our study (and rare in practice), pixel-level constraints are infeasible to apply. We instead propose to enforce the distributions to be statistically indistinguishable, by adversarial learning in both the image domain and feature space. To regularise the anatomical structures between US and MRI during synthesis, we further propose an adversarial structural constraint. A new cross-modal attention technique is proposed to utilise non-local spatial information, by encouraging multi-modal knowledge fusion and propagation. We extend the approach to consider the case where 3D auxiliary information (e.g., 3D neighbours and a 3D location index) from volumetric data is also available, and show that this improves image synthesis. The proposed approach is evaluated quantitatively and qualitatively with comparison to real fetal MR images and other approaches to synthesis, demonstrating its feasibility of synthesising realistic MR images.
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Ypsilantis P, Souftas V, Vyza V, Vraila M, Chatzaki M, Ypsilantou I, Pitiakoudis M. Magnetic resonance imaging for early pregnancy diagnosis in the laboratory rat. Lab Anim 2020; 55:262-269. [PMID: 33210577 DOI: 10.1177/0023677220972744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pregnancy diagnosis and embryo counting are important end points in reproductive, developmental biology and toxicology studies. The purpose of the present study was to assess the feasibility and efficacy of magnetic resonance imaging (MRI) for early pregnancy diagnosis and embryo counting in the laboratory rat. Female Wistar rats were subjected to whole-body MRI scanning using a 1.5T MRI scanner, employing a isotropic T2-weighted 3D short-tau inversion recovery sequence from day 8 to day 12 post coitum (pc) or without prior mating, under general anaesthesia for pregnancy diagnosis and embryo counting. MRI examination was followed by laparotomy and visual inspection of the uterus to verify MRI findings. By day 8 pc, uterine bulges, characteristic of pregnancy, were depicted as oval-shaped structures of high intensity signal. By day 10 pc, embryonic vesicles were detected at the medial side of the uterine bulges. Pregnancy was diagnosed with 0% false-negative diagnosis and 100% accuracy by day 11 pc, while embryos were counted with 100% accuracy by day 12 pc. In conclusion, MRI proved to be a feasible and reliable non-invasive imaging method of early pregnancy diagnosis and embryo counting in the laboratory rat.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Greece
| | - Vasileios Souftas
- Laboratory of Diagnostic and Therapeutic Radiology, University General Hospital of Alexandroupolis, Greece
| | - Victoria Vyza
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Greece
| | - Marianthi Vraila
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Greece
| | - Marilena Chatzaki
- Laboratory of Diagnostic and Therapeutic Radiology, University General Hospital of Alexandroupolis, Greece
| | - Ifigenia Ypsilantou
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Greece
| | - Michael Pitiakoudis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Greece
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Hironaka K, Suzuki M, Tateyama K, Ozeki T, Adachi K, Morita A. Severe Aneurysmal Subarachnoid Hemorrhage after Warning Headache during Pregnancy: A Case Report. J NIPPON MED SCH 2020; 87:162-165. [PMID: 32655093 DOI: 10.1272/jnms.jnms.2020_87-308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is a rare but important cause of maternal death during pregnancy. CASE DESCRIPTION A 34-year-old primigravida (31 weeks of pregnancy) with acute headache but no neurological deficits or neck stiffness was prescribed medication and returned home. Four weeks later she presented with severe headache and consciousness disturbance. She was admitted to our hospital, where she fell into a deep coma. Brain CT and three-dimensional CT angiography showed subarachnoid hemorrhage and a 5-mm right internal carotid-posterior communicating artery aneurysm. Fetal heart rate was 60 beats per minute. Emergent cesarean section and surgical clipping were performed. Intraoperative examination revealed that the aneurysm originated at the right posterior communicating artery. There were no postoperative neurological focal deficits. On postoperative day 13 she developed delayed cerebral ischemia of the right temporo-parieto-occipital lobe. She was discharged home 36 days after surgery with left hemianopsia. The infant was free of complications and was discharged at age 17 days. CONCLUSIONS A pregnant woman with severe headache should undergo brain CT or magnetic resonance imaging to rule out subarachnoid hemorrhage.
