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Maiuro A, Ercolani G, Di Stadio F, Antonelli A, Catalano C, Manganaro L, Capuani S. Two-Compartment Perfusion MR IVIM Model to Investigate Normal and Pathological Placental Tissue. J Magn Reson Imaging 2024; 59:879-891. [PMID: 37329218 DOI: 10.1002/jmri.28858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Perfusion and diffusion coexist in the placenta and can be altered by pathologies. The two-perfusion model, where f1 and, f2 are the perfusion-fraction of the fastest and slowest perfusion compartment, respectively, and D is the diffusion coefficient, may help differentiate between normal and impaired placentas. PURPOSE Investigate the potential of the two-perfusion IVIM model in differentiating between normal and abnormal placentas. STUDY-TYPE Retrospective, case-control. POPULATION 43 normal pregnancy, 9 fetal-growth-restriction (FGR), 6 small-for-gestational-age (SGA), 4 accreta, 1 increta and 2 percreta placentas. FIELD STRENGTH/SEQUENCE Diffusion-weighted-echo planar imaging sequence at 1.5 T. ASSESSMENT Voxel-wise signal-correction and fitting-controls were used to avoid overfitting obtaining that two-perfusion model fitted the observed data better than the IVIM model (Akaike weight: 0.94). The two-perfusion parametric-maps were quantified from ROIs in the fetal and maternal placenta and in the accretion zone of accreta placentas. The diffusion coefficient D was evaluated using a b ≥ 200 sec/mm2 -mono-exponential decay fit. IVIM metrics were quantified to fix f1 + f2 = fIVIM . STATISTICAL-TESTS ANOVA with Dunn-Sidák's post-hoc correction and Cohen's d test were used to compare parameters between groups. Spearman's coefficient was evaluated to study the correlation between variables. A P-value<0.05 indicated a statistically significant difference. RESULTS There was a significant difference in f1 between FGR and SGA, and significant differences in f2 and fIVIM between normal and FGR. The percreta + increta group showed the highest f1 values (Cohen's d = -2.66). The f2 between normal and percreta + increta groups showed Cohen's d = 1.12. Conversely, fIVIM had a small effective size (Cohen's d = 0.32). In the accretion zone, a significant correlation was found between f2 and GA (ρ = 0.90) whereas a significant negative correlation was found between fIVIM and D (ρ = -0.37 in fetal and ρ = -0.56 in maternal side) and f2 and D (ρ = -0.38 in fetal and ρ = -0.51 in maternal side) in normal placentas. CONCLUSION The two-perfusion model provides complementary information to IVIM parameters that may be useful in identifying placenta impairment. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Alessandra Maiuro
- Department of Physics, Sapienza University of Rome, Rome, Italy
- Physics Department Rome, CNR ISC Roma Sapienza, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Amanda Antonelli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Silvia Capuani
- Physics Department Rome, CNR ISC Roma Sapienza, Rome, Italy
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Lu T, Li M, Wang Y, Li H, Wu M, Wang G. Standard diffusion-weighted, diffusion kurtosis and intravoxel incoherent motion in differentiating invasive placentas. Arch Gynecol Obstet 2024; 309:503-514. [PMID: 36790463 DOI: 10.1007/s00404-023-06947-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE To investigate the diagnostic value of monoexponential, biexponential, and diffusion kurtosis MR imaging (MRI) in distinguishing invasive placentas. METHODS A total of 53 patients with invasive placentas and 47 patients with noninvasive placentas undergoing conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) were retrospectively enrolled. The mean, minimum, and maximum parameters including the apparent diffusion coefficient (ADC) and exponential ADC (eADC) from standard DWI, diffusion kurtosis (MK), and diffusion coefficient (MD) from DKI and pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from IVIM were measured and compared from the volumetric analysis. Receiver operating characteristics (ROC) curve and logistic regression analyses were conducted to evaluate the diagnostic efficiency of different diffusion parameters for distinguishing invasive placentas. RESULTS Comparisons between accreta lesions in patients with invasive placentas (AL) and lower 1/3 part of the placenta in patients with noninvasive placentas (LP) demonstrated that MD mean, D mean, and D* mean were significantly lower while ADC max and D max were significantly higher in invasive placentas (all p < 0.05). Multivariate analysis demonstrated that D mean, D max and D* mean differed significantly among all the studied parameters for invasive placentas. A combined use of these three parameters yielded an AUC of 0.86 with sensitivity, specificity, and accuracy of 84.91%, 76.60%, and 80%, respectively. CONCLUSION The combined use of different IVIM parameters is helpful in distinguishing invasive placentas.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Mou Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Hang Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Mingpeng Wu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Guotai Wang
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, West Hi-tech Zone, Chengdu, 611731, China.
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Gowland PA. The Potential of Low-Field-Strength MRI for Simpler Fetal Scanning. Radiology 2023; 309:e232579. [PMID: 37847132 PMCID: PMC10623202 DOI: 10.1148/radiol.232579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Penny A. Gowland
- From the Sir Peter Mansfield Imaging Centre, School of Physics and
Astronomy and Nottingham Biomedical Research Centre, University of Nottingham,
University Park, Nottingham NG7 2RD, England
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Li H, Lu T, Li M, Wang Y, Zhang F, Yuan Y, Zhu M, Zhao X. Differentiation of placenta percreta through MRI features and diffusion-weighted magnetic resonance imaging. Insights Imaging 2023; 14:93. [PMID: 37222836 DOI: 10.1186/s13244-023-01448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES To identify whether parameters measured from diffusion kurtosis and intravoxel incoherent motion help diagnose placenta percreta. METHODS We retrospectively enrolled 75 patients with PAS disorders including 13 patients with placenta percreta and 40 patients without PAS disorders. Each patients underwent diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI). The apparent diffusion coefficient (ADC), perfusion fraction (f), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), mean diffusion kurtosis (MK) and mean diffusion coefficient (MD) were measured by the volumetric analysis and compared. MRI features were also analyzed and compared. The receiver operating characteristic (ROC) curve and logistic regression analysis were used to evaluate the diagnostic efficiency of different diffusion parameters and MRI features for distinguishing placental percreta. RESULTS D* was an independent risk factor from DWI for predicting placenta percreta with sensitivity of 73% and specificity of 76%. Focal exophytic mass remained as independent risk factor from MRI features for predicting placenta percreta with sensitivity of 72.7% and specificity of 88.1%. When the two risk factors were combined together, the AUC was the highest, 0.880 (95% CI 0.8-0.96). CONCLUSION D* and focal exophytic mass were associated with placenta percreta. A combination of the 2 risk factors can be used to predict placenta percreta. CRITICAL RELEVANCE STATEMENT A combination of D* and focal exophytic mass can be used to differentiate placenta percreta.
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Affiliation(s)
- Hang Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Tao Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China.
| | - Mou Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Feng Zhang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Yi Yuan
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Meilin Zhu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Xinyi Zhao
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
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Lu T, Wang Y, Deng Y, Wu C, Li X, Wang G. Diffusion and perfusion MRI parameters in the evaluation of placenta accreta spectrum disorders in patients with placenta previa. MAGMA (NEW YORK, N.Y.) 2022; 35:1009-1020. [PMID: 35802217 DOI: 10.1007/s10334-022-01023-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/22/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To evaluate the placental function by monoexponential, biexponential, and diffusion kurtosis MR imaging (MRI) in patients with placenta previa. METHODS A total of 62 patients with placenta accreta spectrum (PAS) disorders and 11 patients with normal placentas were retrospectively enrolled, who underwent conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI). The apparent diffusion coefficient (ADC) and exponential ADC (eADC) from standard DWI, mean kurtosis (MK), and diffusion coefficient (MD) from DKI, and pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from IVIM were measured and compared from the volumetric analysis. RESULTS Comparisons between patients with PAS disorders and patients with normal placentas demonstrated that MD mean, D mean, and D* mean values in patients with PAS disorders were significantly higher than those in patients with normal placentas (p < 0.05). Comparisons between patients with accreta, increta, and percreta, and patients with normal placentas showed that the D mean was significantly higher in patients with placenta increta and percreta than in patients with normal placentas (p < 0.05). CONCLUSION The accreta lesions in PAS disorders had deceased cellularity and increased blood movement. The alteration of placental cellularity was more prominent in placenta increta and percreta.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Yan Deng
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Chengqian Wu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Xiangqi Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Guotai Wang
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, West Hi-tech Zone, Chengdu, 611731, China.
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Lu T, Wang Y, Guo A, Cui W, Chen Y, Wang S, Wang G. Monoexponential, biexponential and diffusion kurtosis MR imaging models: quantitative biomarkers in the diagnosis of placenta accreta spectrum disorders. BMC Pregnancy Childbirth 2022; 22:349. [PMID: 35459146 PMCID: PMC9034554 DOI: 10.1186/s12884-022-04644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the diagnostic value of monoexponential, biexponential, and diffusion kurtosis MR imaging (MRI) in differentiating placenta accreta spectrum (PAS) disorders. METHODS A total of 65 patients with PAS disorders and 27 patients with normal placentas undergoing conventional DWI, IVIM, and DKI were retrospectively reviewed. The mean, minimum, and maximum parameters including the apparent diffusion coefficient (ADC) and exponential ADC (eADC) from standard DWI, diffusion kurtosis (MK), and mean diffusion coefficient (MD) from DKI and pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from IVIM were measured from the volumetric analysis and compared between patients with PAS disorders and patients with normal placentas. Univariate and multivariated logistic regression analyses were used to evaluate the value of the above parameters for differentiating PAS disorders. Receiver operating characteristics (ROC) curve analyses were used to evaluate the diagnostic efficiency of different diffusion parameters for predicting PAS disorders. RESULTS Multivariate analysis demonstrated that only D mean and D max differed significantly among all the studied parameters for differentiating PAS disorders when comparisons between accreta lesions in patients with PAS (AP) and whole placentas in patients with normal placentas (WP-normal) were performed (all p < 0.05). For discriminating PAS disorders, a combined use of these two parameters yielded an AUC of 0.93 with sensitivity, specificity, and accuracy of 83.08, 88.89, and 83.70%, respectively. CONCLUSION The diagnostic performance of the parameters from accreta lesions was better than that of the whole placenta. D mean and D max were associated with PAS disorders.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Aiwen Guo
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Wei Cui
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Yazheng Chen
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Shaoyu Wang
- Siemens Healthineer, No.278, Zhouzhu Road, Pudong New Area District, Shanghai, 201318, China
| | - Guotai Wang
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, West Hi-tech Zone, Chengdu, 611731, China.
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Malmberg M, Kragsterman E, Sinding M, Hansen DN, Peters DA, Frøkjær JB, Petersen AC, Sørensen A. Perfusion fraction derived from IVIM analysis of diffusion-weighted MRI in the assessment of placental vascular malperfusion antenatally. Placenta 2022; 119:1-7. [DOI: 10.1016/j.placenta.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 12/16/2022]
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Slator PJ, Palombo M, Miller KL, Westin C, Laun F, Kim D, Haldar JP, Benjamini D, Lemberskiy G, de Almeida Martins JP, Hutter J. Combined diffusion-relaxometry microstructure imaging: Current status and future prospects. Magn Reson Med 2021; 86:2987-3011. [PMID: 34411331 PMCID: PMC8568657 DOI: 10.1002/mrm.28963] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/25/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022]
Abstract
Microstructure imaging seeks to noninvasively measure and map microscopic tissue features by pairing mathematical modeling with tailored MRI protocols. This article reviews an emerging paradigm that has the potential to provide a more detailed assessment of tissue microstructure-combined diffusion-relaxometry imaging. Combined diffusion-relaxometry acquisitions vary multiple MR contrast encodings-such as b-value, gradient direction, inversion time, and echo time-in a multidimensional acquisition space. When paired with suitable analysis techniques, this enables quantification of correlations and coupling between multiple MR parameters-such as diffusivity, T 1 , T 2 , and T 2 ∗ . This opens the possibility of disentangling multiple tissue compartments (within voxels) that are indistinguishable with single-contrast scans, enabling a new generation of microstructural maps with improved biological sensitivity and specificity.
