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Hu J, Lv Z, Dong Y, Liu W. Review of shear wave elastography in placental function evaluations. J Matern Fetal Neonatal Med 2023; 36:2203792. [PMID: 37121902 DOI: 10.1080/14767058.2023.2203792] [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: 05/02/2023]
Abstract
Background: Ultrasound is key to evaluating placental function. However, traditional ultrasound examinations cannot evaluate the changes in the biomechanical properties of the placenta in vivo. As a non-invasive technique, shear wave elastography (SWE) can be used analyze the physiological and biomechanical properties of the placenta. Moreover, it can evaluate the pathological changes in early placental insufficiency in a more direct and sensitive manner.Objective: This study aimed to systematically introduce SWE in placental function evaluations.Materials and methods: The terms 'placenta', 'ultrasound', and 'elastography' were searched on Pubmed, Embase, and CNKI databases (Apr 2023); this review was limited to results including placental sonoelastography.Results: Twenty-six studies satisfied the inclusion criteria and were included in this review. Herein, we introduce the basic principle of SWE, analyze the factors affecting placental measurements, and summarize the prospects of clinical applications of SWE in the field of obstetrical diseases.Conclusion: The SWE technology demonstrates excellent clinical application value and research prospects in obstetrics, particularly in placental function evaluation, owing to its objective and repeatable quantitative operation.
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Affiliation(s)
- Jingyuan Hu
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Zimeng Lv
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yue Dong
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Wei Liu
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Su S, Huang Y, Luo W, Li S. The Value of Ultrasonic Elastography in Detecting Placental Stiffness for the Diagnosis of Preeclampsia: A Meta-Analysis. Diagnostics (Basel) 2023; 13:2894. [PMID: 37761261 PMCID: PMC10527587 DOI: 10.3390/diagnostics13182894] [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: 08/23/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
This meta-analysis evaluated the diagnostic value of ultrasonic elastography in detecting placental stiffness in the diagnosis of preeclampsia (PE). A systematic search was conducted in the EMBASE, Web of Science, Cochrane Library, Scopus database, and PubMed databases to identify studies published before June 2023 using ultrasonic elastography to diagnose PE. The sensitivity, specificity, and diagnostic odds ratio of ultrasonic elastography for diagnosing PE were calculated, and a summary receiver operating characteristic curve model was constructed. The degree of heterogeneity was estimated using the I2 statistic, and a meta-regression analysis was performed to explore its sources. A protocol was determined previously (PROSPERO: CRD42023443646). We included 1188 participants from 11 studies, including 190 patients with PE and 998 patients without PE as controls. Overall sensitivity and specificity of ultrasonic elastography in detecting placental stiffness for the diagnosis of PE were 89% (95% CI: 85-93) and 74% (95% CI: 51-89), respectively. The I2 values for sensitivity and specificity were 59% (95% CI: 29-89) and 96% (95% CI: 95-98), respectively. The area under the receiver operating characteristic curve was 0.90 (95% CI: 0.87-0.92). The meta-regression analysis showed no significant heterogeneity. Ultrasonic elastography exhibits good diagnostic accuracy for detecting placental stiffness and can serve as a non-invasive tool for differentially diagnosing PE.
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Affiliation(s)
- Shanshan Su
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China; (S.S.); (Y.H.)
| | - Yanyan Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China; (S.S.); (Y.H.)
- Department of Reproductive in Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Weiwen Luo
- Department of Ultrasound, Zhangzhou Hospital, Zhangzhou 363000, China;
| | - Shaohui Li
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China; (S.S.); (Y.H.)
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Mariano RSG, Santos VJC, Taira AR, da Silva PDA, Rodriguez MGK, Padilha-Nakaghi LC, Simões APR, Maronezi MC, Avante ML, Uscategui RAR, Lima BB, Feliciano MAR, Teixeira PPM, Vicente WRR. Characterization of uterine involution using B-mode ultrasonography, color Doppler and elastography (acoustic radiation force impulse) for assessing postpartum in Santa Inês ewes. Anim Reprod 2023; 20:e20220110. [PMID: 37416868 PMCID: PMC10321682 DOI: 10.1590/1984-3143-ar2022-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
The aim of this study was to investigate uterine involution using ultrasonography techniques during postpartum. Postpartum ultrasonography evaluation (B-mode, color Doppler and Acoustic Radiation Force Impulse elastography) of the uterus was performed by transabdominal approach at immediate after birth and sequentially every 48 hours, during 30 days. The uterine echotexture did not present significant variations (P >0.05) being homogeneous in most evaluations; echogenicity of the uterus increased along the evaluation period (P =0.0452). Progressive and remarkable decrease of the total uterine diameter (UD) were observed (P <0.0001), especially during the first days postpartum. The thickness of uterine wall gradually decreased, as well the endometrial, myometrium and lumen diameters (P <0.0001). Uterine blood flow was assessed by Doppler and decreased during postpartum period, being significantly lower (P=0.0225) on the 30th day of postpartum. Uterine parenchyma presented as homogeneous dark areas (not deformable) on qualitative ultrasound elastography and the means shear velocity values of the uterine wall on quantitative elastography did not differ. This is the first study that evaluate the stiffness of uterine wall in healthy ewes, providing baseline data about quantitative and qualitative stiffness of the normal uterus, and it may be a useful tool for early diagnosis of uterine alterations during the postpartum period, using the reference parameter established for the assessment of uterine integrity during postpartum period.