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Affiliation(s)
- Kohei Hironaka
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Masanori Suzuki
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Kojiro Tateyama
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Tomohiro Ozeki
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Koji Adachi
- Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
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Dong SZ, Zhu M, Ji H, Ren JY, Liu K. Fetal cardiac MRI: a single center experience over 14-years on the potential utility as an adjunct to fetal technically inadequate echocardiography. Sci Rep 2020; 10:12373. [PMID: 32704065 PMCID: PMC7378840 DOI: 10.1038/s41598-020-69375-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/07/2020] [Indexed: 12/26/2022] Open
Abstract
Unlike ultrasound (US) imaging, foetal magnetic resonance imaging (MRI) is not significantly limited by maternal obesity, oligohydramnios, uterine myoma, twins, and foetal lie, which impair US visualization of the foetus. The present study aimed to introduce our foetal cardiac MRI scanning technology and over 14-years of experience on the potential utility of foetal cardiac MRI examination as an adjunct to foetal technically inadequate echocardiography (Echo). This retrospective review included 1,573 pregnant women [1,619 foetuses (46 twins)] referred for a foetal cardiac MRI because of technically limited Echo. Foetal cardiac MRI was performed using two 1.5 T units. Among the 1,619 foetuses referred for cardiac MRI, 1,379 (85.2%) cases were followed up using postnatal imaging and/or surgery, 240 (14.8%), including three twins, had no follow-up confirmation because of pregnancy termination without autopsy or loss to follow-up. The results of the present study indicated that foetal cardiac MRI examinations can be a useful adjunct to foetal echocardiography when the technical limitations of echocardiography make it inadequate for diagnosis.
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Affiliation(s)
- Su-Zhen Dong
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.
| | - Ming Zhu
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.
| | - Hui Ji
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Jing-Ya Ren
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Ke Liu
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
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Abstract
Endometriosis constitutes the presence of ectopic endometrial glands and stroma outside the uterine endometrium, which is hormonally responsive and responds to pregnancy hormones as well. Decidualization is a physiologic process, where the normal endometrium readies itself for optimal accommodation of a pregnancy. A similar hormonal response can be seen with ectopic endometrium as well. As such, ovarian endometriomas and deep endometriosis implants can undergo decidualization. Overall, the progestational state of pregnancy favors an improvement in endometriosis, however, decidualization can lead to findings that can lead to increased size of endometriomas and deep infiltrative endometriosis implants, changes in imaging appearance and even complications, such as spontaneous hemoperitoneum in pregnancy. Awareness of this process can help prevent misdiagnosis of decidualized endometriomas as ovarian malignancy and recognize common imaging manifestations of hormonal effects of pregnancy on endometriosis.
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Incidence of nephrogenic systemic fibrosis after administration of gadoteric acid in patients on renal replacement treatment. Magn Reson Imaging 2020; 70:1-4. [PMID: 32112811 DOI: 10.1016/j.mri.2020.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Nephrogenic system fibrosis (NSF) is a rare complication detected in patients with renal insufficiency exposed to gadolinium-based contrast agents (GBCAs). The aim of our study is to evaluate the prevalence of NSF in a cohort of patients on renal replacement treatment who underwent GBCA-enhanced magnetic resonance imaging (MRI). METHOD We retrospectively reviewed all the charts of kidney transplant (KT) recipients, patients on hemodialysis (HD) and peritoneal dialysis (PD) who received a uniform protocol for contrast material enhanced-MRI with gadoteric acid at our center from January 2004 to December 2017. RESULTS Three-hundred forty-four patients (44.1% on HD, 11.3% on PD and 44.4% KT recipients) underwent 551 gadoteric acid-enhanced MRI. The median age of the patients was 58 years (IQR, 45-70 years) and 65.1% were men. Sixty-three patients (18.3%) had skin punch biopsy after integumentary assessment performed by a dermatologist. No cases of NSF were detected after a median follow-up of 4.5 years (IQR, 1.9-8.2 years). During this period of observation, 116 (33.7%) patients died and 11 (3.1%) were lost at follow-up. CONCLUSIONS None of the patients exposed to gadoteric acid developed NSF. Our results, in line with more recent studies, suggest that the use of gadoteric acid, a macrocyclic GBCA, appears safe even in chronic kidney disease (CKD) patients receiving dialysis.
