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Neves Silva S, McElroy S, Aviles Verdera J, Colford K, St Clair K, Tomi-Tricot R, Uus A, Ozenne V, Hall M, Story L, Pushparajah K, Rutherford MA, Hajnal JV, Hutter J. Fully automated planning for anatomical fetal brain MRI on 0.55T. Magn Reson Med 2024. [PMID: 38650351 DOI: 10.1002/mrm.30122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Widening the availability of fetal MRI with fully automatic real-time planning of radiological brain planes on 0.55T MRI. METHODS Deep learning-based detection of key brain landmarks on a whole-uterus echo planar imaging scan enables the subsequent fully automatic planning of the radiological single-shot Turbo Spin Echo acquisitions. The landmark detection pipeline was trained on over 120 datasets from varying field strength, echo times, and resolutions and quantitatively evaluated. The entire automatic planning solution was tested prospectively in nine fetal subjects between 20 and 37 weeks. A comprehensive evaluation of all steps, the distance between manual and automatic landmarks, the planning quality, and the resulting image quality was conducted. RESULTS Prospective automatic planning was performed in real-time without latency in all subjects. The landmark detection accuracy was 4.2± $$ \pm $$ 2.6 mm for the fetal eyes and 6.5± $$ \pm $$ 3.2 for the cerebellum, planning quality was 2.4/3 (compared to 2.6/3 for manual planning) and diagnostic image quality was 2.2 compared to 2.1 for manual planning. CONCLUSIONS Real-time automatic planning of all three key fetal brain planes was successfully achieved and will pave the way toward simplifying the acquisition of fetal MRI thereby widening the availability of this modality in nonspecialist centers.
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Affiliation(s)
- Sara Neves Silva
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Sarah McElroy
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - Jordina Aviles Verdera
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Kathleen Colford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Kamilah St Clair
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Raphael Tomi-Tricot
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Valéry Ozenne
- CNRS, CRMSB, UMR 5536, IHU Liryc, Université de Bordeaux, Bordeaux, France
| | - Megan Hall
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Women & Children's Health, King's College London, London, UK
| | - Lisa Story
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Women & Children's Health, King's College London, London, UK
| | - Kuberan Pushparajah
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Smart Imaging Lab, Radiological Institute, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Nwandison M, Daly-Jones E, Drought A, Story L, De-Rosnay P, Sebire N, Nyberg D, Oyelese Y. Incorporation of vasa previa screening into a routine anomaly scan: A single center cohort study. Acta Obstet Gynecol Scand 2024. [PMID: 38594913 DOI: 10.1111/aogs.14839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Vasa previa (VP), defined as unprotected fetal vessels traversing the membranes over the cervix, is associated with a high perinatal mortality when undiagnosed prenatally. Conversely, prenatal diagnosis with ultrasound and cesarean delivery before the membranes rupture is associated with excellent outcomes. However, controversy exists regarding screening for VP. In the UK, routine screening for VP is not recommended. The objective of this study was to report the incidence of VP and our experience in the detection of VP with a universal screening protocol at the time of the second-trimester fetal anomaly scan with third-trimester confirmation in an unselected population of pregnancies. MATERIAL AND METHODS We performed a single-center historical cohort study of all pregnant women who underwent routine second-trimester anomaly screening scans at West Middlesex University Hospital, London, UK, between 2012 and 2016. Over 5 years, every patient undergoing routine anomaly screening was evaluated for VP using a systematic protocol during their 20-week anomaly scan. Suspected cases of VP were rescanned in the third trimester by specialist sonographers with an interest in VP. The primary outcomes were the incidence and detection of VP. RESULTS During the study period, 24 690 anatomy scans were performed. A total of 64 patients were identified as having potential VP at the second-trimester anomaly screening scan, of which 19 were confirmed by the specialist sonographer in the third trimester and at delivery. The screen positive rate was 0.26% (95% confidence interval [CI] 0.20%-0.32%). VP at birth was found in 19/24690 births (1:1299 [95% CI: 1:832-1:2030] births). Universal screening for VP using our protocol had a sensitivity of 100% and a specificity of 99.78% (95% CI: 99.72%-99.84%). The false-positive rate of the second-trimester screen was 0.18% (95% CI: 0.13-0.24). There were no false positives or false negatives at delivery. Of the 19 patients with confirmed VP, 17 had scheduled cesarean deliveries, and two required emergency deliveries due to antepartum hemorrhage. One baby died, giving a perinatal mortality of 5%. CONCLUSIONS VP complicates approximately 1:1300 pregnancies. Routine screening for VP yielded a 100% detection rate. We suggest the inclusion of structured VP assessment in standard fetal anomaly screening programs.
