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Bhattacharya S, Price AN, Uus A, Sousa HS, Marenzana M, Colford K, Murkin P, Lee M, Cordero-Grande L, Teixeira RPAG, Malik SJ, Deprez M. In vivo T2 measurements of the fetal brain using single-shot fast spin echo sequences. Magn Reson Med 2024; 92:715-729. [PMID: 38623934 DOI: 10.1002/mrm.30094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/18/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE We propose a quantitative framework for motion-corrected T2 fetal brain measurements in vivo and validate the single-shot fast spin echo (SS-FSE) sequence to perform these measurements. METHODS Stacks of two-dimensional SS-FSE slices are acquired with different echo times (TE) and motion-corrected with slice-to-volume reconstruction (SVR). The quantitative T2 maps are obtained by a fit to a dictionary of simulated signals. The sequence is selected using simulated experiments on a numerical phantom and validated on a physical phantom scanned on a 1.5T system. In vivo quantitative T2 maps are obtained for five fetuses with gestational ages (GA) 21-35 weeks on the same 1.5T system. RESULTS The simulated experiments suggested that a TE of 400 ms combined with the clinically utilized TEs of 80 and 180 ms were most suitable for T2 measurements in the fetal brain. The validation on the physical phantom confirmed that the SS-FSE T2 measurements match the gold standard multi-echo spin echo measurements. We measured average T2s of around 200 and 280 ms in the fetal brain grey and white matter, respectively. This was slightly higher than fetal T2* and the neonatal T2 obtained from previous studies. CONCLUSION The motion-corrected SS-FSE acquisitions with varying TEs offer a promising practical framework for quantitative T2 measurements of the moving fetus.
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Affiliation(s)
- Suryava Bhattacharya
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Anthony N Price
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Alena Uus
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Helena S Sousa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Kathleen Colford
- Centre for the Developing Brain, King's College London, London, UK
| | - Peter Murkin
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Maggie Lee
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Lucilio Cordero-Grande
- Biomedical Image Technologies, ETSI Telecomunicración, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Rui Pedro A G Teixeira
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Shaihan J Malik
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Maria Deprez
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
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Cromb D, Steinweg J, Aviles Verdera J, van Poppel MPM, Bonthrone AF, Lloyd DFA, Pushparajah K, Simpson J, Razavi R, Rutherford M, Counsell SJ, Hutter J. T2*-Relaxometry MRI to Assess Third Trimester Placental and Fetal Brain Oxygenation and Placental Characteristics in Healthy Fetuses and Fetuses With Congenital Heart Disease. J Magn Reson Imaging 2024. [PMID: 38994701 DOI: 10.1002/jmri.29498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Congenital heart disease (CHD) has been linked to impaired placental and fetal brain development. Assessing the placenta and fetal brain in parallel may help further our understanding of the relationship between development of these organs. HYPOTHESIS 1) Placental and fetal brain oxygenation are correlated, 2) oxygenation in these organs is reduced in CHD compared to healthy controls, and 3) placental structure is altered in CHD. STUDY TYPE Retrospective case-control. POPULATION Fifty-one human fetuses with CHD (32 male; median [IQR] gestational age [GA] = 32.0 [30.9-32.9] weeks) and 30 from uncomplicated pregnancies with normal birth outcomes (18 male; median [IQR] GA = 34.5 [31.9-36.7] weeks). FIELD STRENGTH/SEQUENCE 1.5 T single-shot multi-echo-gradient-echo echo-planar imaging. ASSESSMENT Masking was performed using an automated nnUnet model. Mean brain and placental T2* and quantitative measures of placental texture, volume, and morphology were calculated. STATISTICAL TESTS Spearman's correlation coefficient for determining the association between brain and placental T2*, and between brain and placental characteristics with GA. P-values for comparing brain T2*, placenta T2*, and placental characteristics between groups derived from ANOVA. Significance level P < 0.05. RESULTS There was a significant positive association between placental and fetal brain T2* (⍴ = 0.46). Placental and fetal brain T2* showed a significant negative correlation with GA (placental T2* ⍴ = -0.65; fetal brain T2* ⍴ = -0.32). Both placental and fetal brain T2* values were significantly reduced in CHD, after adjusting for GA (placental T2*: control = 97 [±24] msec, CHD = 83 [±23] msec; brain T2*: control = 218 [±26] msec, CHD = 202 [±25] msec). Placental texture and morphology were also significantly altered in CHD (Texture: control = 0.84 [0.83-0.87], CHD = 0.80 [0.78-0.84]; Morphology: control = 9.9 [±2.2], CHD = 10.8 [±2.0]). For all fetuses, there was a significant positive association between placental T2* and placental texture (⍴ = 0.46). CONCLUSION Placental and fetal brain T2* values are associated in healthy fetuses and those with CHD. Placental and fetal brain oxygenation are reduced in CHD. Placental appearance is significantly altered in CHD and shows associations with placental oxygenation, suggesting altered placental development and function may be related. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