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Affiliation(s)
- Renata Sitta Gomes Mariano
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Victor José Correia Santos
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Augusto Ryonosuke Taira
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Priscila Del Aguila da Silva
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Mariana Garcia Kako Rodriguez
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Luciana Cristina Padilha-Nakaghi
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Ana Paula Rodrigues Simões
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Marjury Cristina Maronezi
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Michelle Lopes Avante
- Departamento de Clínica e Cirurgia Veterinária, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Ricardo Andres Ramirez Uscategui
- Departamento de Clínica e Cirurgia Veterinária, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Bruna Bressianini Lima
- Departamento de Clínica e Cirurgia Veterinária, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
| | - Marcus Antônio Rossi Feliciano
- Departamento de Medicina Veterinária, Faculdade de Zootecnia e Engenharia de Alimentos, Universidade de São Paulo, Pirassununga, SP, Brasil
| | | | - Welter Ricardo Russiano Vicente
- Departamento de Clínica e Cirurgia Veterinária, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Jaboticabal, SP, Brasil
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Kucukbas GN, Soylu AR. Comparison of fetal and maternal tissue elasticity between euploid and aneuploid pregnancies by shear wave elastography. J Obstet Gynaecol Res 2023; 49:568-576. [PMID: 36404125 DOI: 10.1111/jog.15483] [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: 03/02/2022] [Revised: 09/18/2022] [Accepted: 10/19/2022] [Indexed: 11/22/2022]
Abstract
AIM B-mode ultrasonography utilized for fetal screening of common trisomies is referred to as a genetic sonogram and includes determining major abnormalities and soft markers such as hypoplastic nasal bone and increased thickness of the nuchal fold. Elastography is a novel ultrasound technique giving information about tissue stiffness used for diagnosing cancer, transplant rejection, and organ fibrosis. This study aimed to determine via shear wave elastography (SWE) whether euploid and aneuploid fetal soft marker tissues vary in stiffness. METHODS The participants were all singleton pregnancies between 19 and 23 weeks of gestation; 35 euploid and 14 aneuploid fetus pregnancies were enrolled. Fetal bowel, kidney, liver, nasal bone, nuchal fold, placenta, and myometrium were investigated with SWE using acoustic radiation impulse force. Images were analyzed with a novel software calibrated and written by us using MATLAB. Statistical analysis was completed with the SPSS Program. Shapiro-Wilk normality distribution analysis, Student's t-test, and Mann-Whitney U methods were used. RESULTS The mean shear wave speed of fetal nasal bone was significantly lower in aneuploid fetuses. There was no difference between other tissues in mean shear wave velocity. CONCLUSIONS Euploid and aneuploid fetuses have different elastic properties of the nasal bone and this may have a role in differentiating aneuploid fetuses noninvasively.
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Affiliation(s)
- Gokce Naz Kucukbas
- Kocaeli Derince Training and Research Hospital, Department of Obstetrics and Gynecology, Perinatology Division, Karadenizliler Mahallesi İzmit Kadın Doğum ve Çocuk Hastanesi, İzmit/Kocaeli, Turkey.,Perinatology Division, Department of Obstetrics and Gynecology, Van Yuzuncu Yil University, Van, Turkey
| | - Abdullah Ruhi Soylu
- Department of Biophysics, Hacettepe University School of Medicine, Ankara, Turkey
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Edwards C, Cavanagh E, Kumar S, Clifton VL, Borg DJ, Priddle J, Wille ML, Drovandi C, Fontanarosa D. Shear wave velocity measurement of the placenta is not limited by placental location. Placenta 2023; 131:23-27. [PMID: 36469959 DOI: 10.1016/j.placenta.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/22/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Ultrasound elastography shows diagnostic promise via the non-invasive determination of placental elastic properties. A limitation is a potential for inadequate measurements from posterior placentae. This study aimed to analyse placental position's influence on measures of shear wave elastography (SWV). METHODS SWV elastography measurements were obtained via ultrasound at 24, 28 and 36 weeks gestation from 238 pregnancies. . The placental position was labelled as either anterior, posterior or fundal/lateral. Average SWV measurements (m/s) and the corresponding standard deviations (SD) were used for data analysis. RESULTS There was a statistically significant difference between SWV recorded from anterior (1.33 ± 0.19)m/s and posterior (1.39 ± 0.18)m/s placentae (p < 0.001). However, the average sampling depth between these groups was significantly different (3.98 cm vs. 5.38 cm, p < 0.001). There was no statistically significant difference between SWV when measurements were compared at similar depths, regardless of placental location. The addition of placental position to a previously developed mixed-effects model confirmed placental position did not result in improved SWV measurements. In this model, sampling depth remained the best predictor for SWV. CONCLUSIONS This study showed that placental position does not influence the accuracy or reliability of SWV.