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Affiliation(s)
- Paddy J. Slator
- Centre for Medical Image ComputingDepartment of Computer ScienceUniversity College LondonLondonUK
| | - Marco Palombo
- Centre for Medical Image ComputingDepartment of Computer ScienceUniversity College LondonLondonUK
| | - Karla L. Miller
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Carl‐Fredrik Westin
- Department of RadiologyBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Frederik Laun
- Institute of RadiologyUniversity Hospital ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Daeun Kim
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
- Signal and Image Processing InstituteUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Justin P. Haldar
- Ming Hsieh Department of Electrical and Computer EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
- Signal and Image Processing InstituteUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Dan Benjamini
- The Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMDUSA
- The Center for Neuroscience and Regenerative MedicineUniformed Service University of the Health SciencesBethesdaMDUSA
| | | | - Joao P. de Almeida Martins
- Division of Physical Chemistry, Department of ChemistryLund UniversityLundSweden
- Department of Radiology and Nuclear MedicineSt. Olav’s University HospitalTrondheimNorway
| | - Jana Hutter
- Centre for Biomedical EngineeringSchool of Biomedical Engineering and ImagingKing’s College LondonLondonUK
- Centre for the Developing BrainSchool of Biomedical Engineering and ImagingKing’s College LondonLondonUK
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Link-Sourani D, Avisdris N, Harel S, Ben-Sira L, Ganot T, Gordon Z, Many A, Ben Bashat D. Ex-Vivo MRI of the Normal Human Placenta: Structural-Functional Interplay and the Association With Birth Weight. J Magn Reson Imaging 2021; 56:134-144. [PMID: 34799945 DOI: 10.1002/jmri.28002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advanced magnetic resonance imaging (MRI) methods are increasingly being used to assess the human placenta. Yet, the structure-function interplay in normal placentas and their associations with pregnancy risks are not fully understood. PURPOSE To characterize the normal human placental structure (volume and umbilical cord centricity index (CI)) and function (perfusion) ex-vivo using MRI, to assess their association with birth weight (BW), and identify imaging-markers for placentas at risk for dysfunction. STUDY TYPE Prospective. POPULATION Twenty normal term ex-vivo placentas. FIELD STRENGTH/SEQUENCE 3 T/ T1 and T2 weighted (T1 W, T2 W) turbo spin-echo, three-dimensional susceptibility-weighted image, and time-resolved angiography with interleaved stochastic trajectories (TWIST), during passage of a contrast agent using MRI compatible perfusion system that mimics placental flow. ASSESSMENT Placental volume and CI were manually extracted from the T1 W images by a fetal-placental MRI scientist (D.L., 7 years of experience). Perfusion maps including bolus arrival-time and full-width at half maximum were calculated from the TWIST data. Mean values, entropy, and asymmetries were calculated from each perfusion map, relating to both the whole placenta and volumes of interest (VOIs) within the umbilical cord and its daughter blood vessels. STATISTICAL TESTS Pearson correlations with correction for multiple comparisons using false discovery rate were performed between structural and functional parameters, and with BW, with P < 0.05 considered significant. RESULTS All placentas were successfully perfused and scanned. Significant correlations were found between whole placenta and VOIs perfusion parameters (mean R = 0.76 ± 0.06, range = 0.67-0.89), which were also significantly correlated with CI (mean R = 0.72 ± 0.05, range = 0.65-0.79). BW was correlated with placental volume (R = 0.62), but not with CI (P = 0.40). BW was also correlated with local perfusion asymmetry (R = -0.71). DATA CONCLUSION Results demonstrate a gradient of placental function, associated with CI and suggest several ex-vivo imaging-markers that might indicate an increased risk for placental dysfunction. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
| | - Netanell Avisdris
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shaul Harel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Liat Ben-Sira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Ganot
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zoya Gordon
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Medical Engineering, Afeka, Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Ariel Many
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Andescavage N, Limperopoulos C. Emerging placental biomarkers of health and disease through advanced magnetic resonance imaging (MRI). Exp Neurol 2021; 347:113868. [PMID: 34562472 DOI: 10.1016/j.expneurol.2021.113868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022]
Abstract
Placental dysfunction is a major cause of fetal demise, fetal growth restriction, and preterm birth, as well as significant maternal morbidity and mortality. Infant survivors of placental dysfunction are at elevatedrisk for lifelong neuropsychiatric morbidity. However, despite the significant consequences of placental disease, there are no clinical tools to directly and non-invasively assess and measure placental function in pregnancy. In this work, we will review advanced MRI techniques applied to the study of the in vivo human placenta in order to better detail placental structure, architecture, and function. We will discuss the potential of these measures to serve as optimal biomarkers of placental dysfunction and review the evidence of these tools in the discrimination of health and disease in pregnancy. Efforts to advance our understanding of in vivo placental development are necessary if we are to optimize healthy pregnancy outcomes and prevent brain injury in successive generations. Current management of many high-risk pregnancies cannot address placental maldevelopment or injury, given the standard tools available to clinicians. Once accurate biomarkers of placental development and function are constructed, the subsequent steps will be to introduce maternal and fetal therapeutics targeting at optimizing placental function. Applying these biomarkers in future studies will allow for real-time assessments of safety and efficacy of novel interventions aimed at improving maternal-fetal well-being.
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Affiliation(s)
- Nickie Andescavage
- Developing Brain Institute, Department of Radiology, Children's National, Washington DC, USA; Department of Neonatology, Children's National, Washington DC, USA
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Srinivasan V, Melbourne A, Oyston C, James JL, Clark AR. Multiscale and multimodal imaging of utero-placental anatomy and function in pregnancy. Placenta 2021; 112:111-122. [PMID: 34329969 DOI: 10.1016/j.placenta.2021.07.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
Placental structures at the nano-, micro-, and macro scale each play important roles in contributing to its function. As such, quantifying the dynamic way in which placental structure evolves during pregnancy is critical to both clinical diagnosis of pregnancy disorders, and mechanistic understanding of their pathophysiology. Imaging the placenta, both exvivo and invivo, can provide a wealth of structural and/or functional information. This review outlines how imaging across modalities and spatial scales can ultimately come together to improve our understanding of normal and pathological pregnancies. We discuss how imaging technologies are evolving to provide new insights into placental physiology across disciplines, and how advanced computational algorithms can be used alongside state-of-the-art imaging to obtain a holistic view of placental structure and its associated functions to improve our understanding of placental function in health and disease.
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Affiliation(s)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, Kings College London, UK
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand
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12
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Intravoxel incoherent motion MR imaging analysis for diagnosis of placenta accrete spectrum disorders: A pilot feasibility study. Magn Reson Imaging 2021; 80:26-32. [PMID: 33766730 DOI: 10.1016/j.mri.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/04/2020] [Accepted: 03/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Placenta accreta spectrum (PAS) disorders occur when the placenta adheres abnormally to the uterine myometrium and can have devastating effects on maternal health due to risks of massive postpartum hemorrhage and possible need for emergency hysterectomy. PAS can be difficult to diagnose using routine clinical imaging with ultrasound and structural MRI. OBJECTIVE To determine feasibility of using intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) analysis in the diagnosis of the placenta accreta spectrum disorders in pregnant women. METHODS A total of 49 pregnant women were recruited including 14 with pathologically confirmed cases of PAS and 35 health controls without prior cesarean delivery and no suspected PAS by ultrasound. All women underwent diffusion-weighted imaging with an 8 b-value scanning sequence. A semi-automated method for image processing was used, creating a 3D object map, which was then fit to a biexponential signal decay curve for IVIM modeling to determine slow diffusion (Ds), fast diffusion (Df), and perfusion fraction (Pf). RESULTS Our results demonstrated a high degree of model fitting (R2 ≥ 0.98), with Pf significantly higher in those with PAS compared to healthy controls (0.451 ± 0.019 versus 0.341 ± 0.022, p = 0.002). By contrast, no statistical difference in the Df (1.70 × 10-2 ± 0.38 × 10-2 versus 1.48 × 10-2 ± 0.08 × 10-2 mm2/s, p = 0.211) or Ds (1.34 × 10-3 ± 0.10 × 10-3 versus 1.45 × 10-3 ± 0.007 × 10-3 mm2/s, p = 0.215) was found between subjects with PAS and healthy controls. CONCLUSIONS The use of MRI, and IVIM modeling in particular, may have potential in aiding in the diagnosis of PAS when other imaging modalities are equivocal. However, the widespread use of these techniques will require generation of large normative data sets, consistent sequencing protocols, and streamlined analysis techniques.
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Sørensen A, Sinding M. Placental Magnetic Resonance Imaging: A Method to Evaluate Placental Function In Vivo. Obstet Gynecol Clin North Am 2020; 47:197-213. [PMID: 32008669 DOI: 10.1016/j.ogc.2019.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes the use of placental magnetic resonance imaging (MRI) relaxation times in the in vivo assessment of placental function. It focuses on T2*-weighted placental MRI, the main area of the authors' research over the past decade. The rationale behind T2*-weighted placental MRI, the main findings reported in the literature, and directions for future research and clinical applications of this method are discussed. The article concludes that placental T2* relaxation time is an easily obtained and robust measurement, which can discriminate between normal and dysfunctional placenta. Placenta T2* is a promising tool for in vivo assessment of placental function.
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Affiliation(s)
- Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, Aalborg 9000, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg 9000, Denmark.
| | - Marianne Sinding
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, Aalborg 9000, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg 9000, Denmark
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Functional diagnosis of placenta accreta by intravoxel incoherent motion model diffusion-weighted imaging. Eur Radiol 2020; 31:740-748. [PMID: 32862290 DOI: 10.1007/s00330-020-07200-1] [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: 04/16/2020] [Revised: 06/21/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the diagnostic value of intravoxel incoherent motion (IVIM) DWI for placenta accreta by comparing diffusion and perfusion characteristics of placentas with accreta lesions (APs) with those of normal placentas (NPs). METHODS Twenty-five pregnant women with AP and 24 with NP underwent 3-T magnetic resonance examinations with IVIM-DWI. The perfusion percentage (f), pseudo-diffusion coefficient (D*), and diffusion coefficient (D) values were calculated from different ROIs: the entire-plane of the AP (AP-ROI) and NP (NP-ROI) and the implanted (IR-ROI) and non-implanted region (NIR-ROI) of the AP. The AP-ROIs and NP-ROIs were compared using covariance analysis; the IR-ROIs and NIR-ROIs were compared using the Wilcoxon signed-rank test. ROC curves were produced to evaluate the parameters for predicting placenta accreta. RESULTS The f and D* values for the AP-ROIs ([45.0 ± 7.63]%, [11.64 ± 2.15]mm2/s) were significantly higher than those for the NP-ROIs ([31.85 ± 5.96]%, [9.04 ± 3.13]mm2/s) (both p < 0.05); the IR-ROIs (54.8%, 14.03 mm2/s) were also significantly higher than the NIR-ROIs (37.4%, 11.4 mm2/s) (both p < 0.05). No significant differences were found between the D values of the AP-ROIs and NP-ROIs (p > 0.05) or of the IR-ROIs and NIR-ROIs (p > 0.05). The areas under the curve for f and D* of the ROC curves were 0.93 and 0.79, respectively. CONCLUSIONS These results suggest that the IVIM parameters f and D* can be used to quantitatively evaluate the higher perfusion of AP when compared with NP. Furthermore, IVIM may be a useful functional diagnostic technique to predict placenta accreta. KEY POINTS • Intravoxel incoherent motion (IVIM) may be a useful diagnostic technique to quantitatively estimate the perfusion of the placenta. • The perfusion percentage (f) and pseudo-diffusion coefficient (D*) values differed significantly between placentas with accreta lesions and normal placentas. • ROC curves showed that perfusion percentage (f) and pseudo-diffusion coefficient (D*) values could accurately predict placenta accreta.