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Wu W, Wang H, Zhao P, Talcott M, Lai S, McKinstry RC, Woodard PK, Macones GA, Schwartz AL, Cahill AG, Cuculich PS, Wang Y. Noninvasive high-resolution electromyometrial imaging of uterine contractions in a translational sheep model. Sci Transl Med 2020; 11:11/483/eaau1428. [PMID: 30867320 DOI: 10.1126/scitranslmed.aau1428] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/09/2018] [Accepted: 02/20/2019] [Indexed: 12/20/2022]
Abstract
In current clinical practice, uterine contractions are monitored via a tocodynamometer or an intrauterine pressure catheter, both of which provide crude information about contractions. Although electrohysterography/electromyography can measure uterine electrical activity, this method lacks spatial specificity and thus cannot accurately measure the exact location of electrical initiation and location-specific propagation patterns of uterine contractions. To comprehensively evaluate three-dimensional uterine electrical activation patterns, we describe here the development of electromyometrial imaging (EMMI) to display the three-dimensional uterine contractions at high spatial and temporal resolution. EMMI combines detailed body surface electrical recording with body-uterus geometry derived from magnetic resonance images. We used a sheep model to show that EMMI can reconstruct uterine electrical activation patterns from electrodes placed on the abdomen. These patterns closely match those measured with electrodes placed directly on the uterine surface. In addition, modeling experiments showed that EMMI reconstructions are minimally affected by noise and geometrical deformation. Last, we show that EMMI can be used to noninvasively measure uterine contractions in sheep in the same setup as would be used in humans. Our results indicate that EMMI can noninvasively, safely, accurately, robustly, and feasibly image three-dimensional uterine electrical activation during contractions in sheep and suggest that similar results might be obtained in clinical setting.
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Affiliation(s)
- Wenjie Wu
- Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Biomedical Engineering, Washington University, St. Louis, MO 63110, USA.,Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Hui Wang
- Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Physics, Washington University, St. Louis, MO 63110, USA
| | - Peinan Zhao
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael Talcott
- Division of Comparative Medicine, Washington University, St. Louis, MO 63110, USA
| | - Shengsheng Lai
- Department of Medical Devices, Guangdong Food and Drug Vocational College, Guangzhou, Guangdong Province, P.R. China
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - George A Macones
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alan L Schwartz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Phillip S Cuculich
- Department of Cardiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Yong Wang
- Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA. .,Department of Biomedical Engineering, Washington University, St. Louis, MO 63110, USA.,Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Yang FP, Chao AS, Lin SH, Chao A, Wang TH, Chang YL, Chang HS, Wang JJ. Functional human brain connectivity during labor and its alteration under epidural analgesia. Brain Imaging Behav 2020; 14:2647-2658. [PMID: 31900889 DOI: 10.1007/s11682-019-00216-2] [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] [Indexed: 11/25/2022]
Abstract
This study used functional magnetic resonance imaging to explore the neural networks of pain during labor and its relief. It was hypothesized that epidural analgesia would affect the neural activities and the underlying network connectivity. Analysis using dynamic causal modelling and functional connectivity was performed to investigate the spatial activity and network connection of labor pain with and without epidural analgesia. This Institutional Review Board approved study acquired Magnetic Resonance Imaging from 15 healthy women of spontaneous normal delivery (with/without epidural analgesia = 7/8, aged 29.6 ± 2.3 and 29.3 ± 4.8 years old respectively) using a 1.5 Tesla scanner. Numerical rating score of pain was evaluated by a research nurse in the beginning of the first stage of labor and approximately 30 min after imaging examination. Six regions of interested from the activated clusters and literature were selected for dynamic causal modelling, which included primary and secondary somatosensory cortex, middle frontal gyrus, anterior cingulate cortex, insula and lentiform. Functional connectivity was calculated from selected sensory and affective regions. All analyses were performed by using software of statistical parametric mapping version 8 and CONN functional connectivity toolbox. The result showed that the experience of labor pain can lead to activations within a distributed brain network. The pain relief from epidural analgesia can be accompanied with altered functional connectivity, which was most evident in the cingulo-frontal system. The present study, therefore, provides an overview of a pain-related neural network that occur during labor and upon epidural analgesia.
