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Melbourne A, Schabel MC, David AL, Roberts VHJ. Magnetic resonance imaging of placental intralobule structure and function in a preclinical nonhuman primate model†. Biol Reprod 2024; 110:1065-1076. [PMID: 38442734 PMCID: PMC11180614 DOI: 10.1093/biolre/ioae035] [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: 11/01/2023] [Revised: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 03/07/2024] Open
Abstract
Although the central role of adequate blood flow and oxygen delivery is known, the lack of optimized imaging modalities to study placental structure has impeded our understanding of its vascular function. Magnetic resonance imaging is increasingly being applied in this field, but gaps in knowledge remain, and further methodological developments are needed. In particular, the ability to distinguish maternal from fetal placental perfusion and the understanding of how individual placental lobules are functioning are lacking. The potential clinical benefits of developing noninvasive tools for the in vivo assessment of blood flow and oxygenation, two key determinants of placental function, are tremendous. Here, we summarize a number of structural and functional magnetic resonance imaging techniques that have been developed and applied in animal models and studies of human pregnancy over the past decade. We discuss the potential applications and limitations of these approaches. Their combination provides a novel source of contrast to allow analysis of placental structure and function at the level of the lobule. We outline the physiological mechanisms of placental T2 and T2* decay and devise a model of how tissue composition affects the observed relaxation properties. We apply this modeling to longitudinal magnetic resonance imaging data obtained from a preclinical pregnant nonhuman primate model to provide initial proof-of-concept data for this methodology, which quantifies oxygen transfer and placental structure across and between lobules. This method has the potential to improve our understanding and clinical management of placental insufficiency once validation in a larger nonhuman primate cohort is complete.
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Affiliation(s)
- Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Obstetrics and Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Matthias C Schabel
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR, USA
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
| | - Anna L David
- Department of Obstetrics and Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Victoria H J Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Portland, OR, USA
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Slator PJ, Cromb D, Jackson LH, Ho A, Counsell SJ, Story L, Chappell LC, Rutherford M, Hajnal JV, Hutter J, Alexander DC. Non-invasive mapping of human placenta microenvironments throughout pregnancy with diffusion-relaxation MRI. Placenta 2023; 144:29-37. [PMID: 37952367 DOI: 10.1016/j.placenta.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION In-vivo measurements of placental structure and function have the potential to improve prediction, diagnosis, and treatment planning for a wide range of pregnancy complications, such as fetal growth restriction and pre-eclampsia, and hence inform clinical decision making, ultimately improving patient outcomes. MRI is emerging as a technique with increased sensitivity to placental structure and function compared to the current clinical standard, ultrasound. METHODS We demonstrate and evaluate a combined diffusion-relaxation MRI acquisition and analysis pipeline on a sizable cohort of 78 normal pregnancies with gestational ages ranging from 15 + 5 to 38 + 4 weeks. Our acquisition comprises a combined T2*-diffusion MRI acquisition sequence - which is simultaneously sensitive to oxygenation, microstructure and microcirculation. We analyse our scans with a data-driven unsupervised machine learning technique, InSpect, that parsimoniously identifies distinct components in the data. RESULTS We identify and map seven potential placental microenvironments and reveal detailed insights into multiple microstructural and microcirculatory features of the placenta, and assess their trends across gestation. DISCUSSION By demonstrating direct observation of micro-scale placental structure and function, and revealing clear trends across pregnancy, our work contributes towards the development of robust imaging biomarkers for pregnancy complications and the ultimate goal of a normative model of placental development.
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Affiliation(s)
- Paddy J Slator
- Cardiff University Brain Research Imaging Centre, School of Psychology, Maindy Road, Cardiff, CF24 4HQ, UK; School of Computer Science and Informatics, Cardiff University, Cardiff, UK; Centre for Medical Image Computing and Department of Computer Science, University College London, London, UK.
| | - Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Laurence H Jackson
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alison Ho
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Lisa Story
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, UK
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Aertsen M, Melbourne A, Couck I, King E, Ourselin S, De Keyzer F, Dymarkowski S, Deprest J, Lewi L. Placental differences between uncomplicated and complicated monochorionic diamniotic pregnancies on diffusion and multicompartment Magnetic Resonance Imaging. Placenta 2023; 142:106-114. [PMID: 37683336 DOI: 10.1016/j.placenta.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Twin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are common complications in monochorionic diamniotic (MCDA) pregnancies. The Diffusion-rElaxation Combined Imaging for Detailed Placental Evaluation (DECIDE) model, a placental-specific model, separates the T2 values of the fetal and maternal blood from the background tissue and estimates the fetal blood oxygen saturation. This study investigates diffusion and relaxation differences in uncomplicated MCDA pregnancies and MCDA pregnancies complicated by TTTS and sFGR in mid-pregnancy. METHODS This prospective monocentric cohort study included uncomplicated MCDA pregnancies and pregnancies complicated by TTTS and sFGR. We performed MRI with conventional diffusion-weighted imaging (DWI) and combined relaxometry - DWI-intravoxel incoherent motion. DECIDE analysis was used to quantify different parameters within the placenta related to the fetal, placental, and maternal compartments. RESULTS We included 99 pregnancies, of which 46 were uncomplicated, 12 were complicated by sFGR and 41 by TTTS. Conventional DWI did not find differences between or within cohorts. On DECIDE imaging, fetoplacental oxygen saturation was significantly lower in the smaller member of sFGR (p = 0.07) and in both members of TTTS (p = 0.01 and p = 0.004) compared to the uncomplicated pairs. Additionally, average T2 relaxation time was significantly lower in the smaller twin of the sFGR (p = 0.004) compared to the uncomplicated twins (p = 0.03). CONCLUSION Multicompartment functional MRI showed significant differences in several MRI parameters between the placenta of uncomplicated MCDA pregnancies and those complicated by sFGR and TTTS in mid-pregnancy.
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Affiliation(s)
- M Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium.
| | - A Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Medical Physics and Biomedical Engineering, University College London, UK
| | - I Couck
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - E King
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - S Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Medical Physics and Biomedical Engineering, University College London, UK
| | - F De Keyzer
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - S Dymarkowski
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - J Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium; Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, Perinatal Imaging and Health, King's College London, King's Health Partners, St.Thomas' Hospital, 1st Floor South Wing, London, SE1 7EH, UK
| | - L Lewi
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
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Cromb D, Slator PJ, De La Fuente M, Price AN, Rutherford M, Egloff A, Counsell SJ, Hutter J. Assessing within-subject rates of change of placental MRI diffusion metrics in normal pregnancy. Magn Reson Med 2023; 90:1137-1150. [PMID: 37183839 PMCID: PMC10962570 DOI: 10.1002/mrm.29665] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Studying placental development informs when development is abnormal. Most placental MRI studies are cross-sectional and do not study the extent of individual variability throughout pregnancy. We aimed to explore how diffusion MRI measures of placental function and microstructure vary in individual healthy pregnancies throughout gestation. METHODS Seventy-nine pregnant, low-risk participants (17 scanned twice and 62 scanned once) were included. T2 -weighted anatomical imaging and a combined multi-echo spin-echo diffusion-weighted sequence were acquired at 3 T. Combined diffusion-relaxometry models were performed using both aT 2 * $$ {\mathrm{T}}_2^{\ast } $$ -ADC and a bicompartmentalT 2 * $$ {\mathrm{T}}_2^{\ast } $$ -intravoxel-incoherent-motion (T 2 * IVIM $$ {\mathrm{T}}_2^{\ast}\;\mathrm{IVIM} $$ ) model fit. RESULTS There was a significant decline in placentalT 2 * $$ {\mathrm{T}}_2^{\ast } $$ and ADC (both P < 0.01) over gestation. These declines are consistent in individuals forT 2 * $$ {\mathrm{T}}_2^{\ast } $$ (covariance = -0.47), but not ADC (covariance = -1.04). TheT 2 * IVIM $$ {\mathrm{T}}_2^{\ast}\;\mathrm{IVIM} $$ model identified a consistent decline in individuals over gestation inT 2 * $$ {\mathrm{T}}_2^{\ast } $$ from both the perfusing and diffusing placental compartments, but not in ADC values from either. The placental perfusing compartment fraction increased over gestation (P = 0.0017), but this increase was not consistent in individuals (covariance = 2.57). CONCLUSION Whole placentalT 2 * $$ {\mathrm{T}}_2^{\ast } $$ and ADC values decrease over gestation, although onlyT 2 * $$ {\mathrm{T}}_2^{\ast } $$ values showed consistent trends within subjects. There was minimal individual variation in rates of change ofT 2 * $$ {\mathrm{T}}_2^{\ast } $$ values from perfusing and diffusing placental compartments, whereas trends in ADC values from these compartments were less consistent. These findings probably relate to the increased complexity of the bicompartmentalT 2 * IVIM $$ {\mathrm{T}}_2^{\ast}\;\mathrm{IVIM} $$ model, and differences in how different placental regions evolve at a microstructural level. These placental MRI metrics from low-risk pregnancies provide a useful benchmark for clinical cohorts.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Paddy J. Slator
- Centre for Medical Image Computing, Department of Computer ScienceUniversity College LondonLondonUK
| | - Miguel De La Fuente
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Anthony N. Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Centre for Medical EngineeringSchool of Biomedical Engineering and Imaging Sciences, King's College LondonLondonUK
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- MRC Centre for Neurodevelopmental DisordersKing's College LondonLondonUK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Serena J. Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Centre for Medical EngineeringSchool of Biomedical Engineering and Imaging Sciences, King's College LondonLondonUK
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Manganaro L, Capuani S, Gennarini M, Miceli V, Ninkova R, Balba I, Galea N, Cupertino A, Maiuro A, Ercolani G, Catalano C. Fetal MRI: what's new? A short review. Eur Radiol Exp 2023; 7:41. [PMID: 37558926 PMCID: PMC10412514 DOI: 10.1186/s41747-023-00358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/22/2023] [Indexed: 08/11/2023] Open
Abstract
Fetal magnetic resonance imaging (fetal MRI) is usually performed as a second-level examination following routine ultrasound examination, generally exploiting morphological and diffusion MRI sequences. The objective of this review is to describe the novelties and new applications of fetal MRI, focusing on three main aspects: the new sequences with their applications, the transition from 1.5-T to 3-T magnetic field, and the new applications of artificial intelligence software. This review was carried out by consulting the MEDLINE references (PubMed) and including only peer-reviewed articles written in English. Among the most important novelties in fetal MRI, we find the intravoxel incoherent motion model which allow to discriminate the diffusion from the perfusion component in fetal and placenta tissues. The transition from 1.5-T to 3-T magnetic field allowed for higher quality images, thanks to the higher signal-to-noise ratio with a trade-off of more frequent artifacts. The application of motion-correction software makes it possible to overcome movement artifacts by obtaining higher quality images and to generate three-dimensional images useful in preoperative planning.Relevance statementThis review shows the latest developments offered by fetal MRI focusing on new sequences, transition from 1.5-T to 3-T magnetic field and the emerging role of AI software that are paving the way for new diagnostic strategies.Key points• Fetal magnetic resonance imaging (MRI) is a second-line imaging after ultrasound.• Diffusion-weighted imaging and intravoxel incoherent motion sequences provide quantitative biomarkers on fetal microstructure and perfusion.• 3-T MRI improves the detection of cerebral malformations.• 3-T MRI is useful for both body and nervous system indications.• Automatic MRI motion tracking overcomes fetal movement artifacts and improve fetal imaging.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy.
| | - Silvia Capuani
- National Research Council (CNR),, Institute for Complex Systems (ISC) c/o Physics Department Sapienza University of Rome, Rome, Italy
| | - Marco Gennarini
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Valentina Miceli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Angelica Cupertino
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandra Maiuro
- National Research Council (CNR),, Institute for Complex Systems (ISC) c/o Physics Department Sapienza University of Rome, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
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Clark A, Flouri D, Mufti N, James J, Clements E, Aughwane R, Aertsen M, David A, Melbourne A. Developments in functional imaging of the placenta. Br J Radiol 2023; 96:20211010. [PMID: 35234516 PMCID: PMC10321248 DOI: 10.1259/bjr.20211010] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022] Open
Abstract
The placenta is both the literal and metaphorical black box of pregnancy. Measurement of the function of the placenta has the potential to enhance our understanding of this enigmatic organ and serve to support obstetric decision making. Advanced imaging techniques are key to support these measurements. This review summarises emerging imaging technology being used to measure the function of the placenta and new developments in the computational analysis of these data. We address three important examples where functional imaging is supporting our understanding of these conditions: fetal growth restriction, placenta accreta, and twin-twin transfusion syndrome.