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Affiliation(s)
- Millicent Nwandison
- Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Foundation Trust Hospital, West Middlesex University Hospital, London, UK
| | - Elizabeth Daly-Jones
- Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Foundation Trust Hospital, West Middlesex University Hospital, London, UK
- Imperial NHS Trust, London, UK
| | - Alexandra Drought
- Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Foundation Trust Hospital, West Middlesex University Hospital, London, UK
| | - Lisa Story
- Department of Women and Children's Health, King's College, London, UK
| | - Philippe De-Rosnay
- Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Foundation Trust Hospital, West Middlesex University Hospital, London, UK
| | - Neil Sebire
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital, London, UK
| | | | - Yinka Oyelese
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Hall M, de Marvao A, Schweitzer R, Cromb D, Colford K, Jandu P, O’Regan DP, Ho A, Price A, Chappell LC, Rutherford MA, Story L, Lamata P, Hutter J. Preeclampsia Associated Differences in the Placenta, Fetal Brain, and Maternal Heart Can Be Demonstrated Antenatally: An Observational Cohort Study Using MRI. Hypertension 2024; 81:836-847. [PMID: 38314606 PMCID: PMC7615760 DOI: 10.1161/hypertensionaha.123.22442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Preeclampsia is a multiorgan disease of pregnancy that has short- and long-term implications for the woman and fetus, whose immediate impact is poorly understood. We present a novel multiorgan approach to magnetic resonance imaging (MRI) investigation of preeclampsia, with the acquisition of maternal cardiac, placental, and fetal brain anatomic and functional imaging. METHODS An observational study was performed recruiting 3 groups of pregnant women: those with preeclampsia, chronic hypertension, or no medical complications. All women underwent a cardiac MRI, and pregnant women underwent a placental-fetal MRI. Cardiac analysis for structural, morphological, and flow data were undertaken; placenta and fetal brain volumetric and T2* (which describes relative tissue oxygenation) data were obtained. All results were corrected for gestational age. A nonpregnant cohort was identified for inclusion in the statistical shape analysis. RESULTS Seventy-eight MRIs were obtained during pregnancy. Cardiac MRI analysis demonstrated higher left ventricular mass in preeclampsia with 3-dimensional modeling revealing additional specific characteristics of eccentricity and outflow track remodeling. Pregnancies affected by preeclampsia demonstrated lower placental and fetal brain T2*. Within the preeclampsia group, 23% placental T2* results were consistent with controls, these were the only cases with normal placental histopathology. Fetal brain T2* results were consistent with normal controls in 31% of cases. CONCLUSIONS We present the first holistic assessment of the immediate implications of preeclampsia on maternal heart, placenta, and fetal brain. As well as having potential clinical implications for the risk stratification and management of women with preeclampsia, this gives an insight into the disease mechanism.
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Affiliation(s)
- Megan Hall
- Department of Women and Children’s Health (M.H., A.d.M., A.H., L.C.C., L.S.), King’s College London, United Kingdom
- Centre for the Developing Brain (M.H., D.C., K.C., A.H., A.P., M.A.R., L.S., J.H.), King’s College London, United Kingdom
| | - Antonio de Marvao
- Department of Women and Children’s Health (M.H., A.d.M., A.H., L.C.C., L.S.), King’s College London, United Kingdom
- School of Cardiovascular Medicine (A.d.M., R.S.), King’s College London, United Kingdom
- MRC London Institute of Medical Sciences, Imperial College London, United Kingdom (A.d.M., R.S., D.P.O.)