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Affiliation(s)
- Fan-Pei Yang
- Department of Foreign Languages and Literature, National Tsing Hua University, Hsinchu, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Sung-Han Lin
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, 259 WenHua 1st Road, TaoYuan county, Taiwan
| | - Anne Chao
- Department of Anesthesia, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Hao Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Yao-Lung Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Hong-Shiu Chang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, 259 WenHua 1st Road, TaoYuan county, Taiwan.
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan.
- Healthy Aging Research Center, Chang Gung University, Taoyuan City, Taiwan.
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Wang H, Wu W, Talcott M, McKinstry RC, Woodard PK, Macones GA, Schwartz AL, Cuculich P, Cahill AG, Wang Y. Accuracy of electromyometrial imaging of uterine contractions in clinical environment. Comput Biol Med 2019; 116:103543. [PMID: 31786490 DOI: 10.1016/j.compbiomed.2019.103543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 11/24/2022]
Abstract
Clinically, uterine contractions are monitored with tocodynamometers or intrauterine pressure catheters. In the research setting, electromyography (EMG), which detects electrical activity of the uterus from a few electrodes on the abdomen, is feasible, can provide more accurate data than these other methods, and may be useful for predicting preterm birth. However, EMG lacks sufficient spatial resolution and coverage to reveal where uterine contractions originate, how they propagate, and whether preterm contractions differ between women who do and do not progress to preterm delivery. To address those limitations, electromyometrial imaging (EMMI) was recently developed and validated to non-invasively assess three-dimensional (3D) electrical activation patterns on the entire uterine surface in pregnant sheep. EMMI uses magnetic resonance imaging to obtain subject-specific body-uterus geometry and collects uterine EMG data from up to 256 electrodes on the body surface. EMMI software then solves an ill-posed inverse computation to combine the two datasets and generate maps of electrical activity on the entire 3D uterine surface. Here, we assessed the feasibility to clinically translate EMMI by evaluating EMMI's accuracy under the unavoidable geometrical alterations and electrical noise contamination in a clinical environment. We developed a hybrid experimental-simulation platform to model the effects of fetal kicks, contractions, fetal/maternal movements, and noise contamination caused by maternal respiration and environmental electrical activity. Our data indicate that EMMI can accurately image uterine electrical activity in the presence of geometrical deformations and electrical noise, suggesting that EMMI can be reliably translated to non-invasively image 3D uterine electrical activation in pregnant women.
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Affiliation(s)
- Hui Wang
- Department of Physics, Washington University, St. Louis, MO, 63130, USA; Center for Reproductive Health Sciences, Washington University, St. Louis, MO, 63130, USA; Department of Obstetrics & Gynecology, School of Medicine, St. Louis, MO, 63110, USA.
| | - Wenjie Wu
- Center for Reproductive Health Sciences, Washington University, St. Louis, MO, 63130, USA; Department of Obstetrics & Gynecology, School of Medicine, St. Louis, MO, 63110, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Michael Talcott
- Division of Comparative Medicine, Washington University, St. Louis, MO, 63110, USA
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Pamela K Woodard
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - George A Macones
- Department of Women's Health, University of Texas at Austin, Austin, TX, 78712, USA
| | - Alan L Schwartz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Phillip Cuculich
- Department of Cardiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Alison G Cahill
- Department of Women's Health, University of Texas at Austin, Austin, TX, 78712, USA.