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Affiliation(s)
- Christopher Edwards
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia.
| | - Erika Cavanagh
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Sailesh Kumar
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.
| | - Vicki L Clifton
- Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Danielle J Borg
- Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Jacob Priddle
- School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Centre for Data Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Marie-Luise Wille
- School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia; ARC Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Christopher Drovandi
- School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Centre for Data Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
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Sakcak B, Alkan M, Denizli R, Farisoğullari N, Kara Ö, Ayhan ŞG, Tanacan A, Şahin D. Point shear wave velocity(pSWV) evaluation of the placenta of pregnant women who had recovered from COVID-19: A prospective cohort study from a tertiary pandemic center. Placenta 2022; 128:57-61. [PMID: 36067701 PMCID: PMC9395301 DOI: 10.1016/j.placenta.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/03/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022]
Abstract
Introduction To assess the placental elasticity using point shear wave velocity (pSWV) in pregnant women who had recovered from coronavirus COVID-19. Methods A total of 40 pregnant women who had recovered from moderate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 40 healthy pregnant women were included in this study. We evaluated placental elasticity by using transabdominal pSWV method. Three measurements were made, and their average was accepted as the mean placental velocity value in each case. The results were compared between the post-COVID-19 and control groups. Results The mean pSWV values were significantly higher in the post-COVID-19 group compared to the control group, indicating that the women with a history of COVID-19 had stiffer placentas. Furthermore, the pSWV values were significantly and positively correlated with the uterine artery pulsatility index. We also found that the NICU requirement was statistically higher in the post-COVID 19 group. Discussion The pregnant women who had recovered from COVID-19 had rigid placentas than the healthy controls. The use of pSWV for the assessment of placental velocity may provide valuable information in the diagnosis and management of post-COVID-19 patients as a complementary tool to the existing ultrasonography methods.
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Affiliation(s)
- Bedri Sakcak
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey.
| | - Mihriban Alkan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ramazan Denizli
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Nihat Farisoğullari
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Özgür Kara
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Şule Göncü Ayhan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Şahin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey; University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Anuk AT, Tanacan A, Erol SA, Alkan M, Altinboga O, Celen S, Keskin HL, Sahin D. Value of shear-wave elastography and cerebral-placental-uterine ratio in women diagnosed with preeclampsia and fetal growth restriction in prediction of adverse perinatal outcomes. J Matern Fetal Neonatal Med 2022; 35:10001-10009. [PMID: 35647897 DOI: 10.1080/14767058.2022.2081804] [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: 10/18/2022]
Abstract
PURPOSE The aim of this study was to measure placental stiffness with shear-wave elastography technique and to evaluate the relationship with cerebral-placental-uterine ratio (CPUR) and adverse perinatal outcomes in patient groups diagnosed with preeclampsia (PE) and fetal growth restriction (FGR) in the second and third trimesters compared to the control group. MATERIALS AND METHODS This prospective cross-sectional study was conducted at our hospital between March 2019 and March 2020. The study groups were divided into three groups: PE, FGR, and low risk pregnancy (LRP) group. The study population had singleton pregnancies and the placental site was at the anterior wall. Both shear-wave elasticity (SWE) and shear-wave velocity (SWV) were measured in the placenta during pregnancy. CPUR was calculated for each group. RESULTS A total of 147 patients were included in this study. The mean SWE (kilopascals) values in the PE group were significantly higher than in the FGR and controls (difference of means = 3.67, 9.45; 95% CI (1.23-6.1, 7-11.8); p < .05), respectively. The mean SWV values were significantly higher in PE and FGR groups than controls (p < .05). CPUR showed correlation with central maternal surface of placenta (p: .02, r: -0.184), central fetal surface of placenta (p < .001, r: -0.288), peripheral maternal surface of placenta (p: .002, r: -0.252), and peripheral fetal surface of placenta SWE values (p: .03, r: -0.181). NICU admission was correlated with central fetal surface of placenta SWE values (p: .002, r: 0.258). CONCLUSION In conclusion, we demonstrated increased placental stiffness in both the PE and the FGR group. Also, this difference was found to be more prominent in preeclampsia. This technique seems useful for assessment of placental function and may strengthen the utility of Doppler parameters for predicting adverse perinatal outcomes in high-risk pregnancies.
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Affiliation(s)
- Ali Taner Anuk
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Seyit Ahmet Erol
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Mihriban Alkan
- Department of Radiology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Orhan Altinboga
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Sevki Celen
- Department of Obstetrics and Gynecology, Division of Perinatology, Etlik Zübeyde Hanım Maternity & Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Hüseyin Levent Keskin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Dokumaci DS, Uyanikoglu H. Shear-wave elastography for detection of placenta percreta: a case-controlled study. Acta Radiol 2022; 63:424-430. [PMID: 33626875 DOI: 10.1177/0284185121997768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prenatal diagnosis of placenta percreta (PP) is important to be able to provide effective management and a multidisciplinary approach to minimize the complications. PURPOSE To evaluate the role of shear-wave elastography (SWE) in the prenatal diagnosis of PP. MATERIAL AND METHODS A total of 18 women with PP and 20 pregnant women with normal placenta in the second or third trimesters were included in this prospective study. SWE was used to determine the elasticities of the placenta (in the maternal edge of the placenta) and myometrium. The obstetric data regarding grayscale and Doppler ultrasonography, and perinatal outcomes were reviewed. A mean placental SW velocity (SWV) cut-off value was determined to predict the presence of placental adherence. RESULTS The SWV values of the PP group in the maternal edge of the placenta were significantly higher than those of the control group (1.95 ± 0.19 m/s and 1.69 ± 0.23 m/s; P = 0.001). Myometrial SWV was also higher in the PP group compared to the control group (2.25 ± 0.39 m/s and 1.90 ± 0.71 m/s; P = 0.002). A receiver operating characteristic (ROC) curve analysis was performed and the best cut-off value of placental SWV was determined as 1.92 m/s with sensitivity of 58% and specificity of 80%, to predict the placental adherence in patients with PP. CONCLUSION Placental stiffness was significantly higher in patients with PP than in pregnant women with normally localized placenta. Thus, we thought that SWE of the placenta might be used as an alternative method in the diagnosis of PP.