| | - Ronny Schweitzer
- School of Cardiovascular Medicine (A.d.M., R.S.), King’s College London, United Kingdom
- MRC London Institute of Medical Sciences, Imperial College London, United Kingdom (A.d.M., R.S., D.P.O.)
| | - Daniel Cromb
- Centre for the Developing Brain (M.H., D.C., K.C., A.H., A.P., M.A.R., L.S., J.H.), King’s College London, United Kingdom
| | - Kathleen Colford
- Centre for the Developing Brain (M.H., D.C., K.C., A.H., A.P., M.A.R., L.S., J.H.), King’s College London, United Kingdom
| | - Priya Jandu
- GKT School of Medical Education (P.J.), King’s College London, United Kingdom
| | - Declan P O’Regan
- MRC London Institute of Medical Sciences, Imperial College London, United Kingdom (A.d.M., R.S., D.P.O.)
| | - Alison Ho
- Department of Women and Children’s Health (M.H., A.d.M., A.H., L.C.C., L.S.), King’s College London, United Kingdom
- Centre for the Developing Brain (M.H., D.C., K.C., A.H., A.P., M.A.R., L.S., J.H.), King’s College London, United Kingdom
| | - Anthony Price
- Centre for the Developing Brain (M.H., D.C., K.C., A.H., A.P., M.A.R., L.S., J.H.), King’s College London, United Kingdom
- Centre for Medical Engineering (A.P., P.L.), King’s College London, United Kingdom
| | - Lucy C. Chappell
- Department of Women and Children’s Health (M.H., A.d.M., A.H., L.C.C., L.S.), King’s College London, United Kingdom
| | - Mary A. Rutherford
- Centre for the Developing Brain (M.H., D.C., K.C., A.H., A.P., M.A.R., L.S., J.H.), King’s College London, United Kingdom
| | - Lisa Story
- Department of Women and Children’s Health (M.H., A.d.M., A.H., L.C.C., L.S.), King’s College London, United Kingdom
- Centre for the Developing Brain (M.H., D.C., K.C., A.H., A.P., M.A.R., L.S., J.H.), King’s College London, United Kingdom
| | - Pablo Lamata
- Centre for Medical Engineering (A.P., P.L.), King’s College London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain (M.H., D.C., K.C., A.H., A.P., M.A.R., L.S., J.H.), King’s College London, United Kingdom
- Smart Imaging Lab, Radiological Institute, University Hospital Erlangen, Germany (J.H.)
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Preston M, Hall M, Shennan A, Story L. The role of placental insufficiency in spontaneous preterm birth: A literature review. Eur J Obstet Gynecol Reprod Biol 2024; 295:136-142. [PMID: 38359634 DOI: 10.1016/j.ejogrb.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
Preterm Birth (delivery before 37 weeks of gestation) is the leading cause of childhood mortality and is also associated with significant morbidity both in the neonatal period and beyond. The aetiology of spontaneous preterm birth is unclear and likely multifactorial incorporating factors such as infection/inflammation and cervical injury. Placental insufficiency is emerging as an additional contributor to spontaneous preterm delivery; however, the mechanisms by which this occurs are not fully understood. Serum biomarkers and imaging techniques have been investigated as potential predictors of placental insufficiency, however none have yet been found to have a sufficient predictive value. This review examines the evidence for the role of the placenta in preterm birth, preterm prelabour rupture of the membranes and abruption as well as highlighting areas where further research is required.
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Affiliation(s)
- Megan Preston
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK
| | - Megan Hall
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK; Department of Perinatal Imaging, St Thomas' Hospital, King's College, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK
| | - Lisa Story
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK; Department of Perinatal Imaging, St Thomas' Hospital, King's College, London, UK.