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Affiliation(s)
- Alys Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Joanna James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eleanor Clements
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Rosalind Aughwane
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Anna David
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
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Slator PJ, Verdera JA, Tomi-Tricot R, Hajnal JV, Alexander DC, Hutter J. Low-Field Combined Diffusion-Relaxation MRI for Mapping Placenta Structure and Function. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.06.23290983. [PMID: 37333076 PMCID: PMC10274995 DOI: 10.1101/2023.06.06.23290983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Purpose Demonstrating quantitative multi-parametric mapping in the placenta with combined T 2 ∗ -diffusion MRI at low-field (0.55T). Methods We present 57 placental MRI scans performed on a commercially available 0.55T scanner. We acquired the images using a combined T 2 ∗ -diffusion technique scan that simultaneously acquires multiple diffusion preparations and echo times. We processed the data to produce quantitative T 2 ∗ and diffusivity maps using a combined T 2 ∗ -ADC model. We compared the derived quantitative parameters across gestation in healthy controls and a cohort of clinical cases. Results Quantitative parameter maps closely resemble those from previous experiments at higher field strength, with similar trends in T 2 ∗ and ADC against gestational age observed. Conclusion Combined T 2 ∗ -diffusion placental MRI is reliably achievable at 0.55T. The advantages of lower field strength - such as cost, ease of deployment, increased accessibility and patient comfort due to the wider bore, and increased T 2 ∗ for larger dynamic ranges - can support the widespread roll out of placental MRI as an adjunct to ultrasound during pregnancy.
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Affiliation(s)
- Paddy J Slator
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Jordina Aviles Verdera
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Raphael Tomi-Tricot
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Daniel C Alexander
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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He J, Chen Z, Chen C, Liu P. Differences in placental oxygenation and perfusion status between fetal growth-restricted and small-for-gestational-age pregnancies: a functional magnetic resonance imaging study. Eur Radiol 2023; 33:1729-1736. [PMID: 36269372 DOI: 10.1007/s00330-022-09185-5] [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: 03/28/2022] [Revised: 07/22/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Functional magnetic resonance imaging (MRI) can assess oxygenation and perfusion status in the placenta. We aimed to explore the differences in functional parameters between pregnancies complicated by fetal growth restriction (FGR) and small-for-gestational-age (SGA). METHODS This was a prospective study. A pregnancy complicated by SGA was defined by prenatal ultrasonic estimated fetal weight (EFW) and a final birthweight < the 10th percentile. A pregnancy complicated by FGR was defined as a more severe subtype (ultrasonic EFW < the 3rd percentile or abnormal Doppler results). All pregnant women underwent T2* and intravoxel incoherent motion (IVIM) scans using a 3.0-T MRI scanner. Functional parameters in the control, SGA, and FGR groups, namely, the T2* Z score, apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f), were calculated and compared. RESULTS In total, 30 pregnancies complicated by SGA, 24 pregnancies complicated by FGR, and 28 control pregnancies were included in the final analysis. Oxygenation status, as assessed by the T2* Z score, was significantly lower in pregnancies complicated by FGR than in pregnancies complicated by SGA (p < 0.001). However, diffusion and perfusion parameters, including the ADC, D, D*, and f, were similar between pregnancies complicated by SGA and FGR (p > 0.05 for all). Compared to the control pregnancies, all the parameters were significantly decreased in the SGA and FGR groups, except for the D* value. The T2* Z score, ADC, and D values were negatively correlated with birthweight. CONCLUSION Although both pregnancies complicated by SGA and FGR were associated with significantly lower oxygenation and perfusion than normal control pregnancies, placental hypoxia seemed to be more predominant in pregnancies complicated by FGR than in pregnancies complicated by SGA. KEY POINTS • Pregnancy complicated by FGR was associated with a more severe type of hypoxia than pregnancy complicated by SGA. • The diffusion and perfusion parameters of pregnancies complicated by SGA and FGR were similar. • SGA may represent another growth disorder that is not entirely healthy.
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Affiliation(s)
- Junshen He
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China
| | - Zhao Chen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China.
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China.
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Differentiating between normal and fetal growth restriction-complicated placentas: is T2∗ imaging imaging more accurate than conventional diffusion-weighted imaging? Clin Radiol 2023; 78:362-368. [PMID: 36858925 DOI: 10.1016/j.crad.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
AIM To compare the performance of T2∗ imaging and apparent diffusion coefficient (ADC) in differentiating normal placentas from those complicated by fetal growth restriction (FGR). MATERIALS AND METHODS This prospective study included 28 control and 30 FGR placentas. Gradient-echo magnetic resonance imaging (MRI) at 16 different echo times and diffusion-weighted imaging (b-value of 0 and 800 s/mm2) were performed on all pregnant women using a 3 T MRI system. RESULTS Both T2∗ imaging Z-score and ADC were significantly lower in the FGR placentas (ADC, (1.69 ± 0.19) × 10-3 versus (1.42 ± 0.28) × 10-3 mm2/s, p<0.001; T2∗ imaging Z-score, -0.004 ± 0.95 versus -2.441 ± 1.48, p<0.001). The area under the curve for T2∗ imaging Z-score and ADC was 0.917 (95% confidence interval [CI] = 0.842-0.991) and 0.788 (95% CI = 0.655-0.887), respectively. The performance of T2∗ imaging in differentiating FGR placentas was significantly better than that of ADC (Z = 2.043, p=0.041). CONCLUSION Placental T2∗ imaging was found to be more reliable than ADC in differentiating between normal and FGR placentas.
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Sun Z, Wu W, Zhao P, Wang Q, Woodard PK, Nelson DM, Odibo A, Cahill A, Wang Y. Association of intraplacental oxygenation patterns on dual-contrast MRI with placental abnormality and fetal brain oxygenation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:215-223. [PMID: 35638228 PMCID: PMC9708928 DOI: 10.1002/uog.24959] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Most human in-vivo placental imaging techniques are unable to distinguish and characterize various placental compartments, such as the intervillous space (IVS), placental vessels (PV) and placental tissue (PT), limiting their specificity. We describe a method that employs T2* and diffusion-weighted magnetic resonance imaging (MRI) data to differentiate automatically placental compartments, quantify their oxygenation properties and identify placental lesions (PL) in vivo. We also investigate the association between placental oxygenation patterns and fetal brain oxygenation. METHODS This was a prospective study conducted between 2018 and 2021 in which dual-contrast clinical MRI data (T2* and diffusion-weighted MRI) were acquired from patients between 20 and 38 weeks' gestation. We trained a fuzzy clustering method to analyze T2* and diffusion-weighted MRI data and assign placental voxels to one of four clusters, based on their distinct imaging domain features. The new method divided automatically the placenta into IVS, PV, PT and PL compartments and characterized their oxygenation changes throughout pregnancy. RESULTS A total of 27 patients were recruited, of whom five developed pregnancy complications. Total placental oxygenation level and T2* did not demonstrate a statistically significant temporal correlation with gestational age (GA) (R2 = 0.060, P = 0.27). In contrast, the oxygenation level reflected by T2* values in the placental IVS (R2 = 0.51, P = 0.0002) and PV (R2 = 0.76, P = 1.1 × 10-7 ) decreased significantly with advancing GA. Oxygenation levels in the PT did not show any temporal change during pregnancy (R2 = 0.00044, P = 0.93). A strong spatial-dependent correlation between PV oxygenation level and GA was observed. The strongest negative correlation between PV oxygenation and GA (R2 = 0.73, P = 4.5 × 10-7 ) was found at the fetal-vessel-dominated region close to the chorionic plate. The location and extent of the placental abnormality were automatically delineated and quantified in the five women with clinically confirmed placental pathology. Compared to the averaged total placental oxygenation, placental IVS oxygenation level best reflected fetal brain oxygenation level during fetal development. CONCLUSION Based on clinically feasible dual-MRI, our method enables accurate spatiotemporal quantification of placental compartment and fetal brain oxygenation across different GAs. This information should improve our knowledge of human placenta development and its relationship with normal and abnormal pregnancy. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Z. Sun
- Department of Biomedical EngineeringWashington University in St LouisSt LouisMOUSA
- Department of Obstetrics and GynecologyWashington University School of Medicine, Washington University in St LouisSt LouisMOUSA
| | - W. Wu
- Department of Biomedical EngineeringWashington University in St LouisSt LouisMOUSA
- Department of Obstetrics and GynecologyWashington University School of Medicine, Washington University in St LouisSt LouisMOUSA
| | - P. Zhao
- Department of Obstetrics and GynecologyWashington University School of Medicine, Washington University in St LouisSt LouisMOUSA
| | - Q. Wang
- Mallinckrodt Institute of RadiologyWashington University School of Medicine, Washington University in St LouisSt LouisMOUSA
| | - P. K. Woodard
- Department of Biomedical EngineeringWashington University in St LouisSt LouisMOUSA
- Mallinckrodt Institute of RadiologyWashington University School of Medicine, Washington University in St LouisSt LouisMOUSA
| | - D. M. Nelson
- Department of Obstetrics and GynecologyWashington University School of Medicine, Washington University in St LouisSt LouisMOUSA
| | - A. Odibo
- Department of Obstetrics and GynecologyWashington University School of Medicine, Washington University in St LouisSt LouisMOUSA
| | - A. Cahill
- Department of Women's HealthUniversity of Texas at Austin, Dell Medical SchoolAustinTXUSA
| | - Y. Wang
- Department of Biomedical EngineeringWashington University in St LouisSt LouisMOUSA
- Department of Obstetrics and GynecologyWashington University School of Medicine, Washington University in St LouisSt LouisMOUSA
- Mallinckrodt Institute of RadiologyWashington University School of Medicine, Washington University in St LouisSt LouisMOUSA
- Department of Electrical & Systems EngineeringWashington University in St LouisSt LouisMOUSA
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11
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Evaluation of placental oxygenation in fetal growth restriction using blood oxygen level-dependent magnetic resonance imaging. Placenta 2022; 126:40-45. [PMID: 35750000 DOI: 10.1016/j.placenta.2022.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Abnormalities in placental function can lead to fetal growth restriction (FGR), but there is no consensus on their evaluation. Using blood oxygen level-dependent magnetic resonance imaging (BOLD MRI), we compared placental oxygenation between FGR cases and previously reported normal pregnancies. METHODS Eight singleton pregnant women (>32 weeks of gestation) diagnosed with fetal growth failure during pregnancy were recruited. BOLD MRI was consecutively performed under normoxia (21% O2), hyperoxia (100% O2), and normoxia for 4 min each. Each placental time-activity curve was evaluated to calculate the peak score (peakΔR2*) and the time from the start of maternal oxygen administration to the time of peakΔR2* (time to peakΔR2*). In six of the eight FGR cases, placental FGR-related pathological findings were evaluated after delivery. RESULTS The parameter peakΔR2* was significantly decreased in the FGR group (8 ± 3 vs 6 ± 1, p < 0.001), but there was no significant difference in time to peakΔR2* (458 ± 74 s vs 468 ± 57 s, p = 0.750). The findings in the six FGR cases assessed for placental pathologies included chorangiosis in two cases, avascular chorions in two cases, placental infarction in two cases, and syncytial knot formation in one case. DISCUSSION The peakΔR2* values were lower in the FGR group than in the normal pregnancy group. This suggests that oxygenation of the placenta is decreased in the FGR group compared to the normal group, and this may be related to FGR. Placental pathology also revealed findings possibly related to FGR, suggesting that low peakΔR2* values in the FGR group may reflect placental dysfunction.