| | - Johannes Steinweg
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, UK
| | - Jordina Aviles Verdera
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Milou P M van Poppel
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, UK
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
| | - David F A Lloyd
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, UK
| | - Kuberan Pushparajah
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, UK
| | - John Simpson
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, UK
| | - Reza Razavi
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical and Engineering Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Smart Imaging Lab, Radiological Institute, University Hospital Erlangen, Erlangen, Germany
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3
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Cromb D, Hall M, Story L, Shangaris P, Al-Adnani M, Rutherford MA, Fox GF, Gupta N. Clinical value of placental examination for paediatricians. Arch Dis Child Fetal Neonatal Ed 2024; 109:362-370. [PMID: 37751993 DOI: 10.1136/archdischild-2023-325674] [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: 04/05/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
The placenta contains valuable clinical information that is linked to fetal development, neonatal morbidity and mortality, and future health outcomes. Both gross inspection and histopathological examination of the placenta may identify intrinsic or secondary placental lesions, which can contribute directly to adverse neonatal outcomes or indicate the presence of an unfavourable intrauterine environment. Placental examination therefore forms an essential component of the care of high-risk neonates and at perinatal post-mortem examination. In this article, we describe the clinical value of placental examination for paediatricians and perinatal clinicians. We discuss common pathological findings on general inspection of the placenta with photographic examples and provide an overview of the placental pathological examination, including how to interpret key findings. We also address the medico-legal and financial implications of placental examinations and describe current and future clinical considerations for clinicians in regard to placental examination.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Neonatal Unit, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Megan Hall
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lisa Story
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Panicos Shangaris
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mudher Al-Adnani
- Department of Cellular Pathology, St Thomas' Hospital, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Grenville F Fox
- Neonatal Unit, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Neelam Gupta
- Neonatal Unit, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
- GKT School of Medical Education, King's College London, London, UK
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4
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Cromb D, Slator PJ, Hall M, Price A, Alexander DC, Counsell SJ, Hutter J. Advanced magnetic resonance imaging detects altered placental development in pregnancies affected by congenital heart disease. Sci Rep 2024; 14:12357. [PMID: 38811636 PMCID: PMC11136986 DOI: 10.1038/s41598-024-63087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/24/2024] [Indexed: 05/31/2024] Open
Abstract
Congenital heart disease (CHD) is the most common congenital malformation and is associated with adverse neurodevelopmental outcomes. The placenta is crucial for healthy fetal development and placental development is altered in pregnancy when the fetus has CHD. This study utilized advanced combined diffusion-relaxation MRI and a data-driven analysis technique to test the hypothesis that placental microstructure and perfusion are altered in CHD-affected pregnancies. 48 participants (36 controls, 12 CHD) underwent 67 MRI scans (50 control, 17 CHD). Significant differences in the weighting of two independent placental and uterine-wall tissue components were identified between the CHD and control groups (both pFDR < 0.001), with changes most evident after 30 weeks gestation. A significant trend over gestation in weighting for a third independent tissue component was also observed in the CHD cohort (R = 0.50, pFDR = 0.04), but not in controls. These findings add to existing evidence that placental development is altered in CHD. The results may reflect alterations in placental perfusion or the changes in fetal-placental flow, villous structure and maturation that occur in CHD. Further research is needed to validate and better understand these findings and to understand the relationship between placental development, CHD, and its neurodevelopmental implications.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Paddy J Slator
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Megan Hall
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Anthony Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.
- Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Smart Imaging Lab, Radiological Institute, University Hospital Erlangen, Erlangen, Germany
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Cromb D, Slator P, Hall M, Price A, Alexander D, Counsell S, Hutter J. Advanced magnetic resonance imaging detects altered placental development in pregnancies affected by congenital heart disease. RESEARCH SQUARE 2024:rs.3.rs-3873412. [PMID: 38343847 PMCID: PMC10854304 DOI: 10.21203/rs.3.rs-3873412/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Congenital heart disease (CHD) is the most common congenital malformation and is associated with adverse neurodevelopmental outcomes. The placenta is crucial for healthy fetal development and placental development is altered in pregnancy when the fetus has CHD. This study utilized advanced combined diffusion-relaxation MRI and a data-driven analysis technique to test the hypothesis that placental microstructure and perfusion are altered in CHD-affected pregnancies. 48 participants (36 controls, 12 CHD) underwent 67 MRI scans (50 control, 17 CHD). Significant differences in the weighting of two independent placental and uterine-wall tissue components were identified between the CHD and control groups (both pFDR<0.001), with changes most evident after 30 weeks gestation. A Significant trend over gestation in weighting for a third independent tissue component was also observed in the CHD cohort (R = 0.50, pFDR=0.04), but not in controls. These findings add to existing evidence that placental development is altered in CHD. The results may reflect alterations in placental perfusion or the changes in fetal-placental flow, villous structure and maturation that occur in CHD. Further research is needed to validate and better understand these findings and to understand the relationship between placental development, CHD, and its neurodevelopmental implications.
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Avena-Zampieri CL, Hutter J, Deprez M, Payette K, Hall M, Uus A, Nanda S, Milan A, Seed PT, Rutherford M, Greenough A, Story L. Assessment of normal pulmonary development using functional magnetic resonance imaging techniques. Am J Obstet Gynecol MFM 2023; 5:100935. [PMID: 36933803 PMCID: PMC10711505 DOI: 10.1016/j.ajogmf.2023.100935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The mainstay of assessment of the fetal lungs in clinical practice is via evaluation of pulmonary size, primarily using 2D ultrasound and more recently with anatomical magnetic resonance imaging. The emergence of advanced magnetic resonance techniques such as T2* relaxometry in combination with the latest motion correction post-processing tools now facilitates assessment of the metabolic activity or perfusion of fetal pulmonary tissue in vivo. OBJECTIVE This study aimed to characterize normal pulmonary development using T2* relaxometry, accounting for fetal motion across gestation. METHODS Datasets from women with uncomplicated pregnancies that delivered at term, were analyzed. All subjects had undergone T2-weighted imaging and T2* relaxometry on a Phillips 3T magnetic resonance imaging system antenatally. T2* relaxometry of the fetal thorax was performed using a gradient echo single-shot echo planar imaging sequence. Following correction for fetal motion using slice-to-volume reconstruction, T2* maps were generated using in-house pipelines. Lungs were manually segmented and mean T2* values calculated for the right and left lungs individually, and for both lungs combined. Lung volumes were generated from the segmented images, and the right and left lungs, as well as both lungs combined were assessed. RESULTS Eighty-seven datasets were suitable for analysis. The mean gestation at scan was 29.9±4.3 weeks (range: 20.6-38.3) and mean gestation at delivery was 40±1.2 weeks (range: 37.1-42.4). Mean T2* values of the lungs increased over gestation for right and left lungs individually and for both lungs assessed together (P=.003; P=.04; P=.003, respectively). Right, left, and total lung volumes were also strongly correlated with increasing gestational age (P<.001 in all cases). CONCLUSION This large study assessed developing lungs using T2* imaging across a wide gestational age range. Mean T2* values increased with gestational age, which may reflect increasing perfusion and metabolic requirements and alterations in tissue composition as gestation advances. In the future, evaluation of findings in fetuses with conditions known to be associated with pulmonary morbidity may lead to enhanced prognostication antenatally, consequently improving counseling and perinatal care planning.
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Affiliation(s)
- Carla L Avena-Zampieri
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story).