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Jiang L, Sun T, Liao Y, Sun Y, Qian Z, Zhang Y, Wu D. Probing the ballistic microcirculation in placenta using flow-compensated and non-compensated intravoxel incoherent motion imaging. Magn Reson Med 2020; 85:404-412. [PMID: 32720386 DOI: 10.1002/mrm.28426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Intravoxel incoherent motion (IVIM) imaging is widely used to evaluate microcirculatory flow, which consists of diffusive and ballistic flow components. We proposed a joint use of flow-compensated (FC) and non-compensated (NC) diffusion gradients to probe the fraction and velocity of ballistic flow in the placenta. METHODS Forty pregnant women were included in this study and scanned on a 1.5T clinical scanner. FC and NC diffusion MRI (dMRI) sequences were achieved using a pair of identical or mirrored bipolar gradients. A joint FC-NC model was established to estimate the fraction (fb ) and velocity (vb ) of the ballistic flow. Conventional IVIM parameters (f, D, and D*) were obtained from the FC and NC data, separately. The vb and f·D*, as placental flow velocity measurements, were correlated with the umbilical-artery Doppler ultrasound indices and gestational ages. RESULTS The ballistic flow component can be observed from the difference between the FC and NC dMRI signal decay curves. vb fitted from the FC-NC model showed strong correlations with umbilical-artery impedance indices, the systolic-to-diastolic (SD) ratio and pulsatility index (PI), with correlation coefficients of 0.65 and 0.62. The f·D* estimated from the NC data positively correlated with SD and PI, while the FC-based f·D* values showed weak negative correlations. Significant gestational-age dependence was also found in the flow velocity measurements. CONCLUSION Our results demonstrated the feasibility of using FC and NC dMRI to noninvasively measure ballistic flow velocity in the placenta, which may be used as a new marker to evaluate placenta microcirculation.
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Affiliation(s)
- Ling Jiang
- Department of Radiology, Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Taotao Sun
- Department of Radiology, Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yuhao Liao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Yi Sun
- MR Collaboration, Siemens Healthcare Ltd., Shanghai, China
| | - Zhaoxia Qian
- Department of Radiology, Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
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Andescavage N, You W, Jacobs M, Kapse K, Quistorff J, Bulas D, Ahmadzia H, Gimovsky A, Baschat A, Limperopoulos C. Exploring in vivo placental microstructure in healthy and growth-restricted pregnancies through diffusion-weighted magnetic resonance imaging. Placenta 2020; 93:113-118. [PMID: 32250735 PMCID: PMC7153576 DOI: 10.1016/j.placenta.2020.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/19/2020] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gross and microstructural changes in placental development can influence placental function and adversely impact fetal growth and well-being; however, there is a paucity of invivo tools available to reliably interrogate in vivo placental microstructural development. The objective of this study is to characterize invivo placental microstructural diffusion and perfusion in healthy and growth-restricted pregnancies (FGR) using non-invasive diffusion-weighted imaging (DWI). METHODS We prospectively enrolled healthy pregnant women and women whose pregnancies were complicated by FGR. Each woman underwent DWI-MRI between 18 and 40 weeks gestation. Placental measures of small (D) and large (D*) scale diffusion and perfusion (f) were estimated using the intra-voxel incoherent motion (IVIM) model. RESULTS We studied 137 pregnant women (101 healthy; 36 FGR). D and D* are increased in late-onset FGR, and the placental perfusion fraction, f, is decreased (p < 0.05 for all). DISCUSSION Placental DWI revealed microstructural alterations of the invivo placenta in FGR, particularly in late-onset FGR. Early and reliable identification of placental pathology in vivo may better guide future interventions.
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Affiliation(s)
- Nickie Andescavage
- Division of Neonatology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA
| | - Wonsang You
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA
| | - Marni Jacobs
- Division of Biostatistics & Study Methodology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA
| | - Kushal Kapse
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA
| | - Jessica Quistorff
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA
| | - Dorothy Bulas
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA; Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA
| | - Homa Ahmadzia
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA
| | - Alexis Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA
| | - Ahmet Baschat
- Department of Gynecology and Obstetrics, Johns Hopkins Center for Fetal Therapy, 600 North Wolfe Street, Nelson 228, Baltimore, MD, 21287, USA
| | - Catherine Limperopoulos
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA; Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC, 20052, USA.
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Lu T, Song B, Pu H, Li KD, Huang MW, Mei J, Wang SY. Prognosticators of intravoxel incoherent motion (IVIM) MRI for adverse maternal and neonatal clinical outcomes in patients with placenta accreta spectrum disorders. Transl Androl Urol 2020; 9:258-266. [PMID: 32420131 PMCID: PMC7214992 DOI: 10.21037/tau.2019.12.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence of placenta accreta spectrum (PAS) disorders has increased rapidly in recent years and is associated with several maternal and neonatal complications. Intravoxel incoherent motion (IVIM) imaging is a method which can assess placental perfusion quantitatively. Therefore, the first aim of this study was to investigate whether patients with adverse maternal and neonatal outcomes of PAS disorders differed in the parameters from IVIM. A second aim was to identify these parameters for adverse peripartum outcome in gravid patients at risk for PAS. METHODS The subject group consisted of patients with placenta previa, in which 75 patients had PAS disorders and 24 patients did not have PAS disorders between 28+0 and 39+6 weeks, respectively. All women underwent magnetic resonance imaging (MRI) examination including an IVIM sequence with 8 b values on a 1.5T scanner. The perfusion fraction (f), pseudodiffusion coefficient (D*), and standard diffusion coefficient (D) were calculated. All medical records were received postpartum. The final degree of placental invasion was established either by placental villi alterations from a placental sample or from maternity records of the women's general practitioners. RESULTS Women with PAS disorders had a higher perfusion fraction (34.12%) than women without the disease (29.39%) (P<0.05). The perfusion fraction was 36.86% in women with massive blood loss and was 35.15% in women requiring transfusion, which was higher than women without massive blood loss and not requiring transfusion (P<0.05). The D value was 1.65×10-3 mm2/s in women with low birth weight, which was lower than that in women with appropriate birth weight (1.70×10-3 mm2/s) (P<0.05). CONCLUSIONS Patients with PAS disorders differed in placental perfusion fraction from women without PAS disorders. The f and D value may be used to recognize patients with certain adverse clinical outcomes.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610037, China
| | - Hong Pu
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, China
| | - Kui-De Li
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, China
| | - Meng-Wei Huang
- Department of Obstetrics, Sichuan Academy of Medical Sciences & Sichuan Provincial Peopleal Sciences sChengdu 610072, China
| | - Jie Mei
- Department of Obstetrics, Sichuan Academy of Medical Sciences & Sichuan Provincial Peopleal Sciences sChengdu 610072, China
| | - Shao-Yu Wang
- MR Scientific Marketing Specialist, Siemens Healthineer, Shanghai 201318, China
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18
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Kristi B A, Ditte N H, Caroline H, Marianne S, Astrid P, Jens B F, David A P, Anne S. Placental diffusion-weighted MRI in normal pregnancies and those complicated by placental dysfunction due to vascular malperfusion. Placenta 2020; 91:52-58. [PMID: 32174307 DOI: 10.1016/j.placenta.2020.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Our aim was to assess placental function by diffusion-weighted magnetic resonance imaging (MRI) using intravoxel incoherent motion (IVIM) analysis in uncomplicated pregnancies and pregnancies complicated by placental dysfunction. METHODS 31 normal pregnancies and 9 pregnancies complicated by placental dysfunction (birthweight ≤ -2SD and histological signs of placental vascular malperfusion) were retrieved from our placental MRI research database. MRI was performed at gestational weeks 20.1-40.6 in a 1.5 T system using 10 b-values (0-1000 s/mm2). Regions of interest were drawn covering the entire placenta in five transverse slices. Diffusion coefficient (D), pseudodiffusion coefficient (D*) and perfusion fraction (f) were estimated by IVIM analysis. RESULTS In normal pregnancies, placental f decreased linearly with gestational age (r = -0.522, p = 0.002) being 26.2% at week 20 and 18.8% at week 40. D and D* were 1.57 ± 0.03 and 31.7 ± 3.1 mm2/s (mean ± SD), respectively, and they were not correlated with gestational age. In complicated pregnancies, f was significantly reduced (mean Z-score = -1.16; p = 0.02) when compared to the group of normal pregnancies, whereas D and D* did not differ significantly between groups. Subgroup analysis demonstrated that f was predominantly reduced in dysfunctional placentas characterized by fetal vascular malperfusion (mean Z-score = -2.11, p < 0.001) rather than maternal vascular malperfusion (mean Z-score = -0.40, p = 0.42). In addition, f was negatively correlated with uterine artery pulsatility index (r = -0.396, p = 0.01). DISCUSSION Among parameters obtained by the IVIM analysis, only f revealed significant differences between the normal and the dysfunctional placentas. Subgroup analysis suggests that placental f may be able to discriminate non-invasively between different histological types of vascular malperfusion.
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Affiliation(s)
- Anderson Kristi B
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, 9000, Aalborg, Denmark.
| | - Hansen Ditte N
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Haals Caroline
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark
| | - Sinding Marianne
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Petersen Astrid
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, 9000, Aalborg, Denmark
| | - Frøkjær Jens B
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark; Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Peters David A
- Department of Clinical Engineering, Central Denmark Region, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Sørensen Anne
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
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Abstract
In utero diffusion magnetic resonance imaging (MRI) provides unique opportunities to noninvasively study the microstructure of tissue during fetal development. A wide range of developmental processes, such as the growth of white matter tracts in the brain, the maturation of placental villous trees, or the fibers in the fetal heart remain to be studied and understood in detail. Advances in fetal interventions and surgery furthermore increase the need for ever more precise antenatal diagnosis from fetal MRI. However, the specific properties of the in utero environment, such as fetal and maternal motion, increased field-of-view, tissue interfaces and safety considerations, are significant challenges for most MRI techniques, and particularly for diffusion. Recent years have seen major improvements, driven by the development of bespoke techniques adapted to these specific challenges in both acquisition and processing. Fetal diffusion MRI, an emerging research tool, is now adding valuable novel information for both research and clinical questions. This paper will highlight specific challenges, outline strategies to target them, and discuss two main applications: fetal brain connectomics and placental maturation.