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Affiliation(s)
- Dilek Sen Dokumaci
- Harran University Medical Faculty, Department of Radiology, Sanliurfa, Turkey
| | - Hacer Uyanikoglu
- Harran University Medical Faculty, Department of Obstetrics and Gynecology, Sanliurfa, Turkey
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Edwards C, Cavanagh E, Kumar S, Clifton VL, Borg DJ, Priddle J, Wille ML, Drovandi C, Fontanarosa D. Changes in placental elastography in the third trimester - Analysis using a linear mixed effect model. Placenta 2021; 114:83-89. [PMID: 34500214 DOI: 10.1016/j.placenta.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Research into the role of ultrasound elastography to assess compromised placental tissue is ongoing. There is particular interest in evaluating its potential in the investigation of changes associated with uteroplacental dysfunction. To date, there is limited data on how different maternal and fetal considerations, such as advancing gestational age, amniotic fluid Index (AFI) and maternal body mass index (BMI) may influence shear wave velocity (SWV) measurements. This study aimed to evaluate longitudinal changes in SWV throughout gestation and model these changes with other developing fetal and maternal physiological and biological characteristics. METHODS The study utilised 238 singleton pregnancies and collected longitudinal data at repeated intervals in the 3rd trimester representing 629 individual data points. Linear mixed model regression analysis was used to identify significant predictors for SWV. RESULTS From a total of ten variables selected for modelling, only gestational age, AFI, BMI, and sample depth were found to be significant predictors of placental SWV, and gestational age and AFI were found to have only a minimal impact on SWV. DISCUSSION Sophisticated statistical modelling demonstrates that many of the expected maternal and fetal changes in the 3rd trimester have no or minimal impact on placental SWV. Understanding which factors influence placental SWV is essential to ascertain the technique's utility in managing pregnancies complicated by placental dysfunction in the future.
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Affiliation(s)
- Christopher Edwards
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia.
| | - Erika Cavanagh
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Sailesh Kumar
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.
| | - Vicki L Clifton
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia
| | - Danielle J Borg
- Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Jacob Priddle
- School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Marie-Luise Wille
- School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia; ARC Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Christopher Drovandi
- School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
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Saw SN, Dai Y, Yap CH. A Review of Biomechanics Analysis of the Umbilical-Placenta System With Regards to Diseases. Front Physiol 2021; 12:587635. [PMID: 34475826 PMCID: PMC8406807 DOI: 10.3389/fphys.2021.587635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Placenta is an important organ that is crucial for both fetal and maternal health. Abnormalities of the placenta, such as during intrauterine growth restriction (IUGR) and pre-eclampsia (PE) are common, and an improved understanding of these diseases is needed to improve medical care. Biomechanics analysis of the placenta is an under-explored area of investigation, which has demonstrated usefulness in contributing to our understanding of the placenta physiology. In this review, we introduce fundamental biomechanics concepts and discuss the findings of biomechanical analysis of the placenta and umbilical cord, including both tissue biomechanics and biofluid mechanics. The biomechanics of placenta ultrasound elastography and its potential in improving clinical detection of placenta diseases are also discussed. Finally, potential future work is listed.
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Affiliation(s)
- Shier Nee Saw
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Yichen Dai
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Choon Hwai Yap
- Department of Bioengineering, Imperial College London, London, United Kingdom
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Altunkeser A, Inal ZO, Baran N. Evaluation of Ovaries in Patients with Polycystic Ovary Syndrome using Shear Wave Elastography. Curr Med Imaging 2021; 16:578-583. [PMID: 32484092 DOI: 10.2174/1573405615666190114150538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/07/2018] [Accepted: 12/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Shear wave electrography (SWE) is a novel non-invasive imaging technique which demonstrate tissue elasticity. Recent research evaluating the elasticity properties of normal and pathological tissues emphasize the diagnostic importance of this technique. AIMS Polycystic ovarian syndrome (PCOS), which is characterized by menstrual irregularity, hyperandrogenism, and polycystic overgrowth, may cause infertility. The aim of this study was to evaluate the elasticity of ovaries in patients with PCOS using SWE. METHODS 66 patients diagnosed with PCOS according to the Rotterdam criteria (PCOS = group I) and 72 patients with non-PCOS (Control = group II), were included in the study. Demographic and clinical characteristics of the participants were recorded. Ovarian elasticity was assessed in all patients with SWE, and speed values were obtained from the ovaries. The elasticity of the ovaries was compared between the two groups. RESULTS While there were statistically significant differences between the groups in body mass index (BMI), right and left ovarian volumes, luteinizing hormone and testosterone levels (p<0.05), no significant differences were found between groups I and II in the velocity (for the right ovary 3.89±1.81 vs. 2.93±0.72, p=0.301; for the left ovary 2.88±0.65 vs. 2.95±0.80, p=0.577) and elastography (for the right ovary 36.62±17.78 vs. 36.79±14.32, p=0.3952; for the left ovary 36.56±14.15 vs. 36.26±15.10, p=0.903) values, respectively. CONCLUSION We could not obtain different velocity and elastography values from the ovaries of the patients with PCOS using SWE. Therefore, further large-scale studies are needed to elucidate this issue.