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Uus AU, Hall M, Grigorescu I, Avena Zampieri C, Egloff Collado A, Payette K, Matthew J, Kyriakopoulou V, Hajnal JV, Hutter J, Rutherford MA, Deprez M, Story L. Automated body organ segmentation, volumetry and population-averaged atlas for 3D motion-corrected T2-weighted fetal body MRI. Sci Rep 2024; 14:6637. [PMID: 38503833 PMCID: PMC10950851 DOI: 10.1038/s41598-024-57087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
Structural fetal body MRI provides true 3D information required for volumetry of fetal organs. However, current clinical and research practice primarily relies on manual slice-wise segmentation of raw T2-weighted stacks, which is time consuming, subject to inter- and intra-observer bias and affected by motion-corruption. Furthermore, there are no existing standard guidelines defining a universal approach to parcellation of fetal organs. This work produces the first parcellation protocol of the fetal body organs for motion-corrected 3D fetal body MRI. It includes 10 organ ROIs relevant to fetal quantitative volumetry studies. We also introduce the first population-averaged T2w MRI atlas of the fetal body. The protocol was used as a basis for training of a neural network for automated organ segmentation. It showed robust performance for different gestational ages. This solution minimises the need for manual editing and significantly reduces time. The general feasibility of the proposed pipeline was also assessed by analysis of organ growth charts created from automated parcellations of 91 normal control 3T MRI datasets that showed expected increase in volumetry during 22-38 weeks gestational age range.
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Affiliation(s)
- Alena U Uus
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
| | - Megan Hall
- Centre for the Developing Brain, King's College London, London, UK
- Department of Women and Children's Health, King's College London, London, UK
- Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Irina Grigorescu
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Carla Avena Zampieri
- Centre for the Developing Brain, King's College London, London, UK
- Department of Women and Children's Health, King's College London, London, UK
| | | | - Kelly Payette
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Jacqueline Matthew
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | | | - Joseph V Hajnal
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Jana Hutter
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
- Smart Imaging Lab, Radiological Institute, University Hospital Erlangen, Erlangen, Germany
| | | | - Maria Deprez
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Lisa Story
- Centre for the Developing Brain, King's College London, London, UK
- Department of Women and Children's Health, King's College London, London, UK
- Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Matthew J, Uus A, De Souza L, Wright R, Fukami-Gartner A, Priego G, Saija C, Deprez M, Collado AE, Hutter J, Story L, Malamateniou C, Rhode K, Hajnal J, Rutherford MA. Craniofacial phenotyping with fetal MRI: a feasibility study of 3D visualisation, segmentation, surface-rendered and physical models. BMC Med Imaging 2024; 24:52. [PMID: 38429666 PMCID: PMC10905839 DOI: 10.1186/s12880-024-01230-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
This study explores the potential of 3D Slice-to-Volume Registration (SVR) motion-corrected fetal MRI for craniofacial assessment, traditionally used only for fetal brain analysis. In addition, we present the first description of an automated pipeline based on 3D Attention UNet trained for 3D fetal MRI craniofacial segmentation, followed by surface refinement. Results of 3D printing of selected models are also presented.Qualitative analysis of multiplanar volumes, based on the SVR output and surface segmentations outputs, were assessed with computer and printed models, using standardised protocols that we developed for evaluating image quality and visibility of diagnostic craniofacial features. A test set of 25, postnatally confirmed, Trisomy 21 fetal cases (24-36 weeks gestational age), revealed that 3D reconstructed T2 SVR images provided 66-100% visibility of relevant craniofacial and head structures in the SVR output, and 20-100% and 60-90% anatomical visibility was seen for the baseline and refined 3D computer surface model outputs respectively. Furthermore, 12 of 25 cases, 48%, of refined surface models demonstrated good or excellent overall quality with a further 9 cases, 36%, demonstrating moderate quality to include facial, scalp and external ears. Additional 3D printing of 12 physical real-size models (20-36 weeks gestational age) revealed good/excellent overall quality in all cases and distinguishable features between healthy control cases and cases with confirmed anomalies, with only minor manual adjustments required before 3D printing.Despite varying image quality and data heterogeneity, 3D T2w SVR reconstructions and models provided sufficient resolution for the subjective characterisation of subtle craniofacial features. We also contributed a publicly accessible online 3D T2w MRI atlas of the fetal head, validated for accurate representation of normal fetal anatomy.Future research will focus on quantitative analysis, optimizing the pipeline, and exploring diagnostic, counselling, and educational applications in fetal craniofacial assessment.