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Can introvoxel incoherent motion MRI be used to differentiate patients with placenta accreta spectrum disorders? BMC Pregnancy Childbirth 2019; 19:531. [PMID: 31888572 PMCID: PMC6937691 DOI: 10.1186/s12884-019-2676-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The incidence of PAS disorders increased rapidly in recent years, and introvoxel incoherent motion (IVIM) MRI has been applied in the assessment of placenta. The study aims to investigate whether the parameters from IVIM can be used to differentiate patients with PAS disorders complicating placenta previa and secondly to differentiate different categories of PAS disorders. METHODS The study participants were comprised of 99 patients with placenta previa, including 16 patients with placenta accreta, 51 patients with increta, 8 patients with percreta and 24 patients without PAS disorders between 28 + 0 and 39 + 6 weeks. IVIM MRI was performed on a 1.5 T scanner. Perfusion fraction (f), pseudodiffusion coefficient (D*) and diffusion coefficient (D) were calculated. RESULTS Women with PAS disorders had a higher perfusion fraction (p = 0.019) than women without the disease. Multiple comparisons showed perfusion fraction in patients without PAS disorders was significantly lower than in patients with placenta accreta and percreta(P = 0.018 and 0.033 respectively), but was not lower than in patients with increta(p = 1). CONCLUSION Patients with placenta accreta and percreta differed in placental perfusion fraction from women with increta and without PAS disorders.
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Hu HH, Branca RT, Hernando D, Karampinos DC, Machann J, McKenzie CA, Wu HH, Yokoo T, Velan SS. Magnetic resonance imaging of obesity and metabolic disorders: Summary from the 2019 ISMRM Workshop. Magn Reson Med 2019; 83:1565-1576. [PMID: 31782551 DOI: 10.1002/mrm.28103] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 02/06/2023]
Abstract
More than 100 attendees from Australia, Austria, Belgium, Canada, China, Germany, Hong Kong, Indonesia, Japan, Malaysia, the Netherlands, the Philippines, Republic of Korea, Singapore, Sweden, Switzerland, the United Kingdom, and the United States convened in Singapore for the 2019 ISMRM-sponsored workshop on MRI of Obesity and Metabolic Disorders. The scientific program brought together a multidisciplinary group of researchers, trainees, and clinicians and included sessions in diabetes and insulin resistance; an update on recent advances in water-fat MRI acquisition and reconstruction methods; with applications in skeletal muscle, bone marrow, and adipose tissue quantification; a summary of recent findings in brown adipose tissue; new developments in imaging fat in the fetus, placenta, and neonates; the utility of liver elastography in obesity studies; and the emerging role of radiomics in population-based "big data" studies. The workshop featured keynote presentations on nutrition, epidemiology, genetics, and exercise physiology. Forty-four proffered scientific abstracts were also presented, covering the topics of brown adipose tissue, quantitative liver analysis from multiparametric data, disease prevalence and population health, technical and methodological developments in data acquisition and reconstruction, newfound applications of machine learning and neural networks, standardization of proton density fat fraction measurements, and X-nuclei applications. The purpose of this article is to summarize the scientific highlights from the workshop and identify future directions of work.
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Affiliation(s)
- Houchun H Hu
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Rosa Tamara Branca
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jürgen Machann
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Tübingen, Germany.,Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Charles A McKenzie
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Holden H Wu
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - S Sendhil Velan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore.,Singapore BioImaging Consortium, Agency for Science Technology and Research, Singapore
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22
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Flouri D, Owen D, Aughwane R, Mufti N, Maksym K, Sokolska M, Kendall G, Bainbridge A, Atkinson D, Vercauteren T, Ourselin S, David AL, Melbourne A. Improved fetal blood oxygenation and placental estimated measurements of diffusion-weighted MRI using data-driven Bayesian modeling. Magn Reson Med 2019; 83:2160-2172. [PMID: 31742785 PMCID: PMC7064949 DOI: 10.1002/mrm.28075] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Motion correction in placental DW-MRI is challenging due to maternal breathing motion, maternal movements, and rapid intensity changes. Parameter estimates are usually obtained using least-squares methods for voxel-wise fitting; however, they typically give noisy estimates due to low signal-to-noise ratio. We introduce a model-driven registration (MDR) technique which incorporates a placenta-specific signal model into the registration process, and we present a Bayesian approach for Diffusion-rElaxation Combined Imaging for Detailed placental Evaluation model to obtain individual and population trends in estimated parameters. METHODS MDR exploits the fact that a placenta signal model is available and thus we incorporate it into the registration to generate a series of target images. The proposed registration method is compared to a pre-existing method used for DCE-MRI data making use of principal components analysis. The Bayesian shrinkage prior (BSP) method has no user-defined parameters and therefore measures of parameter variation in a region of interest are determined by the data alone. The MDR method and the Bayesian approach were evaluated on 10 control 4D DW-MRI singleton placental data. RESULTS MDR method improves the alignment of placenta data compared to the pre-existing method. It also shows a further reduction of the residual error between the data and the fit. BSP approach showed higher precision leading to more clearly apparent spatial features in the parameter maps. Placental fetal oxygen saturation (FO2 ) showed a negative linear correlation with gestational age. CONCLUSIONS The proposed pipeline provides a robust framework for registering DW-MRI data and analyzing longitudinal changes of placental function.
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Affiliation(s)
- Dimitra Flouri
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - David Owen
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Rosalind Aughwane
- Institute for Women's Health, University College Hospital, London, United Kingdom
| | - Nada Mufti
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Institute for Women's Health, University College Hospital, London, United Kingdom
| | - Kasia Maksym
- Institute for Women's Health, University College Hospital, London, United Kingdom
| | | | - Giles Kendall
- Institute for Women's Health, University College Hospital, London, United Kingdom
| | - Alan Bainbridge
- Medical Physics, University College Hospital, London, United Kingdom
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Anna L David
- Institute for Women's Health, University College Hospital, London, United Kingdom.,University Hospital KU Leuven, Leuven, Belgium.,NIHR Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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23
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Luo J, Abaci Turk E, Gagoski B, Copeland N, Zhou IY, Young V, Bibbo C, Robinson JN, Zera C, Barth WH, Roberts DJ, Sun PZ, Grant PE. Preliminary evaluation of dynamic glucose enhanced MRI of the human placenta during glucose tolerance test. Quant Imaging Med Surg 2019; 9:1619-1627. [PMID: 31728306 DOI: 10.21037/qims.2019.09.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate dynamic glucose enhanced (DGE) chemical exchange saturation transfer (CEST) MRI as a means to non-invasively image glucose transport in the human placenta. Methods Continuous wave (CW) CEST MRI was performed at 3.0 Tesla. The glucose contrast enhancement (GCE) was calculated based on the magnetization transfer asymmetry (MTRasym), and the DGE was calculated with the positive side of Z-spectra in reference to the first time point. The glucose CEST (GlucoCEST) was optimized using a glucose solution phantom. Glucose solution perfused ex vivo placenta tissue was used to demonstrate GlucoCEST MRI effect. The vascular density of ex vivo placental tissue was evaluated with yellow dye after MRI scans. Finally, we preliminarily demonstrated GlucoCEST MRI in five pregnant subjects who received a glucose tolerance test. For human studies, the dynamic R2* change was captured with T2*-weighted echo planar imaging (EPI). Results The GCE effect peaks at a saturation B1 field of about 2 μT, and the GlucoCEST effect increases linearly with the glucose concentration between 4-20 mM. In ex vivo tissue, the GlucoCEST MRI was sensitive to the glucose perfusate and the placenta vascular density. Although the in vivo GCE baseline was sensitive to field inhomogeneity and motion artifacts, the temporal evolution of the GlucoCEST effect showed a consistent and positive response after oral glucose tolerance drink. Conclusions Despite the challenges of placental motion and field inhomogeneity, our study demonstrated the feasibility of DGE placenta MRI at 3.0 Tesla.
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Affiliation(s)
- Jie Luo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Esra Abaci Turk
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Borjan Gagoski
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Natalie Copeland
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Iris Y Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Vanessa Young
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Carolina Bibbo
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Julian N Robinson
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Chloe Zera
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - William H Barth
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Phillip Zhe Sun
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
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24
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Afacan O, Estroff JA, Yang E, Barnewolt CE, Connolly SA, Parad RB, Mulkern RV, Warfield SK, Gholipour A. Fetal Echoplanar Imaging: Promises and Challenges. Top Magn Reson Imaging 2019; 28:245-254. [PMID: 31592991 PMCID: PMC6788763 DOI: 10.1097/rmr.0000000000000219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Fetal magnetic resonance imaging (MRI) has been gaining increasing interest in both clinical radiology and research. Echoplanar imaging (EPI) offers a unique potential, as it can be used to acquire images very fast. It can be used to freeze motion, or to get multiple images with various contrast mechanisms that allow studying the microstructure and function of the fetal brain and body organs. In this article, we discuss the current clinical and research applications of fetal EPI. This includes T2*-weighted imaging to better identify blood products and vessels, using diffusion-weighted MRI to investigate connections of the developing brain and using functional MRI (fMRI) to identify the functional networks of the developing brain. EPI can also be used as an alternative structural sequence when banding or standing wave artifacts adversely affect the mainstream sequences used routinely in structural fetal MRI. We also discuss the challenges with EPI acquisitions, and potential solutions. As EPI acquisitions are inherently sensitive to susceptibility artifacts, geometric distortions limit the use of high-resolution EPI acquisitions. Also, interslice motion and transmit and receive field inhomogeneities may create significant artifacts in fetal EPI. We conclude by discussing promising research directions to overcome these challenges to improve the use of EPI in clinical and research applications.
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Affiliation(s)
- Onur Afacan
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Judy A. Estroff
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Advanced Fetal Care Center, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Edward Yang
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Advanced Fetal Care Center, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Carol E. Barnewolt
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Advanced Fetal Care Center, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Susan A. Connolly
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Advanced Fetal Care Center, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Richard B. Parad
- Advanced Fetal Care Center, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Robert V. Mulkern
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Simon K. Warfield
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Ali Gholipour
- Department of Radiology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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25
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Hutter J, Harteveld AA, Jackson LH, Franklin S, Bos C, van Osch MJP, O'Muircheartaigh J, Ho A, Chappell L, Hajnal JV, Rutherford M, De Vita E. Perfusion and apparent oxygenation in the human placenta (PERFOX). Magn Reson Med 2019; 83:549-560. [PMID: 31433077 PMCID: PMC6825519 DOI: 10.1002/mrm.27950] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE To study placental function-both perfusion and an oxygenation surrogate ( T 2 * )-simultaneously and quantitatively in-vivo. METHODS Fifteen pregnant women were scanned on a 3T MR scanner. For perfusion measurements, a velocity selective arterial spin labeling preparation module was placed before a multi-echo gradient echo EPI readout to integrate T 2 * and perfusion measurements in 1 joint perfusion-oxygenation (PERFOX) acquisition. Joint motion correction and quantification were performed to evaluate changes in T 2 * and perfusion over GA. RESULTS The optimized integrated PERFOX protocol and post-processing allowed successful visualization and quantification of perfusion and T 2 * in all subjects. Areas of high T 2 * and high perfusion appear to correspond to placental sub-units and show a systematic offset in location along the maternal-fetal axis. The areas of highest perfusion are consistently closer to the maternal basal plate and the areas of highest T 2 * closer to the fetal chorionic plate. Quantitative results show a strong negative correlation of gestational age with T 2 * and weak negative correlation with perfusion. CONCLUSIONS A strength of the joint sequence is that it provides truly simultaneous and co-registered estimates of local T 2 * and perfusion, however, to achieve this, the time per slice is prolonged compared to a perfusion only scan which can potentially limit coverage. The achieved interlocking can be particularly useful when quantifying transient physiological effects such as uterine contractions. PERFOX opens a new avenue to elucidate the relationship between maternal supply and oxygen uptake, both of which are central to placental function and dysfunction.