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12
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Antonelli A, Capuani S, Ercolani G, Dolciami M, Ciulla S, Celli V, Kuehn B, Piccioni MG, Giancotti A, Porpora MG, Catalano C, Manganaro L. Human placental microperfusion and microstructural assessment by intra-voxel incoherent motion MRI for discriminating intrauterine growth restriction: a pilot study. J Matern Fetal Neonatal Med 2022; 35:9667-9674. [PMID: 35291892 DOI: 10.1080/14767058.2022.2050365] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To evaluate the potential of Intravoxel Incoherent Motion (IVIM) Imaging in the quantification of placental micro-perfusion and microstructural features to identify and discriminate different forms of intrauterine growth restriction (IUGR) and normal fetuses pregnancies. METHODS Small for gestational age SGA (n = 8), fetal growth restriction FGR (n = 10), and normal (n = 49) pregnancies were included in the study. Placental Magnetic Resonance Imaging (MRI) was performed at 1.5 T using a diffusion-weighted sequence with 10 b-values. IVIM fractional perfusion (fp), diffusion (D), and pseudodiffusion (D*) were evaluated on the fetal and maternal placental sides. Correlations between IVIM parameters, Gestational Age (GA), Birth Weight (BW), and the presence or absence of prenatal fetoplacental Doppler abnormalities at the US were investigated in SGA, FGR, and normal placentae. RESULTS fp and D* of the placental fetal side discriminate between SGA and FGR (p = .021; p = .036, respectively), showing lower values in FGR. SGA showed an intermediate perfusion pattern in terms of fp and D* compared to FGR and normal controls. In the intrauterine growth restriction group (SGA + FGR), a significant positive correlation was found between fp and BW (p < .002) in the fetal placenta and a significant negative correlation was found between D and GA in both the fetal (p < .0009) and maternal (p < .006) placentas. CONCLUSIONS Perfusion IVIM parameters fp and D* may be useful to discriminate different micro-vascularization patterns in IUGR being helpful to detect microvascular subtle impairment even in fetuses without any sign of US Doppler impairment in utero. Moreover, fp may predict fetuses' body weight in intrauterine growth restriction pregnancies. The diffusion IVIM parameter D may reflect more rapid microstructural rearrangement of the placenta due to aging processes in the IUGR group than in normal controls.
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Affiliation(s)
- Amanda Antonelli
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Silvia Capuani
- Physics Department, CNR Institute for Complex Systems (ISC), "Sapienza" University of Rome, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | | | - Maria Grazia Piccioni
- Department of Gynaecological-Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Giancotti
- Department of Gynaecological-Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Maria Grazia Porpora
- Department of Gynaecological-Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
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13
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Mizutani T, Kotani T, Kato N, Imai K, Ushida T, Nakano-Kobayashi T, Kinoshita Y, Ito M, Kinoshita F, Yamamuro O, Kajiyama H. Assessment of placental abruption with diffusion-weighted imaging. J Obstet Gynaecol Res 2022; 48:930-937. [PMID: 35194877 DOI: 10.1111/jog.15183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/28/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether placental abruption without fetal distress could be assessed by apparent diffusion coefficient (ADC) values in magnetic resonance imaging (MRI). METHODS We conducted a retrospective case-control study at a single center. ADC values at the lesions of placental abruption in the abruption group (n = 8) were compared to those in the control group (n = 32). In the abruption group, ADC values at the sites of abruption were also compared to those at the nonabruption sites within the same placenta. RESULTS The ADC values in the placental area above the abruption site in the abruption group showed lower values than those in the control group when the slice containing the umbilical cord insertion site was set as the reference, and those values were compared in each corresponding slice. Compared with average ADC values, those above the abruption site in the abruption group were also significantly lower than those in the control group (p < 0.001). Furthermore, ADC values at the area above abruption were lower than those at the nonabruption area of all planes in the abruption group. CONCLUSIONS ADC values at the lesions above the placental abruption site were reduced compared to those in the normal placenta and those in the nonabruption area. Thus, it would be helpful to understand the pathophysiology of placental abruption in expectant management, although further investigations would be needed.
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Affiliation(s)
- Teruyuki Mizutani
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Obstetrics and Gynaecology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Noriko Kato
- Department of Obstetrics and Gynaecology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano-Kobayashi
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshimi Kinoshita
- Diagnostic Radiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Masato Ito
- Diagnostic Radiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Fumie Kinoshita
- Data Science Division, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Osamu Yamamuro
- Department of Obstetrics and Gynaecology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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14
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Liu XL, Feng J, Huang CT, Mei YJ, Xu YK. Use of intravoxel incoherent motion MRI to assess placental perfusion in normal and Fetal Growth Restricted pregnancies on their third trimester. Placenta 2021; 118:10-15. [PMID: 34995915 DOI: 10.1016/j.placenta.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/11/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Intravoxel Incoherent Motion (IVIM) MRI is a non-invasive, in vivo techniques which can assess placental perfusion quantitatively, and be useful for evaluating placental microcirculation. Our primary aim was to investigate whether fetal growth restriction (FGR) pregnancies have different placental perfusion and diffusion compared with normal pregnancies using IVIM. A secondary aim was to investigate correlations between placental IVIM parameters and gestational age in normal pregnancy. METHODS This study population included 17 FGR pregnancies and 36 normal pregnancies between 28 + 3 to 38 + 0 weeks. All women underwent a MRI examination including an IVIM sequence with 9 b-values on a 3.0 T MRI system. The standard diffusion coefficeint (D), pseudodiffusion (D*) and perfusion fraction (f) were calculated. RESULTS Placental f was significantly lower in the FGR group than that in the normal group (33.96 ± 2.62(%) vs 38.48 ± 5.31(%), p = 0.002). Placental D and D* in two groups showed no statistical significance (P > 0.05). Placental f moderately increased with increasing gestational age in normal pregnancies (r = 0.411, p = 0.013), and there existed a negative correlation between D values and gestational age (r = -0.390, p = 0.019). DISCUSSION The f values are able to distinguish FGR from normal pregnancies. It can be uses as a feasible index to evaluate placenta perfusion. Gestational age-associated changes in placental IVIM parameters likely reveal trajectories of microvascular perfusion fraction and diffusion characteristics in the normal developing placenta.
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Affiliation(s)
- Xi-Long Liu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Jie Feng
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Chan-Tao Huang
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Ying-Jie Mei
- Philips Healthcare, Guangzhou, Guangdong, 510055, China
| | - Yi-Kai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China.
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15
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Slator PJ, Palombo M, Miller KL, Westin C, Laun F, Kim D, Haldar JP, Benjamini D, Lemberskiy G, de Almeida Martins JP, Hutter J. Combined diffusion-relaxometry microstructure imaging: Current status and future prospects. Magn Reson Med 2021; 86:2987-3011. [PMID: 34411331 PMCID: PMC8568657 DOI: 10.1002/mrm.28963] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/25/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022]
Abstract
Microstructure imaging seeks to noninvasively measure and map microscopic tissue features by pairing mathematical modeling with tailored MRI protocols. This article reviews an emerging paradigm that has the potential to provide a more detailed assessment of tissue microstructure-combined diffusion-relaxometry imaging. Combined diffusion-relaxometry acquisitions vary multiple MR contrast encodings-such as b-value, gradient direction, inversion time, and echo time-in a multidimensional acquisition space. When paired with suitable analysis techniques, this enables quantification of correlations and coupling between multiple MR parameters-such as diffusivity, T 1 , T 2 , and T 2 ∗ . This opens the possibility of disentangling multiple tissue compartments (within voxels) that are indistinguishable with single-contrast scans, enabling a new generation of microstructural maps with improved biological sensitivity and specificity.
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Affiliation(s)
- Paddy J. Slator
- Centre for Medical Image ComputingDepartment of Computer ScienceUniversity College LondonLondonUK
| | - Marco Palombo
- Centre for Medical Image ComputingDepartment of Computer ScienceUniversity College LondonLondonUK
| | - Karla L. Miller
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Carl‐Fredrik Westin
- Department of RadiologyBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Frederik Laun
- Institute of RadiologyUniversity Hospital ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Daeun Kim
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
- Signal and Image Processing InstituteUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Justin P. Haldar
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
- Signal and Image Processing InstituteUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Dan Benjamini
- The Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMDUSA
- The Center for Neuroscience and Regenerative MedicineUniformed Service University of the Health SciencesBethesdaMDUSA
| | | | - Joao P. de Almeida Martins
- Division of Physical Chemistry, Department of ChemistryLund UniversityLundSweden
- Department of Radiology and Nuclear MedicineSt. Olav’s University HospitalTrondheimNorway
| | - Jana Hutter
- Centre for Biomedical EngineeringSchool of Biomedical Engineering and ImagingKing’s College LondonLondonUK
- Centre for the Developing BrainSchool of Biomedical Engineering and ImagingKing’s College LondonLondonUK
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16
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Link-Sourani D, Avisdris N, Harel S, Ben-Sira L, Ganot T, Gordon Z, Many A, Ben Bashat D. Ex-Vivo MRI of the Normal Human Placenta: Structural-Functional Interplay and the Association With Birth Weight. J Magn Reson Imaging 2021; 56:134-144. [PMID: 34799945 DOI: 10.1002/jmri.28002] [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] [Received: 08/27/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advanced magnetic resonance imaging (MRI) methods are increasingly being used to assess the human placenta. Yet, the structure-function interplay in normal placentas and their associations with pregnancy risks are not fully understood. PURPOSE To characterize the normal human placental structure (volume and umbilical cord centricity index (CI)) and function (perfusion) ex-vivo using MRI, to assess their association with birth weight (BW), and identify imaging-markers for placentas at risk for dysfunction. STUDY TYPE Prospective. POPULATION Twenty normal term ex-vivo placentas. FIELD STRENGTH/SEQUENCE 3 T/ T1 and T2 weighted (T1 W, T2 W) turbo spin-echo, three-dimensional susceptibility-weighted image, and time-resolved angiography with interleaved stochastic trajectories (TWIST), during passage of a contrast agent using MRI compatible perfusion system that mimics placental flow. ASSESSMENT Placental volume and CI were manually extracted from the T1 W images by a fetal-placental MRI scientist (D.L., 7 years of experience). Perfusion maps including bolus arrival-time and full-width at half maximum were calculated from the TWIST data. Mean values, entropy, and asymmetries were calculated from each perfusion map, relating to both the whole placenta and volumes of interest (VOIs) within the umbilical cord and its daughter blood vessels. STATISTICAL TESTS Pearson correlations with correction for multiple comparisons using false discovery rate were performed between structural and functional parameters, and with BW, with P < 0.05 considered significant. RESULTS All placentas were successfully perfused and scanned. Significant correlations were found between whole placenta and VOIs perfusion parameters (mean R = 0.76 ± 0.06, range = 0.67-0.89), which were also significantly correlated with CI (mean R = 0.72 ± 0.05, range = 0.65-0.79). BW was correlated with placental volume (R = 0.62), but not with CI (P = 0.40). BW was also correlated with local perfusion asymmetry (R = -0.71). DATA CONCLUSION Results demonstrate a gradient of placental function, associated with CI and suggest several ex-vivo imaging-markers that might indicate an increased risk for placental dysfunction. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
| | - Netanell Avisdris
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shaul Harel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Liat Ben-Sira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Ganot
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zoya Gordon
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Medical Engineering, Afeka, Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Ariel Many
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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17
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Andescavage N, Limperopoulos C. Emerging placental biomarkers of health and disease through advanced magnetic resonance imaging (MRI). Exp Neurol 2021; 347:113868. [PMID: 34562472 DOI: 10.1016/j.expneurol.2021.113868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022]
Abstract
Placental dysfunction is a major cause of fetal demise, fetal growth restriction, and preterm birth, as well as significant maternal morbidity and mortality. Infant survivors of placental dysfunction are at elevatedrisk for lifelong neuropsychiatric morbidity. However, despite the significant consequences of placental disease, there are no clinical tools to directly and non-invasively assess and measure placental function in pregnancy. In this work, we will review advanced MRI techniques applied to the study of the in vivo human placenta in order to better detail placental structure, architecture, and function. We will discuss the potential of these measures to serve as optimal biomarkers of placental dysfunction and review the evidence of these tools in the discrimination of health and disease in pregnancy. Efforts to advance our understanding of in vivo placental development are necessary if we are to optimize healthy pregnancy outcomes and prevent brain injury in successive generations. Current management of many high-risk pregnancies cannot address placental maldevelopment or injury, given the standard tools available to clinicians. Once accurate biomarkers of placental development and function are constructed, the subsequent steps will be to introduce maternal and fetal therapeutics targeting at optimizing placental function. Applying these biomarkers in future studies will allow for real-time assessments of safety and efficacy of novel interventions aimed at improving maternal-fetal well-being.