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story)
| | - Maria Deprez
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Deprez, Ms Payette, and Ms Uus)
| | - Kelly Payette
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Deprez, Ms Payette, and Ms Uus)
| | - Megan Hall
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Hall, Dr Nanda, and Dr Story)
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Deprez, Ms Payette, and Ms Uus)
| | - Surabhi Nanda
- Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Hall, Dr Nanda, and Dr Story)
| | - Anna Milan
- Neonatal Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Milan)
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story)
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story)
| | - Anne Greenough
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Neonatal Unit, King's College Hospital, London, United Kingdom (Prof Greenough); National Institute for Health and Care Research Biomedical Research Centre based at Guy's & St Thomas NHS Foundation Trusts and King's College London, London, United Kingdom (Prof Greenough)
| | - Lisa Story
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Hall, Dr Nanda, and Dr Story)
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7
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Hutter J, Jackson L, Ho A, Avena Zampieri C, Hajnal JV, Al-Adnani M, Nanda S, Shennan AH, Tribe RM, Gibbons D, Rutherford MA, Story L. The use of functional placental magnetic resonance imaging for assessment of the placenta after prolonged preterm rupture of the membranes in vivo: A pilot study. Acta Obstet Gynecol Scand 2021; 100:2244-2252. [PMID: 34546571 DOI: 10.1111/aogs.14267] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/18/2021] [Accepted: 08/31/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Preterm prelabor rupture of membranes (PPROM) complicates 3% of pregnancies in the UK. Where delivery does not occur spontaneously, expectant management until 37 weeks of gestation is advocated, unless signs of maternal infection develop. However, clinical presentation of maternal infection can be a late sign and injurious fetal inflammatory responses may already have been activated. There is therefore a need for more sensitive markers to aid optimal timing of interventions. At present there is no non-invasive test in clinical practice to assess for infection in the fetal compartment and definitive diagnosis of chorioamnionitis is by histological assessment of the placenta after delivery. This study presents comprehensive functional placental magnetic resonance imaging (MRI) quantification, already used in other organ systems, to assess for infection/inflammation, in women with and without PPROM aiming to explore its use as a biomarker for inflammation within the feto-placental compartment in vivo. MATERIAL AND METHODS Placental MRI scans were performed in a cohort of 12 women (with one having two scans) with PPROM before 34 weeks of gestation (selected because of their high risk of infection), and in a control group of 87 women. Functional placental assessment was performed with magnetic resonance techniques sensitive to changes in the microstructure (diffusion) and tissue composition (relaxometry), with quantification performed both over the entire organ and in regions of interest between the basal and chorionic plate. Placental histology was analyzed after delivery where available. RESULTS Normative evolution of functional magnetic resonance biomarkers over gestation was studied. Cases of inflammation, as assessed by histological presence of chorioamnionitis, and umbilical cord vasculitis with or without funisitis, were associated with lower T2* (mean T2* at 30 weeks 50 ms compared with 58 ms in controls) and higher fractional anisotropy (mean at 30 weeks 0.55 compared with 0.45 in controls). These differences did not reach significance and there was substantial heterogeneity both in T2* and Apparent Diffusivitiy across the cohort. CONCLUSIONS This first exploration of functional placental assessment in a cohort of women with PPROM demonstrates that functional placental MRI can reveal a range of placental changes associated with inflammatory processes. It is a promising tool to gain information and in the future to identify inflammation in vivo, and could therefore assist in improving optimal timing for interventions designed to prevent fetal injury.