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Affiliation(s)
- Jana Hutter
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Anita A. Harteveld
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Laurence H. Jackson
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Suzanne Franklin
- C.J. Gorter Center for High Field MRIDepartment of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Clemens Bos
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Matthias J. P. van Osch
- C.J. Gorter Center for High Field MRIDepartment of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jonathan O'Muircheartaigh
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Alison Ho
- Academic Women's Health DepartmentKing's College LondonLondonUnited Kingdom
| | - Lucy Chappell
- Academic Women's Health DepartmentKing's College LondonLondonUnited Kingdom
| | - Joseph V. Hajnal
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Mary Rutherford
- Centre for the Developing BrainKing's College LondonLondonUnited Kingdom
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
| | - Enrico De Vita
- School of Medical EngineeringKing's College LondonLondonUnited Kingdom
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26
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Use of intravoxel incoherent motion MR imaging to assess placental perfusion in patients with placental adhesion disorder on their third trimester. Clin Imaging 2019; 56:135-139. [DOI: 10.1016/j.clinimag.2019.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 11/23/2022]
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27
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Hutter J, Slator PJ, Jackson L, Gomes ADS, Ho A, Story L, O’Muircheartaigh J, Teixeira RPAG, Chappell LC, Alexander DC, Rutherford MA, Hajnal JV. Multi-modal functional MRI to explore placental function over gestation. Magn Reson Med 2019; 81:1191-1204. [PMID: 30242899 PMCID: PMC6585747 DOI: 10.1002/mrm.27447] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate, visualize and quantify the physiology of the human placenta in several dimensions - functional, temporal over gestation, and spatial over the whole organ. METHODS Bespoke MRI techniques, combining a rich diffusion protocol, anatomical data and T2* mapping together with a multi-modal pipeline including motion correction and extracted quantitative features were developed and employed on pregnant women between 22 and 38 weeks gestational age including two pregnancies diagnosed with pre-eclampsia. RESULTS A multi-faceted assessment was demonstrated showing trends of increasing lacunarity, and decreasing T2* and diffusivity over gestation. CONCLUSIONS The obtained multi-modal acquisition and quantification shows promising opportunities for studying evolution, adaptation and compensation processes.
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Affiliation(s)
- Jana Hutter
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Paddy J. Slator
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Laurence Jackson
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Ana Dos Santos Gomes
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Alison Ho
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | - Lisa Story
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | | | - Rui P. A. G. Teixeira
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
| | - Lucy C. Chappell
- Women's Health Academic CentreKing's College LondonLondonUnited Kingdom
| | - Daniel C. Alexander
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonUnited Kingdom
| | | | - Joseph V. Hajnal
- Centre for the Developing BrainKing's College LondonUnited Kingdom
- Biomedical Engineering DepartmentKing's College LondonUnited Kingdom
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28
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Shi H, Quan X, Liang W, Li X, Ai B, Liu H. Evaluation of Placental Perfusion Based on Intravoxel Incoherent Motion Diffusion Weighted Imaging (IVIM-DWI) and Its Predictive Value for Late-Onset Fetal Growth Restriction. Geburtshilfe Frauenheilkd 2018; 79:396-401. [PMID: 31000885 PMCID: PMC6461467 DOI: 10.1055/a-0717-5275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 01/21/2023] Open
Abstract
Objective
The aim of this study was to investigate placental blood perfusion in middle and late pregnancy and explore its predictive value for fetal growth restriction (FGR).
Methods
All pregnant women included in the study were examined using placental intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). Three IVIM parameters (D, f, D*) were obtained for each pregnant woman and analyzed using Image J software. Perfusion fraction f is a radiological marker of placental perfusion. The pulsatility index (PI) of the uterine artery is used to indirectly evaluate placental function.
Results
f-values were significantly lower in the late-onset FGR group compared to the normal late pregnancy group (19.07 vs. 27.78%). In addition, uterine artery PI values were markedly increased in the late-onset FGR group compared to the normal late pregnancy group (1.96 vs. 1.03), and neonatal weight was significantly lower in the late-onset FGR group (2.75 vs. 3.18 kg). There was a significant positive correlation between f-value, uterine artery PI and neonatal weight (r = 0.968, p < 0.01; r = 0.959, p < 0.01). There was a significant negative correlation between f-value and age of gestation (r = − 0.534, p < 0.01).
Conclusion
Perfusion fraction f was strongly correlated with uterine artery blood flow resistance as measured by color Doppler and had a certain predictive value for late-onset FGR.
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Affiliation(s)
- Hui Shi
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xianyue Quan
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen Liang
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xinming Li
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Ai
- Department of Medical Image, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Hongsheng Liu
- Department of Medical Image, Guangzhou Women and Children's Medical Center, Guangzhou, China
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29
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Slator PJ, Hutter J, McCabe L, Gomes ADS, Price AN, Panagiotaki E, Rutherford MA, Hajnal JV, Alexander DC. Placenta microstructure and microcirculation imaging with diffusion MRI. Magn Reson Med 2018; 80:756-766. [PMID: 29230859 PMCID: PMC5947291 DOI: 10.1002/mrm.27036] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess which microstructural models best explain the diffusion-weighted MRI signal in the human placenta. METHODS The placentas of nine healthy pregnant subjects were scanned with a multishell, multidirectional diffusion protocol at 3T. A range of multicompartment biophysical models were fit to the data, and ranked using the Bayesian information criterion. RESULTS Anisotropic extensions to the intravoxel incoherent motion model, which consider the effect of coherent orientation in both microvascular structure and tissue microstructure, consistently had the lowest Bayesian information criterion values. Model parameter maps and model selection results were consistent with the physiology of the placenta and surrounding tissue. CONCLUSION Anisotropic intravoxel incoherent motion models explain the placental diffusion signal better than apparent diffusion coefficient, intravoxel incoherent motion, and diffusion tensor models, in information theoretic terms, when using this protocol. Future work will aim to determine if model-derived parameters are sensitive to placental pathologies associated with disorders, such as fetal growth restriction and early-onset pre-eclampsia. Magn Reson Med 80:756-766, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Paddy J. Slator
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
| | - Jana Hutter
- Centre for the Developing Brain, King's College LondonLondonUK,Biomedical Engineering DepartmentKing's College LondonLondonUK
| | - Laura McCabe
- Centre for the Developing Brain, King's College LondonLondonUK
| | | | - Anthony N. Price
- Centre for the Developing Brain, King's College LondonLondonUK,Biomedical Engineering DepartmentKing's College LondonLondonUK
| | - Eleftheria Panagiotaki
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
| | | | - Joseph V. Hajnal
- Centre for the Developing Brain, King's College LondonLondonUK,Biomedical Engineering DepartmentKing's College LondonLondonUK
| | - Daniel C. Alexander
- Centre for Medical Image Computing and Department of Computer ScienceUniversity College LondonLondonUK
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30
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Wu D, Xu J, Lei J, Mclane M, van Zijl PC, Burd I. Dynamic glucose enhanced MRI of the placenta in a mouse model of intrauterine inflammation. Placenta 2018; 69:86-91. [PMID: 30213490 DOI: 10.1016/j.placenta.2018.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/04/2018] [Accepted: 07/19/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We investigated the feasibility of dynamic glucose enhanced (DGE) MRI in accessing placental function in a mouse model of intrauterine inflammatory injury (IUI). DGE uses the glucose chemical exchange saturation transfer (glucoCEST) effect to reflect infused d-glucose. METHODS IUI was induced in pregnant CD1 mice by intrauterine injection of lipopolysaccharide (LPS) on embryonic day 17. In vivo MRI was performed on an 11.7 T scanner at 6 h s after injury, and glucoCEST effect was measured using an on-resonance variable delay multi-pulse (onVDMP) technique. onVDMP acquisition was repeated over a period of 25 min, and d-glucose was infused 5 min after the start. The time-resolved glucoCEST signals were characterized using the normalized signal difference (ΔSN) between onVDMP-labeled and nonlabeled images. RESULTS ΔSN in the PBS-exposed placentae (n = 6) showed an initial drop between 1 and 3 min after infusion, followed by a positive peak between 5 and 20 min, the time period expected to be associated with the process of glucose uptake and transport. In the LPS-exposed placentae (n = 10), the positive peak was reduced or even absent, and the corresponding area-under-the-curve (AUC) was significantly lower than that in the controls. Particularly, the AUC maps suggested prominent group differences in the fetal side of the placenta. We also found that glucose transporter 1 in the LPS-exposed placentae did not respond to maternal glucose challenge. DISCUSSION DGE-MRI is useful for evaluating placental functions related to glucose utilization. The technique uses a non-toxic biodegradable agent (d-glucose) and thus has a potential for rapid translation to human studies of placental disorders.
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Affiliation(s)
- Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jiadi Xu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jun Lei
- Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Mclane
- Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter C van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Irina Burd
- Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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31
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Fu L, Zhang J, Xiong S, Sun M. Decreased apparent diffusion coefficient in the placentas of monochorionic twins with selective intrauterine growth restriction. Placenta 2018; 69:26-31. [PMID: 30213481 DOI: 10.1016/j.placenta.2018.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/23/2018] [Accepted: 07/05/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The apparent diffusion coefficient (ADC) was associated with the onset of intrauterine growth restriction in singleton pregnancies. However, the correlation of ADC with selective intrauterine growth restriction (sIUGR) of monochorionic (MC) twin pregnancies remained unknown. In this study, we aimed to evaluate the association of ADC with sIUGR in MC twin pregnancies by exploring diffusion weighted MR imaging (DWI). METHODS Fifty-one MC twin pregnancies, consisting 19 cases of sIUGR and 32 cases without sIUGR, were re-analyzed by DWI. ADCs were quantitated from two regions of interest, surrounding the insertion of the umbilical cord of placenta for each twin. A rADC (ADClarger twin/ADCsmaller twin) in each placenta was also evaluated. Then ADCs and rADCs were compared between cases with and without sIUGR. RESULTS The ADC in cases with sIUGR was significantly decreased compared with cases without sIUGR (1.846 × 103 vs 2.471 × 103 mm2/s, p < 0.001). The rADC in cases with sIUGR was significantly increased (1.346 vs 1.053, p < 0.001). CONCLUSIONS The ADC decreases and the rADC increases in the placentas of MC twins with sIUGR, suggesting that diffusion in the placenta is restricted in pregnancies with sIUGR.
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Affiliation(s)
- Le Fu
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, PR China
| | - Jun Zhang
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, PR China
| | - Shiyi Xiong
- Fetal Medicine Unit & Prenatal Diagnosis Centre, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, PR China
| | - Minghua Sun
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, PR China.
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32
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Placental physiology monitored by hyperpolarized dynamic 13C magnetic resonance. Proc Natl Acad Sci U S A 2018; 115:E2429-E2436. [PMID: 29444856 DOI: 10.1073/pnas.1715175115] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Placental functions, including transport and metabolism, play essential roles in pregnancy. This study assesses such processes in vivo, from a hyperpolarized MRI perspective. Hyperpolarized urea, bicarbonate, and pyruvate were administered to near-term pregnant rats, and all metabolites displayed distinctive behaviors. Little evidence of placental barrier crossing was observed for bicarbonate, at least within the timescales allowed by 13C relaxation. By contrast, urea was observed to cross the placental barrier, with signatures visible from certain fetal organs including the liver. This was further evidenced by the slower decay times observed for urea in placentas vis-à-vis other maternal compartments and validated by mass spectrometric analyses. A clear placental localization, as well as concurrent generation of hyperpolarized lactate, could also be detected for [1-13C]pyruvate. These metabolites also exhibited longer lifetimes in the placentas than in maternal arteries, consistent with a metabolic activity occurring past the trophoblastic interface. When extended to a model involving the administration of a preeclampsia-causing chemical, hyperpolarized MR revealed changes in urea's transport, as well as decreases in placental glycolysis vs. the naïve animals. These distinct behaviors highlight the potential of hyperpolarized MR for the early, minimally invasive detection of aberrant placental metabolism.