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Affiliation(s)
- Nickie Andescavage
- Developing Brain Institute, Department of Radiology, Children's National, Washington DC, USA; Department of Neonatology, Children's National, Washington DC, USA
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18
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Srinivasan V, Melbourne A, Oyston C, James JL, Clark AR. Multiscale and multimodal imaging of utero-placental anatomy and function in pregnancy. Placenta 2021; 112:111-122. [PMID: 34329969 DOI: 10.1016/j.placenta.2021.07.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
Placental structures at the nano-, micro-, and macro scale each play important roles in contributing to its function. As such, quantifying the dynamic way in which placental structure evolves during pregnancy is critical to both clinical diagnosis of pregnancy disorders, and mechanistic understanding of their pathophysiology. Imaging the placenta, both exvivo and invivo, can provide a wealth of structural and/or functional information. This review outlines how imaging across modalities and spatial scales can ultimately come together to improve our understanding of normal and pathological pregnancies. We discuss how imaging technologies are evolving to provide new insights into placental physiology across disciplines, and how advanced computational algorithms can be used alongside state-of-the-art imaging to obtain a holistic view of placental structure and its associated functions to improve our understanding of placental function in health and disease.
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Affiliation(s)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, Kings College London, UK
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand
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19
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Hutter J, Ho A, Jackson LH, Slator PJ, Chappell LC, Hajnal JV, Rutherford MA. An efficient and combined placental T 1 -ADC acquisition in pregnancies with and without pre-eclampsia. Magn Reson Med 2021; 86:2684-2691. [PMID: 34268807 DOI: 10.1002/mrm.28809] [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: 11/13/2020] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE To provide a new approach to jointly assess microstructural and molecular properties of the human placenta in vivo fast and efficiently and to present initial evidence in cohorts of healthy pregnancies and those affected by pre-eclampsia. METHODS Slice and diffusion preparation shuffling, built on the previously proposed ZEBRA method, is presented as a robust and fast way to obtain T 1 and apparent diffusivity coefficient (ADC) values. Joint modeling and evaluation is performed on a cohort of healthy and pre-eclamptic participants at 3T. RESULTS The datasets show the ability to obtain robust and fast T 1 -ADC measurements. Significant decay over gestation in T 1 (-11 ms/week, P < . 05 ) and a trend toward significance in ADC (-0.23 mm/ s 2 /week, P = .08) values can be observed in a control cohort. Values for the pre-eclamptic pregnancies show a negative trend for both ADC and T 1 . CONCLUSIONS The presented sequence allows the simultaneous acquisition of 2 of the most promising quantitative parameters to study placental insufficiency-identified individually as relevant in previous studies-in under 2 minutes. This allows dynamic assessment of physiological processes, reduced inconsistency in spatial comparisons due to reduced motion artefacts and opens novel avenues for analysis. Initial results in pre-eclamptic placentas, with depicted changes in both ADC and T 1 , illustrate its potential to identify cases of placental insufficiency. Future work will focus on expanding the field-of-view using multi-band acceleration techniques and the expansion to larger and more diverse patient groups.
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Affiliation(s)
- Jana Hutter
- Center for Medical Engineering, King's College London, London, UK
- Center for the Developing Brain, School of Biomedical Engineering and Imaging, King's College London, London, UK
| | - Alison Ho
- Academic Women's Health Department, King's College London, London, UK
| | - Laurence H Jackson
- Center for Medical Engineering, King's College London, London, UK
- Center for the Developing Brain, School of Biomedical Engineering and Imaging, King's College London, London, UK
| | - Paddy J Slator
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Lucy C Chappell
- Academic Women's Health Department, King's College London, London, UK
| | - Joseph V Hajnal
- Center for Medical Engineering, King's College London, London, UK
- Center for the Developing Brain, School of Biomedical Engineering and Imaging, King's College London, London, UK
| | - Mary A Rutherford
- Center for Medical Engineering, King's College London, London, UK
- Center for the Developing Brain, School of Biomedical Engineering and Imaging, King's College London, London, UK
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20
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Markovic S, Roussel T, Neeman M, Frydman L. Deuterium Magnetic Resonance Imaging and the Discrimination of Fetoplacental Metabolism in Normal and L-NAME-Induced Preeclamptic Mice. Metabolites 2021; 11:metabo11060376. [PMID: 34200839 PMCID: PMC8230481 DOI: 10.3390/metabo11060376] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022] Open
Abstract
Recent magnetic resonance studies in healthy and cancerous organs have concluded that deuterated metabolites possess highly desirable properties for mapping non-invasively and, as they happen, characterizing glycolysis and other biochemical processes in animals and humans. A promising avenue of this deuterium metabolic imaging (DMI) approach involves looking at the fate of externally administered 2H6,6′-glucose, as it is taken up and metabolized into different products as a function of time. This study employs deuterium magnetic resonance to follow the metabolism of wildtype and preeclamptic pregnant mice models, focusing on maternal and fetoplacental organs over ≈2 h post-injection. 2H6,6′-glucose uptake was observed in the placenta and in specific downstream organs such as the fetal heart and liver. Main metabolic products included 2H3,3′-lactate and 2H-water, which were produced in individual fetoplacental organs with distinct time traces. Glucose uptake in the organs of most preeclamptic animals appeared more elevated than in the control mice (p = 0.02); also higher was the production of 2H-water arising from this glucose. However, the most notable differences arose in the 2H3,3′-lactate concentration, which was ca. two-fold more abundant in the placenta (p = 0.005) and in the fetal (p = 0.01) organs of preeclamptic-like animals, than in control mice. This is consistent with literature reports about hypoxic conditions arising in preeclamptic and growth-restricted pregnancies, which could lead to an enhancement in anaerobic glycolysis. Overall, the present measurements suggest that DMI, a minimally invasive approach, may offer new ways of studying and characterizing health and disease in mammalian pregnancies, including humans.
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Affiliation(s)
- Stefan Markovic
- Department of Chemical and Biological Physics, Weizmann Institute of Science, Rehovot 7610001, Israel;
| | - Tangi Roussel
- Center for Magnetic Resonance in Biology and Medicine, 13385 Marseille, France;
| | - Michal Neeman
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 7610001, Israel;
| | - Lucio Frydman
- Department of Chemical and Biological Physics, Weizmann Institute of Science, Rehovot 7610001, Israel;
- Correspondence: ; Tel.: +972-8934-4093
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21
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Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology. EBioMedicine 2021; 67:103326. [PMID: 33965347 PMCID: PMC8176120 DOI: 10.1016/j.ebiom.2021.103326] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background The umbilical artery (UA) Doppler pulsatility index is used clinically to detect elevated feto-placental vascular resistance. However, this metric is confounded by variation in fetal cardiac function and is only moderately predictive of placental pathology. Our group developed a novel ultrasound methodology that measures wave reflections in the UA, thereby isolating a component of the Doppler signal that is specific to the placenta. The present study examined whether wave reflections in the UA are predictive of placental vascular pathology. Methods Standard clinical Doppler ultrasound of the UAs was performed in 241 pregnant women. Of these, 40 women met narrowly defined preset criteria for the control group, 36 had maternal vascular malperfusion (MVM) and 16 had fetal vascular malperfusion (FVM). Using a computational procedure, the Doppler waveforms were decomposed into a pair of forward and backward propagating waves. Findings Compared to controls, wave reflections were significantly elevated in women with either MVM (p<0.0001) or FVM pathology (p = 0.02). In contrast, the umbilical and uterine artery pulsatility indices were only elevated in the MVM group (p<0.0001) and there were no differences between women with FVM and the controls. Interpretation The measurement of wave reflections in the UA, combined with standard clinical ultrasound parameters, has the potential to improve the diagnostic performance of UA Doppler to detect placental vascular pathology. Identifying women with FVM pathology is particularly challenging prenatally and future investigations will determine if women at risk of this specific placental disease could benefit from this novel diagnostic technique.
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22
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Ho A, Hutter J, Slator P, Jackson L, Seed PT, Mccabe L, Al-Adnani M, Marnerides A, George S, Story L, Hajnal JV, Rutherford M, Chappell LC. Placental magnetic resonance imaging in chronic hypertension: A case-control study. Placenta 2021; 104:138-145. [PMID: 33341490 PMCID: PMC7921773 DOI: 10.1016/j.placenta.2020.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We aimed to explore the use of magnetic resonance imaging (MRI) in vivo as a tool to elucidate the placental phenotype in women with chronic hypertension. METHODS In case-control study, women with chronic hypertension and those with uncomplicated pregnancies were imaged using either a 3T Achieva or 1.5T Ingenia scanner. T2-weighted images, diffusion weighted and T1/T2* relaxometry data was acquired. Placental T2*, T1 and apparent diffusion coefficient (ADC) maps were calculated. RESULTS 129 women (43 with chronic hypertension and 86 uncomplicated pregnancies) were imaged at a median of 27.7 weeks' gestation (interquartile range (IQR) 23.9-32.1) and 28.9 (IQR 26.1-32.9) respectively. Visual analysis of T2-weighted imaging demonstrated placentae to be either appropriate for gestation or to have advanced lobulation in women with chronic hypertension, resulting in a greater range of placental mean T2* values for a given gestation, compared to gestation-matched controls. Both skew and kurtosis (derived from histograms of T2* values across the whole placenta) increased with advancing gestational age at imaging in healthy pregnancies; women with chronic hypertension had values overlapping those in the control group range. Upon visual assessment, the mean ADC declined in the third trimester, with a corresponding decline in placental mean T2* values and showed an overlap of values between women with chronic hypertension and the control group. DISCUSSION A combined placental MR examination including T2 weighted imaging, T2*, T1 mapping and diffusion imaging demonstrates varying placental phenotypes in a cohort of women with chronic hypertension, showing overlap with the control group.
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Affiliation(s)
- Alison Ho
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom; Biomedical Engineering Department, King's College London, London, United Kingdom
| | - Paddy Slator
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Laurence Jackson
- Centre for the Developing Brain, King's College London, London, United Kingdom; Biomedical Engineering Department, King's College London, London, United Kingdom
| | - Paul T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Laura Mccabe
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mudher Al-Adnani
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Andreas Marnerides
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Simi George
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Lisa Story
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, King's College London, London, United Kingdom; Biomedical Engineering Department, King's College London, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
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23
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Magnetic Resonance Imaging of Placenta Accreta Spectrum: A Step-by-Step Approach. Korean J Radiol 2020; 22:198-212. [PMID: 33169550 PMCID: PMC7817633 DOI: 10.3348/kjr.2020.0580] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 11/15/2022] Open
Abstract
Placenta accreta spectrum (PAS) is an abnormal placental adherence or invasion of the myometrium or extrauterine structures. As PAS is primarily staged and managed surgically, imaging can only guide and facilitate diagnosis. But, imaging can aid in preparations for surgical complexity in some cases of PAS. Ultrasound remains the imaging modality of choice; however, magnetic resonance imaging (MRI) is required for evaluation of areas difficult to visualize on ultrasound, and the assessment of the extent of placenta accreta. Numerous MRI features of PAS have been described, including dark intraplacental bands, placental bulge, and placental heterogeneity. Failure to diagnose PAS carries a risk of massive hemorrhage and surgical complications. This article describes a comprehensive, step-by-step approach to diagnostic imaging and its potential pitfalls.