| | - Yong Wang
- Center for Reproductive Health Sciences, Washington University, St. Louis, MO, 63130, USA; Department of Obstetrics & Gynecology, School of Medicine, St. Louis, MO, 63110, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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Domagała Z, Domański J, Zimmer A, Tarczynska A, Sliwa J, Gworys B. Methodology of preparation of corrosive specimens from human placenta - A technical note. Ann Anat 2019; 228:151436. [PMID: 31704147 DOI: 10.1016/j.aanat.2019.151436] [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: 06/19/2019] [Revised: 10/06/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
Detailed knowledge of the anatomy of human placenta vessels is clinically essential and requires the use of many different anatomical and histological techniques. One of the interesting methods of visualising vessels is the corrosion technique. It enables spatial visualisation of the vascular network of the analysed organ. The authors present a developed, own method of preparing the corrosive preparations from human placenta. They underline the advantages and disadvantages of this technique. They describe solutions aimed at reducing the costs of the process. They show that corrosion technology enables relatively fast and inexpensive visualisation of arterial and venous vessels of the human placenta.
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Affiliation(s)
- Zygmunt Domagała
- Division of Anatomy, Department of Human Morphology and Embryology, Wroclaw Medical University, Wroclaw, Poland.
| | - Jurand Domański
- Clinical and Dissecting Anatomy Students Scientific Club, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra Zimmer
- II Department and Clinic of Gynaecology and Obsterics, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Tarczynska
- II Department and Clinic of Gynaecology and Obsterics, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Sliwa
- II Department and Clinic of Gynaecology and Obsterics, Wroclaw Medical University, Wroclaw, Poland
| | - Bohdan Gworys
- Faculty of Health Science and Physical Education, The Witelon State University of Applied Sciences, Legnica, Poland
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Azria É. [Breech Presentation: CNGOF Guidelines for Clinical Practice - Case Selection for Trial of Labour]. ACTA ACUST UNITED AC 2019; 48:120-131. [PMID: 31678509 DOI: 10.1016/j.gofs.2019.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this chapter is to examine on the basis of the knowledge currently available the criteria available before labour for selecting women who would be eligible for trial of vaginal delivery. METHODOLOGY Bibliographical research in French and English using the Medline and Cochrane databases between 1980 and 2019 and the recommendations of international societies. RESULTS It is recommended to offer women who wish to attempt a vaginal delivery at term a pelvimetry to decide with them on their mode of delivery (Grade C). The pelvimetric standards used at the time of the PREMODA study were anteroposterior diameter of inlet≥105mm, a transverse diameter of inlet≥120mm, a transverse interspinous diameter≥100mm. However, since there is no evidence about which pelvic measures to use, nor any evidence to set decision-making thresholds other than those set in published studies, the selected decision-making thresholds can be adjusted according to gestational age at delivery or fetal biometrics (Professional consensus). There is no argument for recommending the practice of pelvimetry in the case of delivery before 37 weeks gestational age (Professional consensus) and in the case of breech presentation discovered at the time of beginning of labour, the absence of pelvimetry alone does not contraindicate the attempt of vaginal delivery (Professional consensus). There is insufficient data to recommend the systematic use of fetal weight estimation and/or biparietal diameter measurement as acceptance criteria for a vaginal delivery attempt. In the event of a known fetal weight estimation before birth greater than 3800g, a cesarean section is to be preferred (Professional consensus). The breech presentation is not in itself a contraindication to an attempt of vaginal delivery for a small fetus for gestational age (Professional consensus). The presentation of the non-frank breech is not in itself a contraindication to an attempt of vaginal delivery (Professional consensus). In the case of premature breech delivery, current data do not allow to recommend one delivery route over another (Professional consensus). It is recommended to check the absence of hyperextension of the fetal head by ultrasound before an attempt of vaginal delivery (Professional consensus) and to prefer a cesarean section if such a position is found (Professional consensus). It is not recommended to propose a caesarean section with the sole reason of nulliparity (Grade C). The history of cesarean section is not in itself a contraindication to an attempt of vaginal delivery in the case of fetal breech presentation (Professional consensus). Premature rupture of the membranes is not in itself a contraindication to an attempt of vaginal delivery (Professional consensus). CONCLUSION A number of the factors analyzed in this chapter are to be incorporated into the decision-making process in order to choose with the woman whose fetus is in breech presentation the delivery route.
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Affiliation(s)
- É Azria
- Maternité Notre-Dame-de-Bon-Secours, groupe hospitalier Paris Saint-Joseph, DHU risques et grossesse, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France; Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75000 Paris, France; Université de Paris, 75000 Paris, France.
