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Aviles Verdera J, Story L, Hall M, Finck T, Egloff A, Seed PT, Malik SJ, Rutherford MA, Hajnal JV, Tomi-Tricot R, Hutter J. Reliability and Feasibility of Low-Field-Strength Fetal MRI at 0.55 T during Pregnancy. Radiology 2023; 309:e223050. [PMID: 37847139 PMCID: PMC10623193 DOI: 10.1148/radiol.223050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/20/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
Abstract
Background The benefits of using low-field-strength fetal MRI to evaluate antenatal development include reduced image artifacts, increased comfort, larger bore size, and potentially reduced costs, but studies about fetal low-field-strength MRI are lacking. Purpose To evaluate the reliability and feasibility of low-field-strength fetal MRI to assess anatomic and functional measures in pregnant participants using a commercially available 0.55-T MRI scanner and a comprehensive 20-minute protocol. Materials and Methods This prospective study was performed at a large teaching hospital (St Thomas' Hospital; London, England) from May to November 2022 in healthy pregnant participants and participants with pregnancy-related abnormalities using a commercially available 0.55-T MRI scanner. A 20-minute protocol was acquired including anatomic T2-weighted fast-spin-echo, quantitative T2*, and diffusion sequences. Key measures like biparietal diameter, transcerebellar diameter, lung volume, and cervical length were evaluated by two radiologists and an MRI-experienced obstetrician. Functional organ-specific mean values were given. Comparison was performed with existing published values and higher-field MRI using linear regression, interobserver correlation, and Bland-Altman plots. Results A total of 79 fetal MRI examinations were performed (mean gestational age, 29.4 weeks ± 5.5 [SD] [age range, 17.6-39.3 weeks]; maternal age, 34.4 years ± 5.3 [age range, 18.4-45.5 years]) in 47 healthy pregnant participants (control participants) and in 32 participants with pregnancy-related abnormalities. The key anatomic two-dimensional measures for the 47 healthy participants agreed with large cross-sectional 1.5-T and 3-T control studies. The interobserver correlations for the biparietal diameter in the first 40 consecutive scans were 0.96 (95% CI: 0.7, 0.99; P = .002) for abnormalities and 0.93 (95% CI: 0.86, 0.97; P < .001) for control participants. Functional features, including placental and brain T2* and placental apparent diffusion coefficient values, strongly correlated with gestational age (mean placental T2* in the control participants: 5.2 msec of decay per week; R2 = 0.66; mean T2* at 30 weeks, 176.6 msec; P < .001). Conclusion The 20-minute low-field-strength fetal MRI examination protocol was capable of producing reliable structural and functional measures of the fetus and placenta in pregnancy. Clinical trial registration no. REC 21/LO/0742 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Gowland in this issue.
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Affiliation(s)
- Jordina Aviles Verdera
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Lisa Story
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Megan Hall
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Tom Finck
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Alexia Egloff
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Paul T. Seed
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Shaihan J. Malik
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Mary A. Rutherford
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Joseph V. Hajnal
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Raphaël Tomi-Tricot
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
| | - Jana Hutter
- From the Centre for the Developing Brain, School of Biomedical
Engineering & Imaging Sciences, King's College London, 1st Floor
South Wing, St Thomas’ Hospital, Westminster Bridge Road SE1 7EH London,
United Kingdom (J.A.V., L.S., M.H., P.T.S., S.J.M., M.A.R., J.V.H, J.H.); Centre
for Medical Biomedical Engineering Department, School of Biomedical Engineering
and Imaging Sciences, King's College London, London, UK (J.A.V., L.S.,
A.E., S.J.M., M.A.R., J.V.H., J.H.); Women's Health, GSTT, London, UK
(L.S., M.H., T.F., P.T.S.); Technical University Munich, Munich, Germany (T.F.);
MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK (R.T.T.);
and Radiological Institute, University Hospital Erlangen, Erlangen, Germany
(J.H.)
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Schwartz DA, Avvad-Portari E, Babál P, Baldewijns M, Blomberg M, Bouachba A, Camacho J, Collardeau-Frachon S, Colson A, Dehaene I, Ferreres JC, Fitzgerald B, Garrido-Pontnou M, Gerges H, Hargitai B, Helguera-Repetto AC, Holmström S, Irles CL, Leijonhfvud Å, Libbrecht S, Marton T, McEntagart N, Molina JT, Morotti R, Nadal A, Navarro A, Nelander M, Oviedo A, Oyamada Otani AR, Papadogiannakis N, Petersen AC, Roberts DJ, Saad AG, Sand A, Schoenmakers S, Sehn JK, Simpson PR, Thomas K, Valdespino-Vázquez MY, van der Meeren LE, Van Dorpe J, Verdijk RM, Watkins JC, Zaigham M. Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury: A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries. Arch Pathol Lab Med 2022; 146:660-676. [PMID: 35142798 DOI: 10.5858/arpa.2022-0029-sa] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Perinatal death is an increasingly important problem as the COVID-19 pandemic continues, but the mechanism of death has been unclear. OBJECTIVE.— To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for SARS-CoV-2. DESIGN.— Case-based retrospective clinico-pathological analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. RESULTS.— All 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis, the three findings constituting SARS-CoV-2 placentitis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25/68) and chronic villitis (32%; 22/68). The majority (19, 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. CONCLUSIONS.— The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.