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Affiliation(s)
- Aysegul Altunkeser
- Department of Radiology, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Zeynep Ozturk Inal
- Department of Reproductive Endocrinology, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Nahide Baran
- Department of Radiology, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
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Ehlers E, Talton OO, Schust DJ, Schulz LC. Placental structural abnormalities in gestational diabetes and when they develop: A scoping review. Placenta 2021; 116:58-66. [PMID: 33958235 DOI: 10.1016/j.placenta.2021.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022]
Abstract
Gestational diabetes mellitus (GDM) is defined as diabetes with onset or first recognition during gestation. It is a common complication of pregnancy that has become more prevalent over the past few decades. Abnormalities in fetal growth, including increased incidence of both large and small for gestational age babies, suggest placental dysfunction. The major goal of this scoping review is to determine what is known about abnormalities in placentas delivered from GDM pregnancies, and how early in gestation these abnormalities arise. A secondary goal is to review to what extent other selected factors, in particular obesity, have been found to influence or modify the reported effects of GDM on placental development, and whether these are considered in the study of GDM placentas. PubMed and Scopus databases were searched using the key terms: "gestational diabetes AND (woman OR human) AND placenta AND (ultrasound OR ultrastructure OR imaging OR histology OR pathology). Studies of gross morphology and histoarchitecture in placentas delivered from GDM pregnancies consistently report increased placental size, villous immaturity and a range of vascular lesions when compared to uncomplicated pregnancies. In contrast, a small number of ultrasound studies have examined placental development in GDM pregnancies in the second, and especially, the first trimester. Relatively few studies have analyzed interactions with maternal BMI, but these do suggest that it may play a role in placental abnormalities. Further examination of placental development early in pregnancy is needed to understand when it becomes disrupted in GDM, as a first step to identifying the underlying causes.
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Affiliation(s)
- Erin Ehlers
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
| | | | - Danny J Schust
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
| | - Laura C Schulz
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA.
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Hefeda MM, Zakaria A. Shear wave velocity by quantitative acoustic radiation force impulse in the placenta of normal and high-risk pregnancy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00246-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Abstract
Background
Traditionally, the placental functional integrity is suggested by indirect ultrasound measurements like fetal growth, amniotic fluid index, and uterine and umbilical artery Doppler indices. Only recently the elasticity of the placenta is studied as a measure of placental consistency and biomechanical prosperities and may reflect the placental function. Shear wave velocity is the quantitative parameter of the shear wave elastography. A high-risk pregnancy is a situation which puts the mother, the fetus, or both at greater risk than a normal pregnancy.
Results
The shear wave velocity (SWV) showed no significant difference between the placenta of normal pregnancies in the second and third trimesters (0.85 ± 0.43 m/s and 0.89 ± 0.57 m/s, respectively). The placenta of patients with preeclampsia/eclampsia had high SWV in the second and third trimesters (2.13 ± 1.48 m/s and 2.23 ± 1.48 m/s) with a highly significant difference from the normal placenta (P < 0.001). The placentas with abnormal location (placenta previa) and penetration (placenta accreta) had higher SWV than the placenta of normal pregnancies. The mean SWV for placenta previa was 1.1 ± 0.74 m/s and 1.3 ± 0.81 m/s in the second and third trimesters, respectively, with a mildly significant difference with the normal placenta. The placenta accreta shows high mean SWV in the second and third trimesters (1.6 ± 0.65 m/s and 1.961.6 ± 0.65, respectively) which differed significantly (P < 0.001) from SWV in the normal placenta in the second and third trimesters.
Conclusion
Shear wave velocity measurement as the quantitative parameter of acoustic radiation force impulse (ARFI) elastography reflects the placental elasticity in normal and high-risk pregnancies. The SWV increases in conditions like hypertension, preeclampsia, maternal renal disease, and diabetes and reflects the structural and biomechanical abnormalities in such diseases. High shear wave velocity correlates with the incidence of growth restriction and abnormal Doppler parameters especially in the hypertensive disease. The virtual touch quantification (VTQ) can be used as a complementary diagnostic and prognostic tool in high-risk pregnancy.