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33
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Jakab A, Tuura RL, Kottke R, Ochsenbein-Kölble N, Natalucci G, Nguyen TD, Kellenberger C, Scheer I. Microvascular perfusion of the placenta, developing fetal liver, and lungs assessed with intravoxel incoherent motion imaging. J Magn Reson Imaging 2017; 48:214-225. [PMID: 29281153 DOI: 10.1002/jmri.25933] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In utero intravoxel incoherent motion magnetic resonance imaging (IVIM-MRI) provides a novel method for examining microvascular perfusion fraction and diffusion in the developing human fetus. PURPOSE To characterize gestational changes in the microvascular perfusion fraction of the placenta, fetal liver, and lungs using IVIM-MRI. STUDY TYPE Retrospective, cross-sectional study. SUBJECTS Fifty-five datasets from 33 singleton pregnancies were acquired (17-36 gestational weeks). FIELD STRENGTH/SEQUENCE In utero diffusion-weighted echo-planar imaging at 1.5T and 3.0T with b-factors ranging from 0 to 900 s/mm2 in 16 steps. ASSESSMENT Using the IVIM principle, microvascular perfusion fraction (f), pseudodiffusion (D*), and diffusion coefficients (d) were estimated for the placenta, liver, and lungs with a biexponential model. A free-form nonlinear deformation algorithm was used to correct for the frame-by-frame motion of the fetal organs and the placenta. The IVIM parameters were then compared to a Doppler ultrasound-based assessment of the umbilical artery resistance index. STATISTICAL TESTS Pearson product-moment correlation coefficient (PMCC) to reveal outlier corrected correlations between Doppler and IVIM parameters. Gestational age-related changes were assessed using linear regression analysis (LR). RESULTS Placental f (0.29 ± 0.08) indicates high blood volume in the microvascular compartment, moderately increased during gestation (LR, R = 0.338), and correlated negatively with the umbilical artery resistance index (PMCC, R = -0.457). The f of the liver decreased sharply during gestation (LR, R = -0.436). Lung maturation was characterized by increasing perfusion fraction (LR, R = 0.547), and we found no gestational changes in d and D* values (LR, R = -0.013 and R = 0.051, respectively). The Doppler measurements of the umbilical artery and middle cerebral artery did not correlate with the IVIM parameters of the lungs and liver. DATA CONCLUSION Gestational age-associated changes of the placental, liver, and lung IVIM parameters likely reflect changes in placental and fetal circulation, and characterize the trajectory of microstructural and functional maturation of the fetal vasculature. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017.
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Affiliation(s)
- András Jakab
- Center for MR-Research, University Children's Hospital, Zurich, Switzerland.,Computational Imaging Research Lab (CIR), Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Ruth L Tuura
- Center for MR-Research, University Children's Hospital, Zurich, Switzerland
| | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
| | | | - Giancarlo Natalucci
- Department of Neonatology, University Hospital and University of Zurich, Switzerland
| | - Thi Dao Nguyen
- Department of Neonatology, University Hospital and University of Zurich, Switzerland
| | | | - Ianina Scheer
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
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Jakab A, Tuura R, Kottke R, Kellenberger CJ, Scheer I. Intra-voxel incoherent motion MRI of the living human foetus: technique and test-retest repeatability. Eur Radiol Exp 2017; 1:26. [PMID: 29708192 PMCID: PMC5909359 DOI: 10.1186/s41747-017-0031-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/03/2017] [Indexed: 01/05/2023] Open
Abstract
Background Our purpose was to test the within-subject (test–retest) reproducibility of the perfusion fraction, diffusion coefficient, and pseudo-diffusion coefficient measurements in various foetus organs and in the placenta based on the intra-voxel incoherent motion (IVIM) principle. Methods In utero diffusion-weighted IVIM magnetic resonance imaging (MRI) was performed in 15 pregnant women (pregnancy age 21–36 weeks) on 1.5-T and 3.0-T clinical scanners with b-factors in the range of 0–900 s/mm2 in 16 steps. A bi-exponential model was fitted on the volume-averaged diffusion values. Perfusion fraction (f), diffusion coefficient (d), and pseudo-diffusion coefficient (D*) were calculated. Within-subject reproducibility was evaluated as test–retest variability (VAR %) of the IVIM parameters in the foetal frontal cortex, frontal white matter, cerebellum, lungs, kidneys, liver, and in the placenta. Results For the foetal lungs, liver and the placenta, test–retest variability was in the range of 14–20% for f, 12–14% for d, and 17–25% for D*. The diffusion coefficients of the investigated brain regions were moderately to highly reproducible (VAR 5–15%). However, f and D* showed inferior reproducibility compared to corresponding measures for the lungs, liver, and placenta. The IVIM parameters of the foetal kidney were revealed to be highly variable across scans. Conclusions IVIM MRI potentially provides a novel method for examining microvascular perfusion and diffusion in the developing human foetus. However, reproducibility of perfusion and diffusion parameters depends greatly upon data quality, foetal and maternal movements, and foetal-specific image post-processing.
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Affiliation(s)
- András Jakab
- 1Center for MR-Research, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland.,2Computational Imaging Research Lab (CIR), Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, 1090 Vienna, Austria
| | - Ruth Tuura
- 1Center for MR-Research, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Raimund Kottke
- 3Department of Diagnostic Imaging, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Christian J Kellenberger
- 3Department of Diagnostic Imaging, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Ianina Scheer
- 3Department of Diagnostic Imaging, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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Wu D, Lei J, Jia B, Xie H, Zhu Y, Xu J, Mori S, Zhang J, Burd I. In vivo assessment of the placental anatomy and perfusion in a mouse model of intrauterine inflammation. J Magn Reson Imaging 2017; 47:1260-1267. [PMID: 28981189 DOI: 10.1002/jmri.25867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/19/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) provides useful markers to examine placental function. MRI features of placental injury due to intrauterine inflammation-a common risk during pregnancy, are not well known. PURPOSE To investigate the capability of structural MRI and intravoxel incoherent motion (IVIM) imaging in examining acute placental injury in a mouse model of intrauterine inflammation, as well as gestation-dependent placental changes. STUDY TYPE Prospective study. ANIMAL MODEL Pregnant CD1 mice were scanned on embryonic day 15 (E15, n = 40 placentas from six dams) and E17. On E17, mice were subjected to intrauterine injury by exposure to lipopolysaccharide (LPS, n = 25 placentas from three dams) or sham injury (n = 25 placentas from three dams). FIELD STRENGTH/SEQUENCE In vivo MRI was performed on an 11.7T Bruker scanner, using a fast spin-echo sequence and a diffusion-weighted echo-planar imaging (EPI) sequence. ASSESSMENT T2 -weighted MRI was acquired to evaluate placental volume. IVIM imaging was performed in a restricted field-of-view using 15 b-values from 10-800 s/mm2 , based on which, the pseudodiffusion fraction (f), pseudodiffusion coefficient (D*), and tissue water coefficient (D) were estimated with a two-step fitting procedure. STATISTICAL TESTS Two-way analysis of variance (ANOVA) was used to evaluate the group differences. RESULTS The placental volume increased by ∼21% from E15 to E17 (P < 0.01), and a 15% volume loss was observed at 6 hours after LPS exposure (P < 0.01). IVIM parameters (f, D*, and f·D*) were similar between the E15 and E17 sham groups (P > 0.05), which was significantly reduced in the LPS-exposed placentas compared to the shams (P < 0.001). D values decreased from E15 to E17 (P < 0.05), which were further reduced after LPS exposure (P < 0.05). Changes in placental area and vascular density were histologically identified in the LPS-exposed group, along with gestation-dependent changes. DATA CONCLUSION Our results suggested structural MRI and IVIM measurements are potential markers for detecting acute placental injury after intrauterine inflammation. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1260-1267.
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Affiliation(s)
- Dan Wu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jun Lei
- Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bei Jia
- Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Gynecology and Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Han Xie
- Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center for Prenatal and Hereditary Disease Diagnosis, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Yan Zhu
- Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Gynecology and Obstetrics, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Jiadi Xu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Susumu Mori
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jiangyang Zhang
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Irina Burd
- Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Siauve N, Hayot PH, Deloison B, Chalouhi GE, Alison M, Balvay D, Bussières L, Clément O, Salomon LJ. Assessment of human placental perfusion by intravoxel incoherent motion MR imaging. J Matern Fetal Neonatal Med 2017; 32:293-300. [PMID: 28974131 DOI: 10.1080/14767058.2017.1378334] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To provide functional information on the human placenta, including perfusion, and diffusion, with no contrast agent injection, and to study correlations between intravoxel incoherent motion (IVIM) placental parameters and fetal growth. MATERIALS AND METHODS MRI was performed in women undergoing legal termination of pregnancy at 17-34 weeks, including a 4-b-value and 11-b-value DW sequences. The apparent diffusion coefficient (ADC), the restricted diffusion coefficient (D), the pseudoperfusion coefficient (D*), and the perfusion fraction (f) were calculated. Their relationships with gestational age, Z-scores for fetal and placental weight were evaluated by means of regression analysis. Logistic regression analysis was used to assess the ability of IVIM parameters to predict/detect intrauterine growth retardation (SGA). RESULTS Fifty-five pregnant women, including nine cases of SGA (16%), were included in the study. The ADC (n = 55) showed a quadratic correlation with gestational age (p < .001) and a linear correlation with the fetal weight Z-score (p = .02). Mean ADC values were significantly different between normally growing and SGA fetuses (2.37 ± 0.25 versus 2.29 ± 0.33 10-3.mm2.s-1, p=.048). The perfusion fraction f (n = 23) showed a quadratic correlation with gestational age (p = .017) and a linear correlation with the fetal weight Z - score (p = .008). Mean f values differed significantly between normally growing and SGA fetuses (42.55 ± 9.30% versus 27.94 ± 8.76%, p = .002). The receiver operating characteristics (ROC) curve for f to predict SGA was produced (area under the ROC curve = 0.9). CONCLUSIONS The observed association between f and fetal weight suggests that fMRI could be suitable for studying placental insufficiency and for identifying risk of SGA.