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Affiliation(s)
- Jana Hutter
- Centre for Medical Engineering, King's College London, London, UK
| | - Laurence Jackson
- Centre for Medical Engineering, King's College London, London, UK
| | - Alison Ho
- Centre for Medical Engineering, King's College London, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Carla Avena Zampieri
- Centre for Medical Engineering, King's College London, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for Medical Engineering, King's College London, London, UK
| | | | - Surabhi Nanda
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Rachel M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Deena Gibbons
- Peter Gorer Department of Immunobiology, 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.,Fetal Medicine Unit, St Thomas' Hospital, London, UK
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8
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Stout JN, Liao C, Gagoski B, Turk EA, Feldman HA, Bibbo C, Barth WH, Shainker SA, Wald LL, Grant PE, Adalsteinsson E. Quantitative T 1 and T 2 mapping by magnetic resonance fingerprinting (MRF) of the placenta before and after maternal hyperoxia. Placenta 2021; 114:124-132. [PMID: 34537569 DOI: 10.1016/j.placenta.2021.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/16/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION MR relaxometry has been used to assess placental exchange function, but methods to date are not sufficiently fast to be robust to placental motion. Magnetic resonance fingerprinting (MRF) permits rapid, voxel-wise, intrinsically co-registered T1 and T2 mapping. After characterizing measurement error, we scanned pregnant women during air and oxygen breathing to demonstrate MRF's ability to detect placental oxygenation changes. METHODS The accuracy of FISP-based, sliding-window reconstructed MRF was tested on phantoms. MRF scans in 9-s breath holds were acquired at 3T in 31 pregnant women during air and oxygen breathing. A mixed effects model was used to test for changes in placenta relaxation times between physiological states, to assess the dependency on gestational age (GA), and the impact of placental motion. RESULTS MRF estimates of known phantom relaxation times resulted in mean absolute errors for T1 of 92 ms (4.8%), but T2 was less accurate at 16 ms (13.6%). During normoxia, placental T1 = 1825 ± 141 ms (avg ± standard deviation) and T2 = 60 ± 16 ms (gestational age range 24.3-36.7, median 32.6 weeks). In the statistical model, placental T2 rose and T1 remained contant after hyperoxia, and no GA dependency was observed for T1 or T2. DISCUSSION Well-characterized, motion-robust MRF was used to acquire T1 and T2 maps of the placenta. Changes with hyperoxia are consistent with a net increase in oxygen saturation. Toward the goal of whole-placenta quantitative oxygenation imaging over time, we aim to implement 3D MRF with integrated motion correction to improve T2 accuracy.
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Affiliation(s)
- Jeffrey N Stout
- Fetal and Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, 02115, USA.
| | - Congyu Liao
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Borjan Gagoski
- Fetal and Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Esra Abaci Turk
- Fetal and Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Henry A Feldman
- Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Carolina Bibbo
- Brigham and Women's Hospital, Division of Maternal-Fetal Medicine, Boston, MA, 02115, USA
| | - William H Barth
- Maternal-Fetal Medicine, Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Scott A Shainker
- Maternal-Fetal Medicine, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Lawrence L Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, 02129, USA
| | - P Ellen Grant
- Fetal and Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Elfar Adalsteinsson
- Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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9
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Steinweg JK, Hui GTY, Pietsch M, Ho A, van Poppel MP, Lloyd D, Colford K, Simpson JM, Razavi R, Pushparajah K, Rutherford M, Hutter J. T2* placental MRI in pregnancies complicated with fetal congenital heart disease. Placenta 2021; 108:23-31. [PMID: 33798991 DOI: 10.1016/j.placenta.2021.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is one of the most important and common group of congenital malformations in humans. Concurrent development and close functional links between the fetal heart and placenta emphasise the importance of understanding placental function and its influence in pregnancy outcomes. The aim of this study was to evaluate placental oxygenation by relaxometry (T2*) to assess differences in placental phenotype and function in CHD. METHODS In this prospective cross-sectional observational study, 69 women with a fetus affected with CHD and 37 controls, whole placental T2* was acquired using a 1.5-Tesla MRI scanner. Gaussian Process Regression was used to assess differences in placental phenotype in CHD cohorts compared to our controls. RESULTS Placental T2* maps demonstrated significant differences in CHD compared to controls at equivalent gestational age. Mean T2* values over the entire placental volume were lowest compared to predicted normal in right sided obstructive lesions (RSOL) (Z-Score 2.30). This cohort also showed highest lacunarity indices (Z-score -1.7), as a marker of lobule size. Distribution patterns of T2* values over the entire placental volume were positively skewed in RSOL (Z-score -4.69) and suspected, not confirmed coarctation of the aorta (CoA-) (Z-score -3.83). Deviations were also reflected in positive kurtosis in RSOL (Z-score -3.47) and CoA- (Z-score -2.86). CONCLUSION Placental structure and function appear to deviate from normal development in pregnancies with fetal CHD. Specific patterns of altered placental function assessed by T2* deliver crucial complementary information to antenatal assessments in the presence of fetal CHD.