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Lai HW, Lyv GR, Wei YT, Zhou T. The diagnostic value of two-dimensional shear wave elastography in gestational diabetes mellitus. Placenta 2020; 101:147-153. [PMID: 32980791 DOI: 10.1016/j.placenta.2020.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of our study is to establish the reference range of Young's modulus values of placenta in normal pregnancies and to evaluate the diagnostic value of two-dimensional shear wave elastography (2D-SWE) in gestational diabetes mellitus (GDM). METHODS A total of 223 normal pregnant women, 22 pregnancies complicated by A1GDM (controlled by diet), and 14 pregnancies complicated by A2GDM (controlled by medication) were recruited for this study. The elasticity values of the central parts of the placentas were determined by 2D-SWE imaging. The mean value (Emean), min value (Emin), and max value (Emax) of the placentas were recorded. Twenty placentas were randomly selected for reliability analysis. RESULTS (1) All values (Emean, Emin, Emax) showed great repeatability and consistency. (2) The reference range of Young's modulus values of placentas in normal pregnancies were Emean (4.12 ± 0.83), Emin (2.15 ± 0.83) and Emax (6.72 ± 1.43). No significant correlations were observed between elasticity values and gestational age (r < 0.3, p > 0.05) or between elasticity values and placental maturity (r < 0.3, p > 0.05). (3) The Young's modulus values in the A1 GDM and A2 GDM women were Emean (6.39 ± 1.74), Emin (2.95 ± 1.05), Emax (10.78 ± 2.94) and Emean (11.96 ± 7.29), Emin (6.79 ± 4.70a), Emax (18.94 ± 11.61) respectively. All values were significantly higher in GDM pregnancies than in normal pregnancies (p < 0.05). A2GDM pregnancies had higher values than A1GDM pregnancies (p < 0.05). CONCLUSION Placental elasticity is independent of gestational age and placental maturity. 2D-SWE can play an important role in diagnosing GDM by assessing placental hardness.
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Affiliation(s)
- Hong-Wei Lai
- The Second Affiliated Hospital of Fujian Medical University, China
| | - Guo-Rong Lyv
- The Second Affiliated Hospital of Fujian Medical University, China; Quanzhou Medical College, China.
| | - Yu-Ting Wei
- Fujian Medical University Affiliated First Quanzhou Hospital, China
| | - Ting Zhou
- The Second Affiliated Hospital of Fujian Medical University, China
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Edwards C, Cavanagh E, Kumar S, Clifton V, Fontanarosa D. The use of elastography in placental research - A literature review. Placenta 2020; 99:78-88. [PMID: 32763616 DOI: 10.1016/j.placenta.2020.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Ultrasound elastography is a technique used to quantify biomechanical changes that occur in parenchymal tissue with disease. Recent research has applied the technique to the placenta in order to investigate changes associated with uteroplacental dysfunction. We performed a literature review to summarise the current available information regarding this novel technique. METHODS Pubmed, CINAHL and Embase were searched using the terms "placenta", "ultrasound" and "elastography". Only full text studies written in English and limited to placental sonoelastography were included. RESULTS Twenty-eight studies met the inclusion criteria and were included in this review. Publications were divided into in vivo and ex vivo groups, and further categorised into four subgroups: normal pregnancy, pregnancy-induced hypertension and pre-eclampsia, fetal growth restriction and other pregnancy complications. CONCLUSION Ultrasound elastography can quantitatively assess biomechanical properties of the placenta in conditions where placental function is compromised.
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Affiliation(s)
- Christopher Edwards
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Institute of Health and Biomedical Innovation, Brisbane, QLD, 4000, Australia; Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4101, Australia
| | - Erika Cavanagh
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Institute of Health and Biomedical Innovation, Brisbane, QLD, 4000, Australia; Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4101, Australia
| | - Sailesh Kumar
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Institute of Health and Biomedical Innovation, Brisbane, QLD, 4000, Australia; Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4101, Australia; University of Queensland, Faculty of Medicine, Herston, QLD, 4006, Australia.
| | - Vicki Clifton
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4101, Australia; University of Queensland, Faculty of Medicine, Herston, QLD, 4006, Australia
| | - Davide Fontanarosa
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Institute of Health and Biomedical Innovation, Brisbane, QLD, 4000, Australia.
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Eroğlu H, Tolunay HE, Tonyalı NV, Orgul G, Şahin D, Yücel A. Comparison of placental elasticity in normal and intrauterine growth retardation pregnancies by ex vivo strain elastography. Arch Gynecol Obstet 2020; 302:109-115. [PMID: 32430754 DOI: 10.1007/s00404-020-05596-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/06/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the placental elasticity in fetuses with or without intrauterine growth restriction (IUGR). MATERIALS AND METHODS One hundred pregnant women (50 IUGR and 50 healthy) with anteriorly located placenta were evaluated during the third trimester of pregnancy. Measurements were carried out by a machine that has a real-time elastographic ultrasonography feature. After obtaining the optimum image, three areas (subcutaneous tissue, center, and the edge of the placenta) were provided to identify the placental strain values. Then, the placental strain ratio (PSR) value was calculated automatically. Two groups compared in terms of their PSR values. RESULTS There was a significant difference in placental elasticity between the groups (P < 0.001). PSR value was 2.8 ± 1.2 in the IUGR group and 1.3 ± 0.6 in the control group. A PSR value of 1.78 had an 86% sensitivity (OR 4.3) and 80% specificity (OR 0.17) in IUGR cases. The positive predictive value was 81.1% and the negative predictive value was 85.1% for this cut-off value. CONCLUSIONS We have shown that placental strain ratio is increased during the third trimester of pregnancy in fetuses with IUGR. Increased stiffness and elasticity may be responsible for the onset of IUGR in some cases.