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Affiliation(s)
- Nathalie Siauve
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,c Assistance Publique: Hôpitaux de Paris , Hôpital Européen Georges Pompidou , Paris , France
| | - Pierre Humbert Hayot
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Benjamin Deloison
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Gihad E Chalouhi
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Marianne Alison
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France
| | - Daniel Balvay
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,e Plateforme d'Imagerie du Vivant , Université Paris Descartes, Sorbonne Paris Cité , Paris , France
| | - Laurence Bussières
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
| | - Olivier Clément
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France
| | - Laurent J Salomon
- a INSERM, U970 , Paris Cardiovascular Research Center - PARCC, Sorbonne Paris Cite , Paris , France.,b EA Fetus & Lumiere Platform , Université Paris Descartes , Paris , France.,d Assistance Publique: Hôpitaux de Paris , Hôpital Necker-Enfants Malades , Paris , France
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Chen WB, Zhang B, Liang L, Dong YH, Cai GH, Liang CH, Lan BW, Zhang SX. To predict the radiosensitivity of nasopharyngeal carcinoma using intravoxel incoherent motion MRI at 3.0 T. Oncotarget 2017; 8:53740-53750. [PMID: 28881847 PMCID: PMC5581146 DOI: 10.18632/oncotarget.17367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 04/11/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To investigate intravoxel incoherent motion (IVIM) MRI for evaluating the sensitivity of radiotherapy on nasopharyngeal carcinoma (NPC). RESULTS The reproducibility between intra-observer and inter-observer was relatively good. D (0.72×10-3 mm2/s±0.14 vs. 0.54×10-3 mm2/s±0.23; P < 0.001) and D* (157.92×10-3 mm2/s±15.21 vs. 120.36×10-3 mm2/s±10.22; P < 0.0001) were significantly higher in effective group than poor-effective group, whereas the difference of f (18.79%±2.51 vs. 16.47%±1.51) and ADC (1.21×10-3 mm2/s±0.11 vs. 1.33×10-3 mm2/s±0.23) could not reach statistical significant between the 2 groups (P > 0.05). CONCLUSIONS IVIM may be potentially useful in assessing the radiosensitivity of NPC. The higher D value combining with higher D* value might indicate the more radiosensitive of NPC, and increased D* might reflect increased blood vessel generation and parenchymal perfusion in NPC. MATERIALS AND METHODS Sixty consecutive patients (20 female, range, 27-83 years, mean age, 52 years) newly diagnosed NPC in the stage of T3 or T4 were enrolled. Forty-two of them were divided into effective group clinically after a standard radiotherapy according to the RECIST criteria. IVIM with 13 b-values (range, 0-800 s/mm2) and general MRI were performed at 3.0T MR scanner before and after radiotherapy. The parameters of IVIM including perfusion fraction (f), perfusion-related diffusion (D*), pure molecular diffusion (D) and apparent diffusion coefficient (ADC) were calculated. Two radiologists major in MRI diagnose analyzed all images independently and placed regions of interest (ROIs). Intra-class correlation coefficient (ICC) was used to evaluate intra-observer and inter-observer agreement. And Mann-Whitney test was used to assess the differences between the two groups.
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Affiliation(s)
- Wen Bo Chen
- Department of Radiology, HuiZhou Municipal Central Hospital, Huizhou, Guangdong, P.R. China
| | - Bin Zhang
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong, P.R. China
- Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Long Liang
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong, P.R. China
| | - Yu Hao Dong
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong, P.R. China
- Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Guan Hui Cai
- Department of Radiology, HuiZhou Municipal Central Hospital, Huizhou, Guangdong, P.R. China
| | - Chang Hong Liang
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong, P.R. China
| | - Bo Wen Lan
- Department of Radiology, HuiZhou Municipal Central Hospital, Huizhou, Guangdong, P.R. China
| | - Shui Xing Zhang
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong, P.R. China
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Capuani S, Guerreri M, Antonelli A, Bernardo S, Porpora MG, Giancotti A, Catalano C, Manganaro L. Diffusion and perfusion quantified by Magnetic Resonance Imaging are markers of human placenta development in normal pregnancy. Placenta 2017; 58:33-39. [PMID: 28962693 DOI: 10.1016/j.placenta.2017.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/20/2017] [Accepted: 08/02/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the potential of bi-exponential model of diffusion-weighted (DW) signal decay to quantify diffusion and perfusion changes in human placenta of normal pregnancies due to its development. METHODS 26 normal pregnancies at 19-37 weeks of gestation underwent Magnetic Resonance Imaging (MRI) examination at 1.5 T. DW Spin-Echo Echo Planar Imaging with diffusion gradients applied along 3 no-coplanar directions at seven different b-values (0,50,100,150,400,700,1000 s/mm2) was used. Apparent diffusion coefficient (ADC), pseudodiffusion (D*) and perfusion fraction (f) were extracted in selected placenta regions: umbilical (U-ROI), central (C-ROI) and peripheral (P-ROI). The relation between ADC, D*, f and mother age, gestational age (GA), Body-Mass Index (BMI), basal Glycaemia (bG), were evaluated. Pearson correlation with Bonferroni correction was used. RESULTS A significant negative correlation was found between ADC and GA, for GA≥30w in P-ROI, while no-dependence of ADC on GA was observed in GA range 19-29 weeks. A positive linear correlation was found between f and GA in the C-ROI and between f and GA in P-ROI for GA≥30 week. No significant correlations were found between ADC, D*, f and age, BMI, bG. CONCLUSION ADC measurements in P-ROI of normal placenta reflects tissue changes occurring in the third trimester of gestation. Specifically, ADC decreases with GA increase. Besides, f increases with the GA increase in the C-ROI and during the third trimester of pregnancy in the P-ROI. These results suggest the potential of diffusion and perfusion parameters extracted by using a biexponential model to provide information about placenta changes during its development.
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Affiliation(s)
| | - Michele Guerreri
- CNR ISC Roma Sapienza, Physics Department, Rome, Italy; SAIMLAL Department, Morphogenesis & Tissue Engineering, Sapienza University of Rome, Rome, Italy
| | - Amanda Antonelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Italy
| | - Silvia Bernardo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Italy
| | - Maria Grazia Porpora
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University of Rome, Italy
| | - Antonella Giancotti
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University of Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Italy
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Wikström J. Re: Placental magnetic resonance imaging T2* measurements in normal pregnancies and in those complicated by fetal growth restriction. M. Sinding, D. A. Peters, J. B. Frøkjaer, O. B. Christiansen, A. Petersen, N. Uldbjerg and A. Sørensen. Ultrasound Obstet Gynecol 2016; 47: 748-754. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:673. [PMID: 27256657 DOI: 10.1002/uog.15952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Wikström
- Neuroradiology Section, Department of Radiology, Uppsala University Hospital, 751 85 Uppsala, Sweden.
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Grigsby PL. Animal Models to Study Placental Development and Function throughout Normal and Dysfunctional Human Pregnancy. Semin Reprod Med 2016; 34:11-6. [PMID: 26752715 DOI: 10.1055/s-0035-1570031] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Abnormalities of placental development and function are known to underlie many pathologies of pregnancy, including spontaneous preterm birth, fetal growth restriction, and preeclampsia. A growing body of evidence also underscores the importance of placental dysfunction in the lifelong health of both mother and offspring. However, our knowledge regarding placental structure and function throughout pregnancy remains limited. Understanding the temporal growth and functionality of the human placenta throughout the entirety of gestation is important if we are to gain a better understanding of placental dysfunction. The utilization of new technologies and imaging techniques that could enable safe monitoring of placental growth and function in vivo has become a major focus area for the National Institutes of Child Health and Human Development, as evident by the establishment of the "Human Placenta Project." Many of the objectives of the Human Placenta Project will necessitate preclinical studies and testing in appropriately designed animal models that can be readily translated to the clinical setting. This review will describe the advantages and limitations of relevant animals such as the guinea pig, sheep, and nonhuman primate models that have been used to study the role of the placenta in fetal growth disorders, preeclampsia, or other maternal diseases during pregnancy.
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Affiliation(s)
- Peta L Grigsby
- Division of Reproductive and Developmental Sciences, Department of Obstetrics and Gynecology, Oregon Health and Science University, Beaverton, Oregon
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Sohlberg S, Mulic-Lutvica A, Olovsson M, Weis J, Axelsson O, Wikström J, Wikström AK. Magnetic resonance imaging-estimated placental perfusion in fetal growth assessment. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:700-705. [PMID: 25640054 PMCID: PMC5063104 DOI: 10.1002/uog.14786] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/29/2014] [Accepted: 01/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate in-vivo placental perfusion fraction, estimated by magnetic resonance imaging (MRI), as a marker of placental function. METHODS A study population of 35 pregnant women, of whom 13 had pre-eclampsia (PE), were examined at 22-40 weeks' gestation. Within a 24-h period, each woman underwent an MRI diffusion-weighted sequence (from which we calculated the placental perfusion fraction), venous blood sampling and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. The perfusion fractions in pregnancies with and without fetal growth restriction were compared and correlations between the perfusion fraction and ultrasound estimates and plasma markers were estimated using linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of PE (P < 0.05) and therefore we included an interaction term between PE and covariates in the models. RESULTS The median placental perfusion fractions in pregnancies with and without fetal growth restriction were 21% and 32%, respectively (P = 0.005). The correlations between placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (P = 0.002 and P = 0.0001, respectively). The highest coefficient of determination (R(2) = 0.56) for placental perfusion fraction was found for a model that included pulsatility index in the ductus venosus, plasma level of soluble fms-like tyrosine kinase-1, estimated fetal weight and presence of PE. CONCLUSION The placental perfusion fraction has the potential to contribute to the clinical assessment of cases with placental insufficiency.
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Affiliation(s)
- S Sohlberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Mulic-Lutvica
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - J Weis
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - O Axelsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - J Wikström
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - A-K Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Serov AS, Salafia C, Grebenkov DS, Filoche M. The role of morphology in mathematical models of placental gas exchange. J Appl Physiol (1985) 2015; 120:17-28. [PMID: 26494446 DOI: 10.1152/japplphysiol.00543.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/08/2015] [Indexed: 02/07/2023] Open
Abstract
The performance of the placenta as a gas exchanger has a direct impact on the future health of the newborn. To provide accurate estimates of respiratory gas exchange rates, placenta models need to account for both the physiology of exchange and the organ morphology. While the former has been extensively studied, accounting for the latter is still a challenge. The geometrical complexity of placental structure requires use of carefully crafted approximations. We present here the state of the art of respiratory gas exchange placenta modeling and demonstrate the influence of the morphology description on model predictions. Advantages and shortcomings of various classes of models are discussed, and experimental techniques that may be used for model validation are summarized. Several directions for future development are suggested.
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Affiliation(s)
- A S Serov
- Physique de la Matière Condensée, Centre National de la Recherche Scientifique, Ecole Polytechnique, Palaiseau, France; and
| | - C Salafia
- Placental Analytics, LLC, Larchmont, New York
| | - D S Grebenkov
- Physique de la Matière Condensée, Centre National de la Recherche Scientifique, Ecole Polytechnique, Palaiseau, France; and
| | - M Filoche
- Physique de la Matière Condensée, Centre National de la Recherche Scientifique, Ecole Polytechnique, Palaiseau, France; and
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Siauve N, Chalouhi GE, Deloison B, Alison M, Clement O, Ville Y, Salomon LJ. Functional imaging of the human placenta with magnetic resonance. Am J Obstet Gynecol 2015; 213:S103-14. [PMID: 26428488 DOI: 10.1016/j.ajog.2015.06.045] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/29/2022]
Abstract
Abnormal placentation is responsible for most failures in pregnancy; however, an understanding of placental functions remains largely concealed from noninvasive, in vivo investigations. Magnetic resonance imaging (MRI) is safe in pregnancy for magnetic fields of up to 3 Tesla and is being used increasingly to improve the accuracy of prenatal imaging. Functional MRI (fMRI) of the placenta has not yet been validated in a clinical setting, and most data are derived from animal studies. FMRI could be used to further explore placental functions that are related to vascularization, oxygenation, and metabolism in human pregnancies by the use of various enhancement processes. Dynamic contrast-enhanced MRI is best able to quantify placental perfusion, permeability, and blood volume fractions. However, the transplacental passage of Gadolinium-based contrast agents represents a significant safety concern for this procedure in humans. There are alternative contrast agents that may be safer in pregnancy or that do not cross the placenta. Arterial spin labeling MRI relies on magnetically labeled water to quantify the blood flows within the placenta. A disadvantage of this technique is a poorer signal-to-noise ratio. Based on arterial spin labeling, placental perfusion in normal pregnancy is 176 ± 91 mL × min(-1) × 100 g(-1) and decreases in cases with intrauterine growth restriction. Blood oxygen level-dependent and oxygen-enhanced MRIs do not assess perfusion but measure the response of the placenta to changes in oxygen levels with the use of hemoglobin as an endogenous contrast agent. Diffusion-weighted imaging and intravoxel incoherent motion MRI do not require exogenous contrast agents, instead they use the movement of water molecules within tissues. The apparent diffusion coefficient and perfusion fraction are significantly lower in placentas of growth-restricted fetuses when compared with normal pregnancies. Magnetic resonance spectroscopy has the ability to extract information regarding metabolites from the placenta noninvasively and in vivo. There are marked differences in all 3 metabolites N-acetyl aspartate/choline levels, inositol/choline ratio between small, and adequately grown fetuses. Current research is focused on the ability of each fMRI technique to make a timely diagnosis of abnormal placentation that would allow for appropriate planning of follow-up examinations and optimal scheduling of delivery. These research programs will benefit from the use of well-defined sequences, standardized imaging protocols, and robust computational methods.