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Affiliation(s)
- Sitthipong Srisajjakul
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Patcharin Prapaisilp
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirikan Bangchokdee
- Department of Internal Medicine, Pratumthani Hospital, Pratumthani, Thailand
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24
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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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25
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Zhang Q, Bao ZK, Deng MX, Xu Q, Ding DD, Pan MM, Xi X, Wang FF, Zou Y, Qu F. Fetal growth, fetal development, and placental features in women with polycystic ovary syndrome: analysis based on fetal and placental magnetic resonance imaging. J Zhejiang Univ Sci B 2020; 21:977-989. [PMID: 33843163 PMCID: PMC7759450 DOI: 10.1631/jzus.b2000350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS), a common endocrine-metabolic dysfunction in reproductive-aged women, may be involved in compromised pregnancy and offspring outcomes. This study aimed to investigate whether maternal PCOS affects fetal growth, fetal development, and placental features. METHODS This retrospective case-control study included 60 pregnant women with PCOS (PCOS group) and 120 healthy pregnant women without PCOS (control group). Fetal magnetic resonance imaging (MRI) was performed followed by an ultrasound examination and indications for imaging, including known or suspected fetal pathology, history of fetal abnormality in previous pregnancy or in a family member, and concern for placenta accreta. Fetal MRI images were analyzed for head circumference (HC), abdomen circumference (AC), lung-to-liver signal intensity ratio (LLSIR, a prenatal marker of fetal lung maturity), lengths of liver and kidney diameters in fetuses, and placental relative signal intensity on T2-weighted single-shot fast spin echo (SSFSE) imaging (rSISSFSE), and placental relative apparent diffusion coefficient value (rADC). Data on height and weight of offspring were collected through telephone follow-up. RESULTS Compared to the control group, the PCOS group showed the following characteristics: (1) smaller biparietal diameter and femur length in fetuses (P=0.026 and P=0.005, respectively), (2) smaller HC in fetuses (evident after 32 weeks; P=0.044), (3) lower LLSIR and smaller dorsoventral length of liver in fetuses (evident before 32 weeks; P=0.005 and P=0.019, respectively), and (4) smaller placental thickness (evident before 32 weeks; P=0.017). No significant differences in placental rSISSFSE or rADC were observed between the groups (all P>0.05). No significant differences in height and weight of offspring during childhood existed between the groups (all P>0.05). CONCLUSIONS There exist alterations of fetal growth, fetal development, and placental features from women with PCOS.
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Affiliation(s)
- Qing Zhang
- School of Obstetrics and Gynecology, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Zhong-kun Bao
- Department of Radiology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Mei-xiang Deng
- Department of Radiology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Qiong Xu
- Department of Radiology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Dan-dan Ding
- Department of Radiology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Man-man Pan
- School of Obstetrics and Gynecology, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Xi Xi
- School of Obstetrics and Gynecology, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Fang-fang Wang
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Yu Zou
- Department of Radiology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Fan Qu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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26
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Aughwane R, Mufti N, Flouri D, Maksym K, Spencer R, Sokolska M, Kendall G, Atkinson D, Bainbridge A, Deprest J, Vercauteren T, Ourselin S, David AL, Melbourne A. Magnetic resonance imaging measurement of placental perfusion and oxygen saturation in early-onset fetal growth restriction. BJOG 2020; 128:337-345. [PMID: 32603546 PMCID: PMC7613436 DOI: 10.1111/1471-0528.16387] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We hypothesised that a multi-compartment magnetic resonance imaging (MRI) technique that is sensitive to fetal blood oxygenation would identify changes in placental blood volume and fetal blood oxygenation in pregnancies complicated by early-onset fetal growth restriction (FGR). DESIGN Case-control study. SETTING London, UK. POPULATION Women with uncomplicated pregnancies (estimated fetal weight [EFW] >10th centile for gestational age [GA] and normal maternal and fetal Doppler ultrasound, n = 12) or early-onset FGR (EFW <3rd centile with or without abnormal Doppler ultrasound <32 weeks GA, n = 12) were studied. METHODS All women underwent MRI examination. Using a multi-compartment MRI technique, we quantified fetal and maternal blood volume and feto-placental blood oxygenation. MAIN OUTCOME MEASURES Disease severity was stratified according to Doppler pulsatility index and the relationship to the MRI parameters was investigated, including the influence of GA at scan. RESULTS The FGR group (mean GA 27+5 weeks, range 24+2 to 33+6 weeks) had a significantly lower EFW compared with the control group (mean GA 29+1 weeks; -705 g, 95% CI -353 to -1057 g). MRI-derived feto-placental oxygen saturation was higher in controls compared with FGR (75 ± 9.6% versus 56 ± 16.2%, P = 0.02, 95% CI 7.8-30.3%). Feto-placental oxygen saturation estimation correlated strongly with GA at scan in controls (r = -0.83). CONCLUSION Using a novel multimodal MRI protocol we demonstrated reduced feto-placental blood oxygen saturation in pregnancies complicated by early-onset FGR. The degree of abnormality correlated with disease severity defined by ultrasound Doppler findings. Gestational age-dependent changes in oxygen saturation were also present in normal pregnancies. TWEETABLE ABSTRACT MRI reveals differences in feto-placental oxygen saturation between normal and FGR pregnancy that is associated with disease severity.
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Affiliation(s)
- R Aughwane
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - N Mufti
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - D Flouri
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,School of Biomedical Engineering and Imaging, Kings College London, London, UK
| | - K Maksym
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Spencer
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,University of Leeds, Leeds, UK
| | - M Sokolska
- Medical Physics, University College Hospital, London, UK
| | - G Kendall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - D Atkinson
- Centre for Medical Imaging, University College London, London, UK
| | - A Bainbridge
- Medical Physics, University College Hospital, London, UK
| | - J Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,School of Biomedical Engineering and Imaging, Kings College London, London, UK.,University Hospital KU Leuven, Leuven, Belgium
| | - T Vercauteren
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,School of Biomedical Engineering and Imaging, Kings College London, London, UK
| | - S Ourselin
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,School of Biomedical Engineering and Imaging, Kings College London, London, UK
| | - A L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,University Hospital KU Leuven, Leuven, Belgium.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - A Melbourne
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,School of Biomedical Engineering and Imaging, Kings College London, London, UK
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27
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Kumar I, Verma A, Jain M, Shukla RC. Structured evaluation and reporting in imaging of placenta and umbilical cord. Acta Radiol 2020; 61:685-704. [PMID: 31550171 DOI: 10.1177/0284185119875644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The human placenta plays a pivotal role in development and growth of the fetus. Disorder of this multifunctional organ is central to various fetal disorders. Doppler sonography and MRI provide excellent diagnostic evaluation of the placental morphology and umbilical cord. Decades of experience in obstetric imaging have highlighted the need of careful prenatal assessment of placenta. However, in most of the routine obstetric scans, the evaluation and reporting of the placental examination is limited to the location and grade of the placenta. The purpose of this article is to review the existing literature and facilitate step-by-step evaluation of the placenta and umbilical cord by the radiologists.
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Affiliation(s)
- Ishan Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Madhu Jain
- Department of Obstetric and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ram C Shukla
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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28
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Andescavage N, You W, Jacobs M, Kapse K, Quistorff J, Bulas D, Ahmadzia H, Gimovsky A, Baschat A, Limperopoulos C. Exploring in vivo placental microstructure in healthy and growth-restricted pregnancies through diffusion-weighted magnetic resonance imaging. Placenta 2020; 93:113-118. [PMID: 32250735 PMCID: PMC7153576 DOI: 10.1016/j.placenta.2020.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/19/2020] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gross and microstructural changes in placental development can influence placental function and adversely impact fetal growth and well-being; however, there is a paucity of invivo tools available to reliably interrogate in vivo placental microstructural development. The objective of this study is to characterize invivo placental microstructural diffusion and perfusion in healthy and growth-restricted pregnancies (FGR) using non-invasive diffusion-weighted imaging (DWI). METHODS We prospectively enrolled healthy pregnant women and women whose pregnancies were complicated by FGR. Each woman underwent DWI-MRI between 18 and 40 weeks gestation. Placental measures of small (D) and large (D*) scale diffusion and perfusion (f) were estimated using the intra-voxel incoherent motion (IVIM) model. RESULTS We studied 137 pregnant women (101 healthy; 36 FGR). D and D* are increased in late-onset FGR, and the placental perfusion fraction, f, is decreased (p < 0.05 for all). DISCUSSION Placental DWI revealed microstructural alterations of the invivo placenta in FGR, particularly in late-onset FGR. Early and reliable identification of placental pathology in vivo may better guide future interventions.
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Affiliation(s)
- Nickie Andescavage
- Division of Neonatology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA
| | - Wonsang You
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA
| | - Marni Jacobs
- Division of Biostatistics & Study Methodology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA
| | - Kushal Kapse
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA
| | - Jessica Quistorff
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA
| | - Dorothy Bulas
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA; Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA
| | - Homa Ahmadzia
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA
| | - Alexis Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA
| | - Ahmet Baschat
- Department of Gynecology and Obstetrics, Johns Hopkins Center for Fetal Therapy, 600 North Wolfe Street, Nelson 228, Baltimore, MD, 21287, USA
| | - Catherine Limperopoulos
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA; Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA.
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29
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Görkem SB, Coşkun A, Eşlik M, Kütük MS, Öztürk A. Diffusion-weighted imaging of placenta in intrauterine growth restriction with worsening Doppler US findings. ACTA ACUST UNITED AC 2020; 25:280-284. [PMID: 31120426 DOI: 10.5152/dir.2019.18358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to compare the placental diffusion difference between intrauterine growth restriction (IUGR) patients with worsening Doppler ultrasonography (US) findings and control group with normal Doppler US findings by using diffusion-weighted imaging (DWI). METHODS We performed a prospective study to compare the placental diffusion difference in 63 patients (gestational week, 28-34 weeks), including 50 IUGR patients (mean gestational week, 30 weeks 3 days ±16.2 days) with worsening Doppler US findings and 13 patients with normal Doppler US findings (mean gestational week, 29 weeks 4 days ±12.3 days) by using DWI (b value, 0-1000 s/mm2). We classified IUGR patients into three groups according to the reference values of the umbilical artery pulsatility index (PI) chart. Placenta apparent diffusion coefficient (ADC) calculations were performed by freehand drawn regions-of-interest (ROIs) (min, 8.04 cm2; max, 200 cm2). RESULTS Placental ADC values in IUGR patients (mean, 1.624±0.181 ×10-³ mm²/s; range, 1.35-1.96 ×10-3 mm2/s) were significantly reduced compared with the control group (mean, 1.827±0.191 ×10-³ mm²/s; range, 1.35-2.84 ×10-3 mm2/s) (P = 0.001). For adjusted ROI area calculation, ADC values were significantly lower in groups 3, 2 and 1, respectively, compared with the control group (P < 0.05); and there was no significant difference between groups 1 and 2 (P > 0.05). Preeclampsia significantly reduced the placental diffusion compared with patients without preeclampsia (P = 0.003). Gestational aging did not significantly affect ADC values in control patients (r=0.08, P = 0.561). The sensitivity, specificity, negative and positive predictive values of ADC to detect IUGR were 72%, 84.6%, 44%, and 94.7% with a cutoff value of 1.727 ×10-3 mm2/s, respectively. CONCLUSION The diagnostic estimation of placental ADC values to predict the severity of IUGR is comparable to that of umbilical artery PI. Considering that at the very early onset of IUGR, placental diffusion diminishes, ADC as a marker for IUGR in lieu of umbilical artery PI has the potential to determine the threshold for decreased placental diffusion. Therefore, DWI should be added to routine fetal MRI to show diffusion changes in placenta.
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Affiliation(s)
- Süreyya Burcu Görkem
- Division of Pediatric Radiology, Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Abdulhakim Coşkun
- Division of Pediatric Radiology, Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Murside Eşlik
- Department of Obstetrics and Gynaecology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Mehmet Serdar Kütük
- Department of Obstetrics and Gynaecology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ahmet Öztürk
- Department of Biostatistics, Erciyes University School of Medicine, Kayseri, Turkey
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Aughwane R, Ingram E, Johnstone ED, Salomon LJ, David AL, Melbourne A. Placental MRI and its application to fetal intervention. Prenat Diagn 2020; 40:38-48. [PMID: 31306507 PMCID: PMC7027916 DOI: 10.1002/pd.5526] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/18/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) of placental invasion has been part of clinical practice for many years. The possibility of being better able to assess placental vascularization and function using MRI has multiple potential applications. This review summarises up-to-date research on placental function using different MRI modalities. METHOD We discuss how combinations of these MRI techniques have much to contribute to fetal conditions amenable for therapy such as singletons at high risk for fetal growth restriction (FGR) and monochorionic twin pregnancies for planning surgery and counselling for selective growth restriction and transfusion conditions. RESULTS The whole placenta can easily be visualized on MRI, with a clear boundary against the amniotic fluid, and a less clear placental-uterine boundary. Contrasts such as diffusion weighted imaging, relaxometry, blood oxygenation level dependent MRI and flow and metabolite measurement by dynamic contrast enhanced MRI, arterial spin labeling, or spectroscopic techniques are contributing to our wider understanding of placental function. CONCLUSION The future of placental MRI is exciting, with the increasing availability of multiple contrasts and new models that will boost the capability of MRI to measure oxygen saturation and placental exchange, enabling examination of placental function in complicated pregnancies.