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Affiliation(s)
- Johannes K Steinweg
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom.
| | - Grace Tin Yan Hui
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Maximilian Pietsch
- Centre for the Developing Brain, King's College London, London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
| | - Alison Ho
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Milou Pm van Poppel
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
| | - David Lloyd
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Kathleen Colford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - John M Simpson
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Reza Razavi
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Kuberan Pushparajah
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom; Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
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10
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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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11
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Ho AEP, Hutter J, Jackson LH, Seed PT, Mccabe L, Al-Adnani M, Marnerides A, George S, Story L, Hajnal JV, Rutherford MA, Chappell LC. T2* Placental Magnetic Resonance Imaging in Preterm Preeclampsia: An Observational Cohort Study. HYPERTENSION (DALLAS, TEX. : 1979) 2020; 75:1523-1531. [PMID: 32336233 PMCID: PMC7682790 DOI: 10.1161/hypertensionaha.120.14701] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Placental dysfunction underlies the cause of pregnancies complicated by preeclampsia. The use of placental magnetic resonance imaging to provide an insight into the pathophysiology of preeclampsia and thus assess its potential use to inform prognosis and clinical management was explored. In this prospective observational cohort study, 14 women with preterm preeclampsia and 48 gestation-matched controls using 3-Tesla magnetic resonance imaging at median of 31.6 weeks (interquartile range [IQR], 28.6-34.6) and 32.2 weeks (IQR, 28.6-33.8), respectively, were imaged. The acquired data included T2-weighted images and T2* maps of the placenta, the latter an indicative measure of placental oxygenation. Placentae in women with preeclampsia demonstrated advanced lobulation, varied lobule sizes, high granularity, and substantial areas of low-signal intensity on T2-weighted imaging, with reduced entire placental mean T2* values for gestational age (2 sample t test, t=7.49) correlating with a reduction in maternal PlGF (placental growth factor) concentrations (Spearman rank correlation coefficient 0.76) and increased lacunarity values (t=3.26). Median mean T2* reduced from 67 ms (IQR, 54-73) at 26.0 to 29.8 weeks' gestation to 38 ms (IQR, 28-40) at 34.0 to 37.9 weeks' gestation in the control group. In women with preeclampsia, median T2* was 23 ms (IQR, 20-23) at 26.0 to 29.8 weeks' gestation and remained low (22 ms [IQR, 20-26] at 34.0-37.8 weeks' gestation). Histological features of maternal vascular malperfusion were only found in placentae from women with preeclampsia. Placental volume did not differ between the control group and women with preeclampsia. Placental magnetic resonance imaging allows both objective quantification of placental function in vivo and elucidation of the complex mechanisms underlying preeclampsia development.
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Affiliation(s)
- Alison E P Ho
- From the Department of Women and Children's Health, School of Life Course Sciences (A.E.P.H., P.S., L.S., L.C.C.), King's College London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain (J.H., L.H.J., L.M., J.V.H., M.A.R.), King's College London, United Kingdom.,Biomedical Engineering Department (J.H., L.H.J., J.V.H.), King's College London, United Kingdom
| | - Laurence H Jackson
- Centre for the Developing Brain (J.H., L.H.J., L.M., J.V.H., M.A.R.), King's College London, United Kingdom.,Biomedical Engineering Department (J.H., L.H.J., J.V.H.), King's College London, United Kingdom
| | - Paul T Seed
- From the Department of Women and Children's Health, School of Life Course Sciences (A.E.P.H., P.S., L.S., L.C.C.), King's College London, United Kingdom
| | - Laura Mccabe
- Centre for the Developing Brain (J.H., L.H.J., L.M., J.V.H., M.A.R.), King's College London, United Kingdom
| | - Mudher Al-Adnani
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom (M.A.-A., A.M., S.G.)
| | - Andreas Marnerides
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom (M.A.-A., A.M., S.G.)
| | - Simi George
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom (M.A.-A., A.M., S.G.)
| | - Lisa Story
- From the Department of Women and Children's Health, School of Life Course Sciences (A.E.P.H., P.S., L.S., L.C.C.), King's College London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain (J.H., L.H.J., L.M., J.V.H., M.A.R.), King's College London, United Kingdom.,Biomedical Engineering Department (J.H., L.H.J., J.V.H.), King's College London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain (J.H., L.H.J., L.M., J.V.H., M.A.R.), King's College London, United Kingdom
| | - Lucy C Chappell
- From the Department of Women and Children's Health, School of Life Course Sciences (A.E.P.H., P.S., L.S., L.C.C.), King's College London, United Kingdom
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