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Affiliation(s)
- Hasan Eroğlu
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey.
| | - Harun Egemen Tolunay
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey
| | - Nazan Vanlı Tonyalı
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey
| | - Gokcen Orgul
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey
| | - Dilek Şahin
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey
| | - Aykan Yücel
- Perinatology Department, Training and Research Hospital, Etlik Zubeyde Hanim Women's Health Care, Ankara, Turkey
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Tolunay HE, Eroğlu H, Kaya O, Şahin D, Yücel A. The effect of placental elasticity on intraoperative bleeding in pregnant women with previous cesarean section. J Perinat Med 2020; 48:217-221. [PMID: 32045355 DOI: 10.1515/jpm-2019-0448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/07/2020] [Indexed: 12/18/2022]
Abstract
Background We aimed to evaluate the efficiency of placental elasticity in predicting the amount of intraoperative bleeding via real-time tissue elastography technique. Methods Pregnant women in the third trimester of pregnancy who had planned delivery via cesarean section due to the recurrent cesareans were enrolled in the research (n = 78). Elastographic measurements of placental tissues of all cases were carried out by real-time elastographic ultrasonography. It is a tissue elastography software (Esaote MyLabSeven) that uses a 8-1-MHz multifrequency AC2541 Probe. Results A significant relationship was found between placental elasticity and intraoperative bleeding. There was a significant correlation between alterations in the preoperative and postoperative hemoglobin (Hb) and hematocrit (Hct) levels and placental strain ratio (SR) (P < 0.001, r: 0.831; P < 0.001, r: 0.733, respectively). Conclusion These findings may reflect an alteration at the tissue elasticity level. We hope that the use of real-time elastographic ultrasonography technique may give an idea about the amount of bleeding during the cesarean section.
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Affiliation(s)
- Harun Egemen Tolunay
- Perinatology Department, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, 06010 Ankara, Turkey
| | - Hasan Eroğlu
- Perinatology Department, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, 06010 Ankara, Turkey
| | - Onur Kaya
- Perinatology Department, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, 06010 Ankara, Turkey
| | - Dilek Şahin
- Perinatology Department, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, 06010 Ankara, Turkey
| | - Aykan Yücel
- Perinatology Department, Etlik Zubeyde Hanim Women's Health Care, Training and Research Hospital, 06010 Ankara, Turkey
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Bayramoğlu Tepe N, Gelebek Yilmaz F, Bozdag Z, Uğur MG. Subgroup analysis of accreta, increta and percreta cases using acoustic radiation force impulse elastography. J Obstet Gynaecol Res 2020; 46:699-706. [PMID: 32153105 DOI: 10.1111/jog.14229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/07/2020] [Accepted: 02/24/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare acoustic radiation force impulse (ARFI) elastography values and histopathological diagnoses (accreta, increta, percreta) in patients suspected of having abnormal placental invasion (API). MATERIALS AND METHODS This prospective study included 54 patients in the third trimester with a history of caesarian section (CS) and API based on gray scale and Doppler ultrasonography (USG) and 35 healthy controls. Patients underwent ARFI elastography preoperatively. Elastography measurements of the fetal and maternal sides of the placenta were compared to histopathology. RESULTS Patients had higher maternal-side, fetal-side and average elastography values (P = 0.001). Intraoperatively, eight patients (14.8%) showed abnormal cervical canal invasion and 46 (85.2%) bladder and/or parametrial invasion. Eight patients underwent CS + placental-bed suture, 11 CS + excision of the lower segment, and 35 caesarean-hysterectomy. Histopathology of lower segment excision/caesarian-hysterectomy patients determined 10 (21.7%) accreta, 10 (21.7%) increta and 26 (56.6%) percreta cases. ARFI values were highest in the percreta subgroup. The increta subgroup showed higher ARFI values than the accreta subgroup but maternal-side, fetal-side and average ARFI values were not significantly different across the subgroups (P > 0.05). The cut-off values for average, peripheral and central elastography were determined as >0.90, >0.76, >0.98 (m/s) with sensitivities of 98, 64, 98% and specificities of 85, 80, 91%, respectively. CONCLUSION ARFI elastography can detect API. However, it cannot determine invasion depth reliably. More studies with subgroup analyses are warranted to reveal its usefulness for invasion depth.