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Shulman M, Cho E, Aasi B, Cheng J, Nithiyanantham S, Waddell N, Sussman D. Quantitative analysis of fetal magnetic resonance phantoms and recommendations for an anthropomorphic motion phantom. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:257-272. [PMID: 31487004 DOI: 10.1007/s10334-019-00775-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/08/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To provide a review and quantitative analysis of the available fetal MR imaging phantoms. MATERIALS AND METHODS A literature search was conducted across Pubmed, Google Scholar, and Ryerson University Library databases to identify fetal MR imaging phantoms. Phantoms were graded on a semi-quantitative scale in regards to four evaluation categories: (1) anatomical accuracy in size and shape, (2) dielectric conductivity similar to the simulated tissue, (3) relaxation times similar to simulated tissue, and (4) physiological motion similar to fetal gross body, cardiovascular, and breathing motion. This was followed by statistical analysis to identify significant findings. RESULTS Seventeen fetal phantoms were identified and had an average overall percentage accuracy of 26%, with anatomical accuracy being satisfied the most (56%) and physiological motion the least (7%). Phantoms constructed using 3D printing were significantly more accurate than conventionally constructed phantoms. DISCUSSION Currently available fetal phantoms lack accuracy and motion simulation. 3D printing may lead to higher accuracy compared with traditional manufacturing. Future research needs to focus on properly simulating both fetal anatomy and physiological motion to produce a phantom that is appropriate for fetal MRI sequence development and optimization.
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Affiliation(s)
- Michael Shulman
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, ON, M5B 2K3, Canada.,Institute for Biomedical Engineering, Science and Technology (iBEST), Ryerson University and St. Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Eunyoung Cho
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, ON, M5B 2K3, Canada.,Institute for Biomedical Engineering, Science and Technology (iBEST), Ryerson University and St. Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Bipin Aasi
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, ON, M5B 2K3, Canada.,Institute for Biomedical Engineering, Science and Technology (iBEST), Ryerson University and St. Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Jin Cheng
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, ON, M5B 2K3, Canada.,Institute for Biomedical Engineering, Science and Technology (iBEST), Ryerson University and St. Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Saiee Nithiyanantham
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, ON, M5B 2K3, Canada.,Institute for Biomedical Engineering, Science and Technology (iBEST), Ryerson University and St. Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Nicole Waddell
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, ON, M5B 2K3, Canada.,Institute for Biomedical Engineering, Science and Technology (iBEST), Ryerson University and St. Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Dafna Sussman
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, ON, M5B 2K3, Canada. .,Institute for Biomedical Engineering, Science and Technology (iBEST), Ryerson University and St. Michael's Hospital, Toronto, ON, M5B 1T8, Canada. .,The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, M5B 1T8, Canada. .,Department of Biomedical Physics, Ryerson University, Toronto, ON, M5B 2K3, Canada.
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47
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Carlin A, Kadji C, Cannie MM, Resta S, Kang X, Jani JC. The use of magnetic resonance imaging in the prediction of birthweight. Prenat Diagn 2019; 40:125-135. [PMID: 31319434 DOI: 10.1002/pd.5530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/05/2019] [Accepted: 07/08/2019] [Indexed: 01/11/2023]
Abstract
Extremes of fetal growth can increase adverse pregnancy outcomes, and this is equally applicable to single and multiple gestations. Traditionally, these cases have been identified using simple two-dimensional ultrasound which is quite limited by its low precision. Magnetic resonance imaging (MRI) has now been used for many years in obstetrics, mainly as an adjunct to ultrasound for congenital abnormalities and increasingly as part of the post-mortem examination. However, MRI can also be used to accurately assess fetal weight as first demonstrated by Baker et al in 1994, using body volumes rather than standard biometric measurements. This publication was followed by several others, all of which confirmed the superiority of MRI; however, despite this initial promise, the technique has never been successfully integrated into clinical practice. In this review, we provide an overview of the literature, detail the various techniques and formulas currently available, discuss the applicability to specific high-risk groups and present our vision for the future of MRI within clinical obstetrics.