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Affiliation(s)
| | - Emma Ingram
- Division of Developmental Biology & MedicineUniversity of ManchesterManchesterUK
| | - Edward D. Johnstone
- Division of Developmental Biology & MedicineUniversity of ManchesterManchesterUK
| | - Laurent J. Salomon
- Hôpital Necker‐Enfants Malades, AP‐HP, EHU PACT and LUMIERE PlatformUniversité Paris DescartesParisFrance
| | - Anna L. David
- Institute for Women's HealthUniversity College LondonLondonUK
- National Institute for Health ResearchUniversity College London Hospitals Biomedical Research CentreLondonUK
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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Mansour S, Hamed S, Sayed S, Hosny S. Role of diffusion MR imaging (DWI) and three-dimensional ultrasound (3DUS) in the assessment of placental insufficiency in the gestational hypertension. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
DWI is a non-invasive MR modality that is not contrast-based. In the current study, we aimed to evaluate DWI in correlation with 3DUS in the detection of placental insufficiency in high-risk pregnancies complicated with hypertension.
This prospective analysis included 80 pregnancies; 40 hypertensive and 40 controls, gestational age ranged from 22 to 34 weeks. All cases had undergone 3DUS aided by power Doppler scanning and DWI. There is no given contrast. Data were correlated to histopathology.
Results
Doppler US showed a significant relation between RI of the right uterine artery of cases and control (P = 0.014). There was also a positive correlation between the presence of the diastolic notch and RI value. The mean ADC value in the controls was 1.87 ± 0.26 mm2/s, while in hypertensive was 1.36 ± 0.09 mm2/s. In DWI images, there was a significant difference between patients with normal and those with abnormal placental signals (P value = 0.047). Also, there was a significant difference between the measurement of placental volume by MRI and US among cases and controls (P values ≤0.001 and 0.017, respectively).
Conclusion
Diffusion-weighted imaging can detect early subtle findings and signs of placental dysfunction more than detected with 3DUS, so it can add to the diagnostic accuracy of US in imaging of pregnancies at high risk of placental insufficiency.
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Hutter J, Harteveld AA, Jackson LH, Franklin S, Bos C, van Osch MJP, O'Muircheartaigh J, Ho A, Chappell L, Hajnal JV, Rutherford M, De Vita E. Perfusion and apparent oxygenation in the human placenta (PERFOX). Magn Reson Med 2019; 83:549-560. [PMID: 31433077 PMCID: PMC6825519 DOI: 10.1002/mrm.27950] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE To study placental function-both perfusion and an oxygenation surrogate ( T 2 * )-simultaneously and quantitatively in-vivo. METHODS Fifteen pregnant women were scanned on a 3T MR scanner. For perfusion measurements, a velocity selective arterial spin labeling preparation module was placed before a multi-echo gradient echo EPI readout to integrate T 2 * and perfusion measurements in 1 joint perfusion-oxygenation (PERFOX) acquisition. Joint motion correction and quantification were performed to evaluate changes in T 2 * and perfusion over GA. RESULTS The optimized integrated PERFOX protocol and post-processing allowed successful visualization and quantification of perfusion and T 2 * in all subjects. Areas of high T 2 * and high perfusion appear to correspond to placental sub-units and show a systematic offset in location along the maternal-fetal axis. The areas of highest perfusion are consistently closer to the maternal basal plate and the areas of highest T 2 * closer to the fetal chorionic plate. Quantitative results show a strong negative correlation of gestational age with T 2 * and weak negative correlation with perfusion. CONCLUSIONS A strength of the joint sequence is that it provides truly simultaneous and co-registered estimates of local T 2 * and perfusion, however, to achieve this, the time per slice is prolonged compared to a perfusion only scan which can potentially limit coverage. The achieved interlocking can be particularly useful when quantifying transient physiological effects such as uterine contractions. PERFOX opens a new avenue to elucidate the relationship between maternal supply and oxygen uptake, both of which are central to placental function and dysfunction.
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Affiliation(s)
- Jana Hutter
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Anita A. Harteveld
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Laurence H. Jackson
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Suzanne Franklin
- C.J. Gorter Center for High Field MRIDepartment of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Clemens Bos
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Matthias J. P. van Osch
- C.J. Gorter Center for High Field MRIDepartment of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jonathan O'Muircheartaigh
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Alison Ho
- Academic Women's Health DepartmentKing's College LondonLondonUnited Kingdom
| | - Lucy Chappell
- Academic Women's Health DepartmentKing's College LondonLondonUnited Kingdom
| | - Joseph V. Hajnal
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Mary Rutherford
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Enrico De Vita
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
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Chen T, Zhao M, Song J, Mu X, Jiang Y, Zhou X, Zhou X, Dai Y. The effect of maternal hyperoxygenation on placental perfusion in normal and Fetal Growth Restricted pregnancies using Intravoxel Incoherent Motion. Placenta 2019; 88:28-35. [PMID: 31606612 DOI: 10.1016/j.placenta.2019.08.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/05/2019] [Accepted: 08/07/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the effect of maternal hyperoxygenation on placental perfusion in normal and Fetal Growth Restricted (FGR) pregnancies using Intravoxel Incoherent Motion (IVIM). METHODS Ten FGR pregnancies and twenty-five normal pregnancies underwent IVIM examinations before and after maternal hyperoxygenation (95% O2, 5% CO2) using a 1.5T MR scanner. The IVIM parameters (fp, Dt, Dp) were determined for the placentas of both groups. The IVIM parameters within and between groups and their correlations with Doppler findings were statistically analyzed. ROC analysis was performed to evaluate the diagnostic power of IVIM derived parameters. RESULTS Before maternal hyperoxygenation, the perfusion fraction fp was significantly lower in the FGR group than that in the normal group (22.88±10.29 (%) vs. 36.28±9.70 (%), p = 0.000). After maternal hyperoxygenation, fp decreased significantly in the normal group (36.28±9.70 (%) vs. 29.93±10.25 (%), p = 0.032), whereas it remained relatively stable in the FGR group (22.88±10.29 (%) vs. 24.38±13.67 (%), p = 0.508). An increase of Dt was found only for the normal group and Dp did not changed significantly after maternal hyperoxygenation. There existed a negative correlation between fppre and umbilical artery pulsatility index (PI) (r = -0.385, p < 0.05) as well as Dtpost and PI (r = -0.574, p < 0.01). The fppre displayed a best diagnostic power of all parameters with the area under curve (AUC) of 0.912. CONCLUSION The perfusion fraction, fp, is able to distinguish FGR from normal pregnancies by its value pre and by its change (or lack thereof) post maternal hyperoxygenation. IVIM may potentially help improve the diagnosis of placenta function as it relates to disease.
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Affiliation(s)
- Ting Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Meng Zhao
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Jiacheng Song
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Xihu Mu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yong Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xin Zhou
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xuanyi Zhou
- United Imaging Healthcare, MR Collaboration, Shanghai, 201302, China
| | - Yongming Dai
- United Imaging Healthcare, MR Collaboration, Shanghai, 201302, China
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Slator PJ, Hutter J, Palombo M, Jackson LH, Ho A, Panagiotaki E, Chappell LC, Rutherford MA, Hajnal JV, Alexander DC. Combined diffusion-relaxometry MRI to identify dysfunction in the human placenta. Magn Reson Med 2019; 82:95-106. [PMID: 30883915 PMCID: PMC6519240 DOI: 10.1002/mrm.27733] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/04/2019] [Accepted: 01/27/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE A combined diffusion-relaxometry MR acquisition and analysis pipeline for in vivo human placenta, which allows for exploration of coupling between T 2 * and apparent diffusion coefficient (ADC) measurements in a sub 10-minute scan time. METHODS We present a novel acquisition combining a diffusion prepared spin echo with subsequent gradient echoes. The placentas of 17 pregnant women were scanned in vivo, including both healthy controls and participants with various pregnancy complications. We estimate the joint T 2 * -ADC spectra using an inverse Laplace transform. RESULTS T 2 * -ADC spectra demonstrate clear quantitative separation between normal and dysfunctional placentas. CONCLUSIONS Combined T 2 * -diffusivity MRI is promising for assessing fetal and maternal health during pregnancy. The T 2 * -ADC spectrum potentially provides additional information on tissue microstructure, compared to measuring these two contrasts separately. The presented method is immediately applicable to the study of other organs.
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Affiliation(s)
- Paddy J. Slator
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Jana Hutter
- Biomedical Engineering DepartmentKing’s College LondonLondonUnited Kingdom
- Centre for the Developing BrainKing’s College LondonLondonUnited Kingdom
| | - Marco Palombo
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Laurence H. Jackson
- Biomedical Engineering DepartmentKing’s College LondonLondonUnited Kingdom
- Centre for the Developing BrainKing’s College LondonLondonUnited Kingdom
| | - Alison Ho
- Women’s Health DepartmentKing’s College LondonLondonUnited Kingdom
| | - Eleftheria Panagiotaki
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
| | - Lucy C. Chappell
- Women’s Health DepartmentKing’s College LondonLondonUnited Kingdom
| | - Mary A. Rutherford
- Centre for the Developing BrainKing’s College LondonLondonUnited Kingdom
| | - Joseph V. Hajnal
- Biomedical Engineering DepartmentKing’s College LondonLondonUnited Kingdom
- Centre for the Developing BrainKing’s College LondonLondonUnited Kingdom
| | - Daniel C. Alexander
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUnited Kingdom
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Apparent Diffusion Coefficient of the Placenta and Fetal Organs in Intrauterine Growth Restriction. J Comput Assist Tomogr 2019; 43:507-512. [PMID: 30762655 DOI: 10.1097/rct.0000000000000844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE This study aimed to assess apparent diffusion coefficient (ADC) of the placenta and fetal organs in intrauterine growth restriction (IUGR). MATERIALS AND METHODS A prospective study of 30 consecutive pregnant women (aged 21-38 years with mean age of 31.5 years and a mean gestational week of 35 ± 2.3) with IUGR and 15 age-matched pregnant women was conducted. All patients and controls underwent diffusion-weighted magnetic resonance imaging. The ADCs of the placenta and fetal brain, kidney, and lung were calculated and correlated with neonates needing intensive care unit (ICU) admission. RESULTS There was a significant difference in ADC of the placenta and fetal brain, lung, and kidney (P = 0.001, 0.001, 0.04, and 0.04, respectively) between the patients and the controls. The cutoff ADCs of the placenta and fetal brain, lung, and kidney used to detect IUGR were 1.45, 1.15, 1.80, and 1.40 × 10 mm/s, respectively, with areas under the curve (AUCs) of 0.865, 0.858, 0.812, and 0.650, respectively, and accuracy values of 75%, 72.5%, 72.5%, and 70%, respectively. Combined ADC of the placenta and fetal organs used to detect IUGR revealed an AUC of 1.00 and an accuracy of 100%. There was a significant difference in ADC of the placenta and fetal brain, lung, and kidney between neonates needing admission and those not needing ICU admission (P = 0.001, 0.001, 0.002, and 0.002, respectively). The cutoff ADCs of the placenta and fetal brain, lung, and kidney used to define neonates needing ICU were 1.35, 1.25, 1.95, and 1.15 × 10 mm/s with AUCs of 0.955, 0.880, 0.884, and 0.793, respectively, and accuracy values of 86.7%, 46.7%, 76.7%, and 70%, respectively. Combined placental and fetal brain ADC used to define neonates needing ICU revealed an AUC of 0.968 and an accuracy of 93.3%. CONCLUSION Combined ADC of the placenta and fetal organs can detect IUGR, and combined ADC of the placenta and fetal brain can define fetuses needing ICU.