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Affiliation(s)
| | - Elyzabeth Avvad-Portari
- Department of Pathology, Fernandes Figueira Institute, FIOCRUZ - Rio de Janeiro, Brazil (Avvad-Portari)
| | - Pavel Babál
- Department of Pathology, Faculty of Medicine, Comenius University, Bratislava, Slovakia (Babál)
| | - Marcella Baldewijns
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium (Baldewijns)
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden (Blomberg)
| | - Amine Bouachba
- Institut de Pathologie Multisite des Hospices Civils de Lyon, Lyon, France; SOFFOET-Société Française de Foetopathologie, Paris, France (Bouachba)
| | - Jessica Camacho
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Camacho)
| | - Sophie Collardeau-Frachon
- Department of Pathology, Hopital Femme-Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 and SOFFOET-Société Française de Foetopathologie, Paris France (Collardeau-Frachon)
| | - Arthur Colson
- Department of Obstetrics, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium (Colson)
| | - Isabelle Dehaene
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Dehaene)
| | - Joan Carles Ferreres
- Pathology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Barcelona, Spain (Ferreres)
| | - Brendan Fitzgerald
- Department of Pathology, Cork University Hospital, Wilton, Cork, Republic of Ireland (Fitzgerald)
| | - Marta Garrido-Pontnou
- Pathology Department, Hospital Universitari Vall d'Hebron, Department of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain (Garrido-Pontnou)
| | - Hazem Gerges
- Department of Obstetrics and Gynaecology, Doncaster and Bassetlaw NHS Teaching Hospitals, Women's Hospital, Doncaster, United Kingdom (Gerges)
| | - Beata Hargitai
- Division of Perinatal Pathology, Department of Cellular Pathology, Birmingham Women's and Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Hargitai)
| | - A Cecilia Helguera-Repetto
- Immunobiochemistry Department, National Institute of Perinatology, Mexico City, Mexico (Helguera-Repetto)
| | - Sandra Holmström
- Department of Obstetrics and Gynaecology, Halland Hospital, Varberg, Sweden (Holmström)
| | - Claudine Liliane Irles
- Department of Physiology and Cellular Development, National Institute of Perinatology "Isidro Espinosa de los Reyes", Mexico City, Mexico (Irles)
| | - Åsa Leijonhfvud
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Department of Clinical Science Helsingborg, Lund University, Lund, Sweden (Leijonhfvud)
| | - Sasha Libbrecht
- Department of Pathological Anatomy, Antwerp University Hospital, Edegem, Belgium (Libbrecht)
| | - Tamás Marton
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham, United Kingdom (Marton)
| | - Noel McEntagart
- Histopathology, Rotunda Hospital, Dublin, Republic of Ireland (McEntagart)
| | - James T Molina
- Pathology and Laboratory Medicine, CHRISTUS Hospital St. Elizabeth, 2830 Calder St, Beaumont, Texas (Molina)
| | - Raffaella Morotti
- Department of Pathology and Pediatrics, Autopsy Service, Yale University School of Medicine, New Haven, Connecticut (Morotti)
| | - Alfons Nadal
- Pathology Department, Hospital Clínic, Barcelona, Spain (Nadal).,Department of Basic Clinical Practice, School of Medicine, Universitat de Barcelona, and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (Nadal)
| | - Alexandra Navarro
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Navarro)
| | - Maria Nelander
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (Nelander)
| | - Angelica Oviedo
- Department of Pathology and Laboratory Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico (Oviedo)
| | | | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Department of Pathology, Karolinska University Hospital, Stockholm, Sweden (Papadogiannakis)
| | - Astrid C Petersen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark (Petersen)
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Roberts)
| | - Ali G Saad
- Pediatric Pathology and Neuropathology, Department of Pathology, University of Miami Miller School of Medicine/Jackson Health System/Holtz Children's Hospital, Miami, Florida (Saad)
| | - Anna Sand
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Obstetrics and Gynaecology, Karolinska University Hospital, Solna, Stockholm, Sweden (Sand)
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands (Schoenmakers)
| | - Jennifer K Sehn
- Department of Pathology, St. Louis University School of Medicine, St. Louis, Missouri (Sehn)
| | - Preston R Simpson
- Department of Pathology, CHRISTUS Hospital St. Elizabeth, 2830 Calder St., Beaumont, Texas (Simpson)
| | - Kristen Thomas
- Department of Pathology, NYU Langone Health - Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, New York (Thomas)
| | | | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (van der Meeren).,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands (van der Meeren)
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium (Van Dorpe)
| | - Robert M Verdijk
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands (Verdijk)
| | - Jaclyn C Watkins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Watkins)
| | - Mehreen Zaigham
- Obstetrics & Gynecology, Institution of Clinical Sciences Lund, Lund University, Sweden (Zaigham).,Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden (Zaigham)
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