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Affiliation(s)
- Andrew Carlin
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Kadji
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Brussels, Belgium.,Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Serena Resta
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Xin Kang
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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48
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Zaghal AA, Hussain HK, Berjawi GA. MRI evaluation of the placenta from normal variants to abnormalities of implantation and malignancies. J Magn Reson Imaging 2019; 50:1702-1717. [PMID: 31102327 DOI: 10.1002/jmri.26764] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/06/2022] Open
Abstract
Even though the placenta has been known for millennia, it is still considered one of the most complex and least understood human organs. Imaging of the placenta is gaining attention due to its impact on fetal and maternal outcomes. MRI plays a vital role in evaluation of inconclusive cases by ultrasonography. It enables precise mapping of placental abnormalities for proper multidisciplinary planning and management. In this article we provide a comprehensive in-depth review of the role of antenatal MR in evaluating "The Placenta." We will describe the protocols and techniques used for MRI of the placenta, review anatomy of the placenta, describe MRI features of major placental abnormalities including those related to position, depth of implantation, hemorrhage, gestational trophoblastic neoplasia, and retained products of conception and discuss the added value of MRI in the management and preoperative planning of such abnormalities. Level of Evidence: 3 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019;50:1702-1717.
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Affiliation(s)
- Arwa A Zaghal
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hero K Hussain
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghina A Berjawi
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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49
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Shah NM, Scott DM, Kandagatla P, Moravek MB, Cobain EF, Burness ML, Jeruss JS. Young Women with Breast Cancer: Fertility Preservation Options and Management of Pregnancy-Associated Breast Cancer. Ann Surg Oncol 2019; 26:1214-1224. [PMID: 30680478 PMCID: PMC6458084 DOI: 10.1245/s10434-019-07156-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy diagnosed in women of childbearing age. A breast cancer diagnosis in this young patient population can be uniquely complex to navigate when considering the potential impact of fertility loss associated with specific gonadotoxic therapies. Another unique challenge for young breast cancer patients is pregnancy-associated breast cancer (PABC), which occurs in approximately 1 of every 3000 pregnancies. Pregnancy adds a layer of complexity to breast cancer treatment planning as many therapies can affect the developing fetus. These two clinical challenges require nuanced multidisciplinary approaches to facilitate optimal treatment outcomes. We sought to review and summarize the management strategy options for both fertility preservation and PABC. METHODS A guideline and literature review was performed for fertility preservation, young patients with breast cancer, and pregnancy-associated breast cancer. RESULTS Fertility preservation options, both established and experimental, are detailed. Suggested clinical practice guidelines for PABC are also presented, which delineate breast cancer treatment recommendations based on pregnancy trimester. CONCLUSION A multidisciplinary approach to patient care, including oncologists and early referral to reproductive specialists, can provide young breast cancer patients with options for fertility preservation. Under the guidance of a multidisciplinary treatment team, PABC can also be diagnosed and treated to permit the best possible outcomes for the mother and the developing fetus.
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Affiliation(s)
- Nikita M Shah
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Dana M Scott
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Pridvi Kandagatla
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, Henry Ford Health System/Wayne State University, Detroit, MI, USA
| | - Molly B Moravek
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Erin F Cobain
- Division of Medical Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Monika L Burness
- Division of Medical Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jacqueline S Jeruss
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
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50
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Ahn T, Roberts MJ, Navaratnam A, Chung E, Wood ST. Wunder-women: Systematic review of causes, treatment and outcomes of Wunderlich syndrome during pregnancy. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818759367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1 years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine patients; 45%) and due to renal neoplasm, specifically angiomyolipoma (AML; 12 patients; 60%), followed by renal artery aneurysm (RAA; five patients; 25%). Surgical intervention (55%) was most commonly used for acute SRH. Foetal demise was not uncommon (15%). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4
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Affiliation(s)
- Thomas Ahn
- Department of Urology, Princess Alexandra Hospital, Australia
| | - Matthew J Roberts
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Australia
| | | | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- AndroUrology Centre, Australia
| | - Simon T Wood
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Australia
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