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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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Vasung L, Abaci Turk E, Ferradal SL, Sutin J, Stout JN, Ahtam B, Lin PY, Grant PE. Exploring early human brain development with structural and physiological neuroimaging. Neuroimage 2019; 187:226-254. [PMID: 30041061 PMCID: PMC6537870 DOI: 10.1016/j.neuroimage.2018.07.041] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
Early brain development, from the embryonic period to infancy, is characterized by rapid structural and functional changes. These changes can be studied using structural and physiological neuroimaging methods. In order to optimally acquire and accurately interpret this data, concepts from adult neuroimaging cannot be directly transferred. Instead, one must have a basic understanding of fetal and neonatal structural and physiological brain development, and the important modulators of this process. Here, we first review the major developmental milestones of transient cerebral structures and structural connectivity (axonal connectivity) followed by a summary of the contributions from ex vivo and in vivo MRI. Next, we discuss the basic biology of neuronal circuitry development (synaptic connectivity, i.e. ensemble of direct chemical and electrical connections between neurons), physiology of neurovascular coupling, baseline metabolic needs of the fetus and the infant, and functional connectivity (defined as statistical dependence of low-frequency spontaneous fluctuations seen with functional magnetic resonance imaging (fMRI)). The complementary roles of magnetic resonance imaging (MRI), electroencephalography (EEG), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS) are discussed. We include a section on modulators of brain development where we focus on the placenta and emerging placental MRI approaches. In each section we discuss key technical limitations of the imaging modalities and some of the limitations arising due to the biology of the system. Although neuroimaging approaches have contributed significantly to our understanding of early brain development, there is much yet to be done and a dire need for technical innovations and scientific discoveries to realize the future potential of early fetal and infant interventions to avert long term disease.
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Affiliation(s)
- Lana Vasung
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Esra Abaci Turk
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Silvina L Ferradal
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jason Sutin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jeffrey N Stout
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Banu Ahtam
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Pei-Yi Lin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Non-invasive assessment of placental perfusion in vivo using arterial spin labeling (ASL) MRI: A preclinical study in rats. Placenta 2019; 77:39-45. [PMID: 30827354 DOI: 10.1016/j.placenta.2019.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 01/13/2019] [Accepted: 01/21/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Non-invasive assessment of placental perfusion is of great interest to characterize placental function in clinical practice. This article proposes a strictly non-invasive MRI technique using ASL to quantify placental blood flow in vivo. The aim of this study was to develop a fMRI tool to quantify placental blood flow (PBF) in rat, by using arterial spin labeling (ASL) MRI at 4.7 T. MATERIALS AND METHODS MRI was performed with a dedicated magnet for small animals, in pregnant rats on day 20 of the 22-day gestation period. A Look-Locker flow-sensitive alternating inversion recovery gradient echo sequence was developed as ASL technique (TE: 1.55 ms; TR: 3.5 ms, TI: 56 ms, deltaTI: 56 ms, FA: 20°, Matrix: 128 × 128, 8 segments, 4 Nex). Labeling was performed with global and slice-selective inversions, and T1 map was obtained for each mode of inversion. PBF was then derived from a compartmental model of the variation of T1 between global and slice-selective inversions. RESULTS The full protocol was completed and ASL image post-processing was successful in 18 rats. Forty-seven placentas were analyzed, with a mean PBF of 147 ± 70 ml/min/100 g of placenta, consistent with published values of placental perfusion using invasive techniques. CONCLUSION ASL MRI is feasible for the quantification of PBF in rats at 4.7 T. This technique, which requires no administration of contrast media, could have implications for non-invasive longitudinal and in vivo animal studies and may be useful for the management of human pregnancies.
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Hutter J, Slator PJ, Jackson L, Gomes ADS, Ho A, Story L, O’Muircheartaigh J, Teixeira RPAG, Chappell LC, Alexander DC, Rutherford MA, Hajnal JV. Multi-modal functional MRI to explore placental function over gestation. Magn Reson Med 2019; 81:1191-1204. [PMID: 30242899 PMCID: PMC6585747 DOI: 10.1002/mrm.27447] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate, visualize and quantify the physiology of the human placenta in several dimensions - functional, temporal over gestation, and spatial over the whole organ. METHODS Bespoke MRI techniques, combining a rich diffusion protocol, anatomical data and T2* mapping together with a multi-modal pipeline including motion correction and extracted quantitative features were developed and employed on pregnant women between 22 and 38 weeks gestational age including two pregnancies diagnosed with pre-eclampsia. RESULTS A multi-faceted assessment was demonstrated showing trends of increasing lacunarity, and decreasing T2* and diffusivity over gestation. CONCLUSIONS The obtained multi-modal acquisition and quantification shows promising opportunities for studying evolution, adaptation and compensation processes.
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Affiliation(s)
- Jana Hutter
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Paddy J. Slator
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Laurence Jackson
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Ana Dos Santos Gomes
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Alison Ho
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | - Lisa Story
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | | | - Rui P. A. G. Teixeira
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Lucy C. Chappell
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | - Daniel C. Alexander
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonUnited Kingdom
| | | | - Joseph V. Hajnal
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
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Cao C, Cai W, Niu X, Fu J, Ni J, Lei Q, Niu J, Zhou X, Li Y. Prehypertension during pregnancy and risk of small for gestational age: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2018; 33:1447-1454. [PMID: 30173597 DOI: 10.1080/14767058.2018.1519015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: Emerging evidence shows that high blood pressure (BP) level even below 140/90 mmHg during pregnancy is associated with increased risk for maternal and infant complications. The meta-analysis evaluated the associations between prehypertension (BP 120-139/80-89 mmHg) during pregnancy and the risk of small for gestational age (SGA), as well as the impact of prehypertension on birth weight (BW).Methods: Databases (PubMed, Embase, and Cochrane Library) were searched for cohort studies with data on prehypertension in pregnancy and adverse obstetrical outcomes, including SGA and/or BW. The relative risks (RRs) of SGA and weighted mean differences (WMD) in BW were calculated and reported with 95% confidence intervals (95% CIs). We calculated pooled RRs using fixed- and random-effects models.Results: A total of 143,835 participants from five cohort studies were included. Prehypertension in pregnancy increased the risk of SGA (RR 1.59, 95%CI 1.44 to 1.76, p < .00001) and lowered BW (WMD -13.71, 95% CI -83.28 to 55.87, p = .70) compared with optimal BP (<120/80 mmHg). In subgroup analyses, for prehypertension in late pregnancy, the risk of SGA was significantly higher than for optimal BP (RR 1.60, 95% CI 1.44 to 1.78).Conclusion: BP within the range of 120-139/80-89 mmHg during pregnancy, as previously defined as prehypertension, particularly in late pregnancy, was associated with a 59% increase in the risk of having an SGA birth.
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Affiliation(s)
- Chunxia Cao
- Institute of Disaster Medicine, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Wei Cai
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Xiulong Niu
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Jiaxi Fu
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Jianmei Ni
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Qiong Lei
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jianmin Niu
- Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xin Zhou
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Yuming Li
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
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Diagnostic accuracy of magnetic resonance imaging in assessing placental adhesion disorder in patients with placenta previa: Correlation with histological findings. Eur J Radiol 2018; 106:77-84. [DOI: 10.1016/j.ejrad.2018.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/19/2022]
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Slator PJ, Hutter J, McCabe L, Gomes ADS, Price AN, Panagiotaki E, Rutherford MA, Hajnal JV, Alexander DC. Placenta microstructure and microcirculation imaging with diffusion MRI. Magn Reson Med 2018; 80:756-766. [PMID: 29230859 PMCID: PMC5947291 DOI: 10.1002/mrm.27036] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess which microstructural models best explain the diffusion-weighted MRI signal in the human placenta. METHODS The placentas of nine healthy pregnant subjects were scanned with a multishell, multidirectional diffusion protocol at 3T. A range of multicompartment biophysical models were fit to the data, and ranked using the Bayesian information criterion. RESULTS Anisotropic extensions to the intravoxel incoherent motion model, which consider the effect of coherent orientation in both microvascular structure and tissue microstructure, consistently had the lowest Bayesian information criterion values. Model parameter maps and model selection results were consistent with the physiology of the placenta and surrounding tissue. CONCLUSION Anisotropic intravoxel incoherent motion models explain the placental diffusion signal better than apparent diffusion coefficient, intravoxel incoherent motion, and diffusion tensor models, in information theoretic terms, when using this protocol. Future work will aim to determine if model-derived parameters are sensitive to placental pathologies associated with disorders, such as fetal growth restriction and early-onset pre-eclampsia. Magn Reson Med 80:756-766, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Paddy J. Slator
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
| | - Jana Hutter
- Centre for the Developing Brain, King's College LondonLondonUK,Biomedical Engineering DepartmentKing's College LondonLondonUK
| | - Laura McCabe
- Centre for the Developing Brain, King's College LondonLondonUK
| | | | - Anthony N. Price
- Centre for the Developing Brain, King's College LondonLondonUK,Biomedical Engineering DepartmentKing's College LondonLondonUK
| | - Eleftheria Panagiotaki
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
| | | | - Joseph V. Hajnal
- Centre for the Developing Brain, King's College LondonLondonUK,Biomedical Engineering DepartmentKing's College LondonLondonUK
| | - Daniel C. Alexander
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
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43
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Fu L, Zhang J, Xiong S, Sun M. Decreased apparent diffusion coefficient in the placentas of monochorionic twins with selective intrauterine growth restriction. Placenta 2018; 69:26-31. [PMID: 30213481 DOI: 10.1016/j.placenta.2018.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/23/2018] [Accepted: 07/05/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The apparent diffusion coefficient (ADC) was associated with the onset of intrauterine growth restriction in singleton pregnancies. However, the correlation of ADC with selective intrauterine growth restriction (sIUGR) of monochorionic (MC) twin pregnancies remained unknown. In this study, we aimed to evaluate the association of ADC with sIUGR in MC twin pregnancies by exploring diffusion weighted MR imaging (DWI). METHODS Fifty-one MC twin pregnancies, consisting 19 cases of sIUGR and 32 cases without sIUGR, were re-analyzed by DWI. ADCs were quantitated from two regions of interest, surrounding the insertion of the umbilical cord of placenta for each twin. A rADC (ADClarger twin/ADCsmaller twin) in each placenta was also evaluated. Then ADCs and rADCs were compared between cases with and without sIUGR. RESULTS The ADC in cases with sIUGR was significantly decreased compared with cases without sIUGR (1.846 × 103 vs 2.471 × 103 mm2/s, p < 0.001). The rADC in cases with sIUGR was significantly increased (1.346 vs 1.053, p < 0.001). CONCLUSIONS The ADC decreases and the rADC increases in the placentas of MC twins with sIUGR, suggesting that diffusion in the placenta is restricted in pregnancies with sIUGR.
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Affiliation(s)
- Le Fu
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, PR China
| | - Jun Zhang
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, PR China
| | - Shiyi Xiong
- Fetal Medicine Unit & Prenatal Diagnosis Centre, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, PR China
| | - Minghua Sun
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, PR China.
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44
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Shapira-Zaltsberg G, Grynspan D, Quintana MV, Dominguez PC, Reddy D, Davila JH, Miller E. MRI features of the placenta in fetuses with and without CNS abnormalities. Clin Radiol 2018; 73:836.e9-836.e15. [PMID: 29895388 DOI: 10.1016/j.crad.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 05/01/2018] [Indexed: 11/25/2022]
Abstract
AIM To investigate if magnetic resonance imaging (MRI) features of the placenta are different in fetuses with and without central nervous system (CNS) abnormalities. MATERIAL AND METHODS Institutional research ethics board approval was obtained. Fetal MRI of 97 singleton pregnancies were analysed retrospectively (19-25 weeks gestation), 65 with CNS morphological abnormalities and 32 controls. Placental T2 signal intensity, placental and fetal volumes, placental-to-fetal volume ratio, and placental apparent diffusion coefficient (ADC) values were assessed. Measurements were compared with the presence or absence of CNS fetal abnormalities using the Mann-Whitney test. Separate slopes models and intercept models were used to check for significant differences in the slopes and intercepts, respectively, among the groups. RESULTS Placental ADC values were significantly lower in placentas of fetuses with CNS abnormalities compared to controls (p=0.04). Placental T2 signal intensity, fetal and placental volumes did not differ between the two groups. The rate of increase in fetal-to-placental volume ratio with gestational age (GA) was greater among the controls. CONCLUSION The presence of fetal CNS abnormalities is associated with reduced ADC values of the placenta. Moreover, placentas of fetuses with CNS abnormalities show a less rapid increase in fetal to placental volume ratio with GA. Therefore, ADC mapping, as well as different growth kinetics of the placenta relative to the fetus, may potentially serve as early markers of pathological neurodevelopment.