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Affiliation(s)
- Nathalie Siauve
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | - Gihad E Chalouhi
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Benjamin Deloison
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Marianne Alison
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France
| | - Olivier Clement
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | - Yves Ville
- EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Laurent J Salomon
- INSERM, U970, Sorbonne Paris Cite, Paris Cardiovascular Research Center-PARCC, Paris, France; EA FETUS and LUMIERE Unit, Université Paris-Descartes, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France.
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Avni R, Neeman M, Garbow JR. Functional MRI of the placenta--From rodents to humans. Placenta 2015; 36:615-22. [PMID: 25916594 PMCID: PMC4452090 DOI: 10.1016/j.placenta.2015.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/30/2015] [Accepted: 04/04/2015] [Indexed: 01/26/2023]
Abstract
The placenta performs a wide range of physiological functions; insufficiencies in these functions may result in a variety of severe prenatal and postnatal syndromes with long-term negative impacts on human adult health. Recent advances in magnetic resonance imaging (MRI) studies of placental function, in both animal models and humans, have contributed significantly to our understanding of placental structure, blood flow, oxygenation status, and metabolic profile, and have provided important insights into pregnancy complications.
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Affiliation(s)
- R Avni
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 76100, Israel
| | - M Neeman
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 76100, Israel.
| | - J R Garbow
- Biomedical MR Laboratory, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, United States.
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Andescavage NN, DuPlessis A, Limperopoulos C. Advanced MR imaging of the placenta: Exploring the in utero placenta-brain connection. Semin Perinatol 2015; 39:113-23. [PMID: 25765905 PMCID: PMC4409865 DOI: 10.1053/j.semperi.2015.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The placenta is a vital organ necessary for the healthy neurodevelopment of the fetus. Despite the known associations between placental dysfunction and neurologic impairment, there is a paucity of tools available to reliably assess in vivo placental health and function. Existing clinical tools for placental assessment remain insensitive in predicting and evaluating placental well-being. Advanced MRI techniques hold significant promise for the dynamic, non-invasive, real-time assessment of placental health and identification of early placental-based disorders. In this review, we summarize the available clinical tools for placental assessment, including ultrasound, Doppler, and conventional MRI. We then explore the emerging role of advanced placental MR imaging techniques for supporting the developing fetus and appraise the strengths and limitations of quantitative MRI in identifying early markers of placental dysfunction for improved pregnancy monitoring and fetal outcomes.
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Affiliation(s)
- Nickie Niforatos Andescavage
- Division of Neonatology, Children’s National Health System, 111
Michigan Ave. NW, Washington, DC 20010,Fetal & Transitional Medicine, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine,
2300 Eye St. NW, Washington, DC 20037
| | - Adre DuPlessis
- Fetal & Transitional Medicine, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Diagnostic Imaging & Radiology, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine,
2300 Eye St. NW, Washington, DC 20037
| | - Catherine Limperopoulos
- Division of Neonatology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Division of Fetal and Transitional Medicine, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037; Division of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Division of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037.
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46
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Optimal villi density for maximal oxygen uptake in the human placenta. J Theor Biol 2015; 364:383-96. [DOI: 10.1016/j.jtbi.2014.09.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/31/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022]
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47
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Intravoxel incoherent motion (IVIM) imaging at different magnetic field strengths: what is feasible? Magn Reson Imaging 2014; 32:1247-58. [PMID: 25109587 DOI: 10.1016/j.mri.2014.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 05/28/2014] [Accepted: 07/25/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Due to limited SNR the cerebral applications of the intravoxel incoherent motion (IVIM) concept have been sparse. MRI hardware developments have resulted in improved SNR and this may justify a reassessment of IVIM imaging for non-invasive quantification of the cerebral blood volume (CBV) as a first step toward determining the optimal field strength. PURPOSE To investigate intravoxel incoherent motion imaging for its potential to assess cerebral blood volume (CBV) at three different MRI field strengths. MATERIALS AND METHODS Four volunteers were scanned twice at 1.5 T, 3 T as well as 7 T. By correcting for field-strength-dependent effects of relaxation, estimates of corrected CBV (cCBV) were obtained in deep gray matter (DGM), frontal gray matter (FGM) and frontal white matter (FWM), using Bayesian analysis. In addition, simulations were performed to facilitate the interpretation of experimental data. RESULTS In DGM, FGM and FWM we obtained cCBV estimates of 2.2 ml/100 ml, 2.7 ml/100 ml, 1.4 ml/100 ml at 1.5 T; 3.7 ml/100 ml, 5.0 ml/100 ml, 3.2 ml/100 ml at 3 T and 15.5 ml/100 ml, 20.3 ml/100 ml, 7.0 ml/100 ml at 7 T. CONCLUSION Quantitative cCBV values obtained at 1.5 T and 3 T corresponded better to physiological reference values, while 7 T showed the largest deviation from expected values. Simulations of synthetic tissue voxels indicated that the discrepancy at 7 T can partly be explained by SNR issues. Results were generally more repeatable at 7 T (intraclass correlation coefficient, ICC=0.84) than at 1.5 T (ICC=0.68) and 3 T (ICC=0.46).
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48
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Major mouse placental compartments revealed by diffusion-weighted MRI, contrast-enhanced MRI, and fluorescence imaging. Proc Natl Acad Sci U S A 2014; 111:10353-8. [PMID: 24969421 DOI: 10.1073/pnas.1401695111] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mammalian models, and mouse studies in particular, play a central role in our understanding of placental development. Magnetic resonance imaging (MRI) could be a valuable tool to further these studies, providing both structural and functional information. As fluid dynamics throughout the placenta are driven by a variety of flow and diffusion processes, diffusion-weighted MRI could enhance our understanding of the exchange properties of maternal and fetal blood pools--and thereby of placental function. These studies, however, have so far been hindered by the small sizes, the unavoidable motions, and the challenging air/water/fat heterogeneities, associated with mouse placental environments. The present study demonstrates that emerging methods based on the spatiotemporal encoding (SPEN) of the MRI information can robustly overcome these obstacles. Using SPEN MRI in combination with albumin-based contrast agents, we analyzed the diffusion behavior of developing placentas in a cohort of mice. These studies successfully discriminated the maternal from the fetal blood flows; the two orders of magnitude differences measured in these fluids' apparent diffusion coefficients suggest a nearly free diffusion behavior for the former and a strong flow-based component for the latter. An intermediate behavior was observed by these methods for a third compartment that, based on maternal albumin endocytosis, was associated with trophoblastic cells in the interphase labyrinth. Structural features associated with these dynamic measurements were consistent with independent intravital and ex vivo fluorescence microscopy studies and are discussed within the context of the anatomy of developing mouse placentas.
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49
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Zhang SX, Jia QJ, Zhang ZP, Liang CH, Chen WB, Qiu QH, Li H. Intravoxel incoherent motion MRI: emerging applications for nasopharyngeal carcinoma at the primary site. Eur Radiol 2014; 24:1998-2004. [PMID: 24838795 PMCID: PMC4082649 DOI: 10.1007/s00330-014-3203-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/14/2014] [Accepted: 04/24/2014] [Indexed: 01/02/2023]
Abstract
Objectives We compared pure molecular diffusion (D), perfusion-related diffusion (D*), perfusion fraction (f) and apparent diffusion coefficient (ADC) based on intravoxel incoherent motion (IVIM) theory in patients with nasopharyngeal carcinoma (NPC). Methods Sixty-five consecutive patients (48 men) with suspected NPC were examined using a 3.0-T MR system. Diffusion-weighted imaging (DWI) was performed with 13 b values (range, 0–800 s/mm2). We regarded the result of endoscopy and biopsy as the gold standard for detection. D, D* and f were compared between patients with primary NPC and enlarged adenoids. Results IVIM DWI was successful in 37 of 40 NPC and 23 of 25 enlarged adenoids cases. D (P = 0.001) and f (P < 0.0001) were significantly lower in patients with NPC than in patients with enlarged adenoids, whereas D* was significantly higher (P < 0.0001). However, the ADC was not significantly different between the two groups (P > 0.05). The area under the ROC curve (AUC) for D was 0.849 and was significantly larger than that for ADC (P < 0.05). Conclusions IVIM DWI is a feasible technique for investigating primary NPC. D was significantly decreased in primary NPC, and increased D* reflected increased blood vessel generation and parenchymal perfusion in primary NPC. Key Points • Intravoxel incoherent motion (IVIM) analysis permits separate quantification of diffusion and perfusion. • IVIM DWI is a feasible technique for investigating primary NPC. • IVIM suggests that primary NPC tissue voxels exhibit both perfusion and diffusion.
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Affiliation(s)
- Shui-xing Zhang
- Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, No. 106 Zhongshan Er Road, 510080, Guangzhou, Guangdong Prov., People's Republic of China
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50
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Frias AE, Schabel MC, Roberts VHJ, Tudorica A, Grigsby PL, Oh KY, Kroenke CD. Using dynamic contrast-enhanced MRI to quantitatively characterize maternal vascular organization in the primate placenta. Magn Reson Med 2014; 73:1570-8. [PMID: 24753177 DOI: 10.1002/mrm.25264] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/09/2022]
Abstract
PURPOSE The maternal microvasculature of the primate placenta is organized into 10-20 perfusion domains that are functionally optimized to facilitate nutrient exchange to support fetal growth. This study describes a dynamic contrast-enhanced magnetic resonance imaging method for identifying vascular domains and quantifying maternal blood flow in them. METHODS A rhesus macaque on the 133rd day of pregnancy (G133, term = 165 days) underwent Doppler ultrasound procedures, dynamic contrast-enhanced magnetic resonance imaging and Cesarean-section delivery. Serial T1 -weighted images acquired throughout intravenous injection of a contrast reagent bolus were analyzed to obtain contrast reagent arrival time maps of the placenta. RESULTS Watershed segmentation of the arrival time map identified 16 perfusion domains. The number and location of these domains corresponded to anatomical cotyledonary units observed following delivery. Analysis of the contrast reagent wave front through each perfusion domain enabled determination of volumetric flow, which ranged from 9.03 to 44.9 mL/s (25.2 ± 10.3 mL/s). These estimates are supported by Doppler ultrasound results. CONCLUSIONS The dynamic contrast-enhanced magnetic resonance imaging analysis described here provides quantitative estimates of the number of maternal perfusion domains in a primate placenta and estimates flow within each domain. Anticipated extensions of this technique are to the study placental function in non-human primate models of obstetric complications.
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Affiliation(s)
- Antonio E Frias
- Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Beaverton, Oregon, USA; Division of Developmental and Reproductive Sciences, Oregon National Primate Research Center, Beaverton, Oregon, USA; Department of Obstetrics and Gynecology, Oregon National Primate Research Center, Beaverton, Oregon, USA
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