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Affiliation(s)
| | | | - Zehra Bozdag
- Department of Pathology, University of Gaziantep, Gaziantep, Turkey
| | - Mete Gürol Uğur
- Department of Obstetrics and Gynecology, University of Gaziantep, Gaziantep, Turkey
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Simon EG, Callé S, Perrotin F, Remenieras JP. Measurement of shear wave speed dispersion in the placenta by transient elastography: A preliminary ex vivo study. PLoS One 2018; 13:e0194309. [PMID: 29621270 PMCID: PMC5886409 DOI: 10.1371/journal.pone.0194309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/28/2018] [Indexed: 12/31/2022] Open
Abstract
Background Placental elasticity may be modified in women with placental insufficiency. Shear wave elastography (SWE) can measure this, using acoustic radiation force, but the safety of its use in pregnant women has not yet been demonstrated. Transient elastography (TE) is a safer alternative, but has not yet been applied to the placenta. Moreover, the dispersion of shear wave speed (SWS) as a function of frequency has received relatively little study for placental tissue, although it might improve the accuracy of biomechanical assessment. Objective To explore the feasibility and reproducibility of TE for placental analysis, to compare the values of SWS and Young’s modulus (YM) from TE and SWE, and to analyze SWS dispersion as a function of frequency ex vivo in normal placentas. Materials and methods Ten normal placentas were analyzed ex vivo by an Aixplorer ultrasound system as shear waves were generated by a vibrating plate and by using an Aixplorer system. The frequency analysis provided the value of the exponent n from a fractional rheological model applied to the TE method. We calculated intra- and interobserver agreement for SWS and YM with 95% prediction intervals, created Bland-Altman plots with 95% limits of agreement, and estimated the intraclass correlation coefficient (ICC). Main results The mean SWS was 1.80 m/s +/- 0.28 (standard deviation) with the TE method at 50 Hz and 1.82 m/s +/-0.13 with SWE (P = 0.912). No differences were observed between the central and peripheral regions of placentas with either TE or SWE. With TE, the intraobserver ICC for SWS was 0.68 (0.50–0.82), and the interobserver ICC for SWS 0.65 (0.37–0.85). The mean parameter n obtained from the fractional rheological model was 1.21 +/- 0.12, with variable values of n for any given SWS. Conclusions TE is feasible and reproducible on placentas ex vivo. The frequency analysis of SWS provides additional information about placental elasticity and appears to be able to distinguish differences between placental structures.
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Affiliation(s)
- Emmanuel G. Simon
- UMR 1253, iBrain, University of Tours, Inserm, Tours, France
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital Center of Tours, Tours, France
- * E-mail:
| | - Samuel Callé
- UMR 1253, iBrain, University of Tours, Inserm, Tours, France
- GREMAN, UMR CNRS 7347, University of Tours, Tours, France
| | - Franck Perrotin
- UMR 1253, iBrain, University of Tours, Inserm, Tours, France
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital Center of Tours, Tours, France
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Arslan H, Tolunay HE, Cim N, Boza B, Yavuz A, İlik İ, Sahin HG, Yildizhan R. Shear-wave elastography – virtual touch tissue quantification of fetal placentas with a single umbilical artery. J Matern Fetal Neonatal Med 2018; 32:2481-2485. [DOI: 10.1080/14767058.2018.1439007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Harun Arslan
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Harun Egemen Tolunay
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Numan Cim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Barış Boza
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - İbrahim İlik
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Hanim Guler Sahin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Recep Yildizhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
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Arioz Habibi H, Alici Davutoglu E, Kandemirli SG, Aslan M, Ozel A, Kalyoncu Ucar A, Zeytun P, Madazli R, Adaletli I. In vivo assessment of placental elasticity in intrauterine growth restriction by shear-wave elastography. Eur J Radiol 2017; 97:16-20. [DOI: 10.1016/j.ejrad.2017.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 08/31/2017] [Accepted: 10/03/2017] [Indexed: 11/24/2022]
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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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23
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Abeysekera JM, Ma M, Pesteie M, Terry J, Pugash D, Hutcheon JA, Mayer C, Lampe L, Salcudean S, Rohling R. SWAVE Imaging of Placental Elasticity and Viscosity: Proof of Concept. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1112-1124. [PMID: 28392000 DOI: 10.1016/j.ultrasmedbio.2017.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/17/2017] [Accepted: 01/22/2017] [Indexed: 06/07/2023]
Abstract
The placenta is the interface between the fetus and the mother and is vital for fetal development. Ultrasound elastography provides a non-invasive way to examine in vivo the stiffness of the placenta; increased stiffness has previously been linked to fetal growth restriction. This study used a previously developed dynamic elastography method, called shear wave absolute vibro-elastography, to study 61 post-delivery clinically normal placentas. The shear wave speeds in the placenta were recorded under five different low-frequency mechanical excitations. The elasticity and viscosity were estimated through rheological modeling. The shear wave speeds at excitation frequencies of 60, 80, 90, 100 and 120 Hz were measured to be 1.23 ± 0.44, 1.67 ± 0.76, 1.74 ± 0.72, 1.80 ± 0.78 and 2.25 ± 0.80 m/s. The shear wave speed values we obtained are consistent with previous studies. In addition, our multi-frequency acquisition approach enables us to provide viscosity estimates that have not been previously reported.
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Affiliation(s)
- Jeffrey M Abeysekera
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada; Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manyou Ma
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mehran Pesteie
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jefferson Terry
- Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Denise Pugash
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Mayer
- Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Lutz Lampe
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Septimiu Salcudean
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Rohling
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada; Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.
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