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Affiliation(s)
- G Shapira-Zaltsberg
- Medical Imaging Department, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.
| | - D Grynspan
- Pathology Department, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - M V Quintana
- Medical Imaging Department, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - P C Dominguez
- Medical Imaging Department, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - D Reddy
- Research Institute, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - J H Davila
- Medical Imaging Department, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - E Miller
- Medical Imaging Department, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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45
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Shapira-Zaltsberg G, Grynspan D, Reddy D, Miller E. Apparent Diffusion Coefficient of the Placenta in Twin versus Singleton Pregnancies. Fetal Diagn Ther 2018. [PMID: 29518777 DOI: 10.1159/000479686] [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
Previous studies in singleton pregnancies reported conflicting trends in apparent diffusion coefficient (ADC) values with gestational age (GA) and stable relative ADC (rADC; ADC placenta divided by ADC globe) throughout pregnancy. The purpose of our study was to compare the ADC and rADC of placentas of twin and singleton pregnancies. MATERIALS AND METHODS Fetal MRI of 11 twin and 23 singleton pregnancies were retrospectively analyzed. Each group was further divided by GA (≤24 and >24 weeks). On ADC, 3 regions of interest were selected in the placenta and 1 in the globe. ADC and rADC measurements were compared between different GA and between singleton and twin placentas. RESULTS No significant difference was shown between ADC and rADC values of singleton and twin placentas as well as between ADC and rADC values of singleton and twin placentas at different GA. No significant difference was shown when accounting for both GA and number of fetuses. CONCLUSION The diffusion characteristics of twin placentas are similar to those of singleton placentas. ADC and rADC remain stable throughout pregnancy in twin and singleton placentas, reflecting stable extracellular water diffusion, despite changes associated with placental maturation.
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46
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Zun Z, Limperopoulos C. Placental perfusion imaging using velocity-selective arterial spin labeling. Magn Reson Med 2018; 80:1036-1047. [PMID: 29436733 DOI: 10.1002/mrm.27100] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/30/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Zungho Zun
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.,Division of Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.,Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC.,Department of Radiology, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Catherine Limperopoulos
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.,Division of Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.,Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC.,Department of Radiology, School of Medicine and Health Sciences, George Washington University, Washington, DC
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47
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Burton GJ, Jauniaux E. Pathophysiology of placental-derived fetal growth restriction. Am J Obstet Gynecol 2018; 218:S745-S761. [PMID: 29422210 DOI: 10.1016/j.ajog.2017.11.577] [Citation(s) in RCA: 518] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 01/03/2023]
Abstract
Placental-related fetal growth restriction arises primarily due to deficient remodeling of the uterine spiral arteries supplying the placenta during early pregnancy. The resultant malperfusion induces cell stress within the placental tissues, leading to selective suppression of protein synthesis and reduced cell proliferation. These effects are compounded in more severe cases by increased infarction and fibrin deposition. Consequently, there is a reduction in villous volume and surface area for maternal-fetal exchange. Extensive dysregulation of imprinted and nonimprinted gene expression occurs, affecting placental transport, endocrine, metabolic, and immune functions. Secondary changes involving dedifferentiation of smooth muscle cells surrounding the fetal arteries within placental stem villi correlate with absent or reversed end-diastolic umbilical artery blood flow, and with a reduction in birthweight. Many of the morphological changes, principally the intraplacental vascular lesions, can be imaged using ultrasound or magnetic resonance imaging scanning, enabling their development and progression to be followed in vivo. The changes are more severe in cases of growth restriction associated with preeclampsia compared to those with growth restriction alone, consistent with the greater degree of maternal vasculopathy reported in the former and more extensive macroscopic placental damage including infarcts, extensive fibrin deposition and microscopic villous developmental defects, atherosis of the spiral arteries, and noninfectious villitis. The higher level of stress may activate proinflammatory and apoptotic pathways within the syncytiotrophoblast, releasing factors that cause the maternal endothelial cell activation that distinguishes between the 2 conditions. Congenital anomalies of the umbilical cord and placental shape are the only placental-related conditions that are not associated with maldevelopment of the uteroplacental circulation, and their impact on fetal growth is limited.
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48
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Jakab A, Tuura RL, Kottke R, Ochsenbein-Kölble N, Natalucci G, Nguyen TD, Kellenberger C, Scheer I. Microvascular perfusion of the placenta, developing fetal liver, and lungs assessed with intravoxel incoherent motion imaging. J Magn Reson Imaging 2017; 48:214-225. [PMID: 29281153 DOI: 10.1002/jmri.25933] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In utero intravoxel incoherent motion magnetic resonance imaging (IVIM-MRI) provides a novel method for examining microvascular perfusion fraction and diffusion in the developing human fetus. PURPOSE To characterize gestational changes in the microvascular perfusion fraction of the placenta, fetal liver, and lungs using IVIM-MRI. STUDY TYPE Retrospective, cross-sectional study. SUBJECTS Fifty-five datasets from 33 singleton pregnancies were acquired (17-36 gestational weeks). FIELD STRENGTH/SEQUENCE In utero diffusion-weighted echo-planar imaging at 1.5T and 3.0T with b-factors ranging from 0 to 900 s/mm2 in 16 steps. ASSESSMENT Using the IVIM principle, microvascular perfusion fraction (f), pseudodiffusion (D*), and diffusion coefficients (d) were estimated for the placenta, liver, and lungs with a biexponential model. A free-form nonlinear deformation algorithm was used to correct for the frame-by-frame motion of the fetal organs and the placenta. The IVIM parameters were then compared to a Doppler ultrasound-based assessment of the umbilical artery resistance index. STATISTICAL TESTS Pearson product-moment correlation coefficient (PMCC) to reveal outlier corrected correlations between Doppler and IVIM parameters. Gestational age-related changes were assessed using linear regression analysis (LR). RESULTS Placental f (0.29 ± 0.08) indicates high blood volume in the microvascular compartment, moderately increased during gestation (LR, R = 0.338), and correlated negatively with the umbilical artery resistance index (PMCC, R = -0.457). The f of the liver decreased sharply during gestation (LR, R = -0.436). Lung maturation was characterized by increasing perfusion fraction (LR, R = 0.547), and we found no gestational changes in d and D* values (LR, R = -0.013 and R = 0.051, respectively). The Doppler measurements of the umbilical artery and middle cerebral artery did not correlate with the IVIM parameters of the lungs and liver. DATA CONCLUSION Gestational age-associated changes of the placental, liver, and lung IVIM parameters likely reflect changes in placental and fetal circulation, and characterize the trajectory of microstructural and functional maturation of the fetal vasculature. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017.
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Affiliation(s)
- András Jakab
- Center for MR-Research, University Children's Hospital, Zurich, Switzerland.,Computational Imaging Research Lab (CIR), Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Ruth L Tuura
- Center for MR-Research, University Children's Hospital, Zurich, Switzerland
| | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
| | | | - Giancarlo Natalucci
- Department of Neonatology, University Hospital and University of Zurich, Switzerland
| | - Thi Dao Nguyen
- Department of Neonatology, University Hospital and University of Zurich, Switzerland
| | | | - Ianina Scheer
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
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49
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Fadl S, Moshiri M, Fligner CL, Katz DS, Dighe M. Placental Imaging: Normal Appearance with Review of Pathologic Findings. Radiographics 2017; 37:979-998. [PMID: 28493802 DOI: 10.1148/rg.2017160155] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The placenta plays a crucial role throughout pregnancy, and its importance may be overlooked during routine antenatal imaging evaluation. Detailed systematic assessment of the placenta at ultrasonography (US), the standard imaging examination during pregnancy, is important. Familiarity with the normal and abnormal imaging appearance of the placenta along with the multimodality and methodical approach for evaluation of its related abnormalities is necessary, so that radiologists can alert clinicians regarding appropriate prompt management decisions. This will potentially decrease fetal and maternal morbidity and mortality. This article reviews early placental formation and the expected imaging appearance of the placenta during pregnancy, as well as variations in its morphology. It also discusses various placental diseases and their potential clinical consequences. Placental pathologic conditions include abnormalities of placental size, cord insertion, placental and cord location, and placental adherence. Other conditions such as bleeding in and around the placenta, as well as trophoblastic and nontrophoblastic tumors of the placenta, are also discussed. US with Doppler imaging is the initial imaging modality of choice for placental evaluation. Magnetic resonance (MR) imaging is reserved for equivocal cases or when additional information is needed. Computed tomography (CT) has a limited role in evaluation of placental abnormalities because of the ionizing radiation exposure and the relatively limited assessment of the placenta; however, CT can provide important information in specific circumstances, particularly evaluation of trauma and staging of choriocarcinoma. This article also addresses recent techniques and updates in placental imaging, including elastography, diffusion-weighted MR imaging, and blood oxygen level-dependent (BOLD) MR imaging. These advanced imaging techniques may provide additional information in evaluation of abnormal placental adherence and new insights into placental pathophysiology in selected patients. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Shaimaa Fadl
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Mariam Moshiri
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Corinne L Fligner
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Douglas S Katz
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Manjiri Dighe
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
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50
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Siauve N, Hayot PH, Deloison B, Chalouhi GE, Alison M, Balvay D, Bussières L, Clément O, Salomon LJ. Assessment of human placental perfusion by intravoxel incoherent motion MR imaging. J Matern Fetal Neonatal Med 2017; 32:293-300. [PMID: 28974131 DOI: 10.1080/14767058.2017.1378334] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To provide functional information on the human placenta, including perfusion, and diffusion, with no contrast agent injection, and to study correlations between intravoxel incoherent motion (IVIM) placental parameters and fetal growth. MATERIALS AND METHODS MRI was performed in women undergoing legal termination of pregnancy at 17-34 weeks, including a 4-b-value and 11-b-value DW sequences. The apparent diffusion coefficient (ADC), the restricted diffusion coefficient (D), the pseudoperfusion coefficient (D*), and the perfusion fraction (f) were calculated. Their relationships with gestational age, Z-scores for fetal and placental weight were evaluated by means of regression analysis. Logistic regression analysis was used to assess the ability of IVIM parameters to predict/detect intrauterine growth retardation (SGA). RESULTS Fifty-five pregnant women, including nine cases of SGA (16%), were included in the study. The ADC (n = 55) showed a quadratic correlation with gestational age (p < .001) and a linear correlation with the fetal weight Z-score (p = .02). Mean ADC values were significantly different between normally growing and SGA fetuses (2.37 ± 0.25 versus 2.29 ± 0.33 10-3.mm2.s-1, p=.048). The perfusion fraction f (n = 23) showed a quadratic correlation with gestational age (p = .017) and a linear correlation with the fetal weight Z - score (p = .008). Mean f values differed significantly between normally growing and SGA fetuses (42.55 ± 9.30% versus 27.94 ± 8.76%, p = .002). The receiver operating characteristics (ROC) curve for f to predict SGA was produced (area under the ROC curve = 0.9). CONCLUSIONS The observed association between f and fetal weight suggests that fMRI could be suitable for studying placental insufficiency and for identifying risk of SGA.
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Affiliation(s)
- Nathalie Siauve
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,c Assistance Publique: Hôpitaux de Paris , Hôpital Européen Georges Pompidou , Paris , France
| | - Pierre Humbert Hayot
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Benjamin Deloison
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Gihad E Chalouhi
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Marianne Alison
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France
| | - Daniel Balvay
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,e Plateforme d'Imagerie du Vivant , Université Paris Descartes, Sorbonne Paris Cité , Paris , France
| | - Laurence Bussières
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Olivier Clément
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France
| | - Laurent J Salomon
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
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