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Affiliation(s)
- Jacqueline Matthew
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK.
- Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Alena Uus
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Leah De Souza
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Robert Wright
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Abi Fukami-Gartner
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Gema Priego
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Carlo Saija
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Maria Deprez
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Alexia Egloff Collado
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jana Hutter
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Lisa Story
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Kawal Rhode
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Jo Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Mary A Rutherford
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Hall M, Hutter J, Uus A, du Crest E, Egloff A, Suff N, Al Adnani M, Seed PT, Gibbons D, Deprez M, Tribe RM, Shennan A, Rutherford M, Story L. Adrenal volumes in fetuses delivering prior to 32 weeks' gestation: An MRI pilot study. Acta Obstet Gynecol Scand 2024; 103:512-521. [PMID: 38009386 PMCID: PMC10867361 DOI: 10.1111/aogs.14733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Spontaneous preterm birth prior to 32 weeks' gestation accounts for 1% of all deliveries and is associated with high rates of morbidity and mortality. A total of 70% are associated with chorioamnionitis which increases the incidence of morbidity, but for which there is no noninvasive antenatal test. Fetal adrenal glands produce cortisol and dehydroepiandosterone-sulphate which upregulate prior to spontaneous preterm birth. Ultrasound suggests that adrenal volumes may increase prior to preterm birth, but studies are limited. This study aimed to: (i) demonstrate reproducibility of magnetic resonance imaging (MRI) derived adrenal volumetry; (ii) derive normal ranges of total adrenal volumes, and adrenal: body volume for normal; (iii) compare with those who have spontaneous very preterm birth; and (iv) correlate with histopathological chorioamnionitis. MATERIAL AND METHODS Patients at high risk of preterm birth prior to 32 weeks were prospectively recruited, and included if they did deliver prior to 32 weeks; a control group who delivered an uncomplicated pregnancy at term was also recruited. T2 weighted images of the entire uterus were obtained, and a deformable slice-to-volume method was used to reconstruct the fetal abdomen. Adrenal and body volumes were obtained via manual segmentation, and adrenal: body volume ratios generated. Normal ranges were created using control data. Differences between groups were investigated accounting for the effect of gestation by use of regression analysis. Placental histopathology was reviewed for pregnancies delivering preterm. RESULTS A total of 56 controls and 26 cases were included in the analysis. Volumetry was consistent between observers. Adrenal volumes were not higher in the case group (p = 0.2); adrenal: body volume ratios were higher (p = 0.011), persisting in the presence of chorioamnionitis (p = 0.017). A cluster of three pairs of adrenal glands below the fifth centile were noted among the cases all of whom had a protracted period at risk of preterm birth prior to MRI. CONCLUSIONS Adrenal: body volume ratios are significantly larger in fetuses who go on to deliver preterm than those delivering at term. Adrenal volumes were not significantly larger, we hypothesize that this could be due to an adrenal atrophy in fetuses with fulminating chorioamnionitis. A straightforward relationship of adrenal size being increased prior to preterm birth should not be assumed.
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Affiliation(s)
- Megan Hall
- Center for the Developing BrainSt Thomas' Hospital, King's College LondonLondonUK
- Department of Women and Children's HealthSt Thomas' Hospital, King's College LondonLondonUK
| | - Jana Hutter
- Center for the Developing BrainSt Thomas' Hospital, King's College LondonLondonUK
| | - Alena Uus
- Center for the Developing BrainSt Thomas' Hospital, King's College LondonLondonUK
| | - Elise du Crest
- Department of Women and Children's HealthSt Thomas' Hospital, King's College LondonLondonUK
| | - Alexia Egloff
- Center for the Developing BrainSt Thomas' Hospital, King's College LondonLondonUK
| | - Natalie Suff
- Department of Women and Children's HealthSt Thomas' Hospital, King's College LondonLondonUK
| | - Mudher Al Adnani
- Department of Cellular PathologySt Thomas' Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Paul T. Seed
- Department of Women and Children's HealthSt Thomas' Hospital, King's College LondonLondonUK
| | - Deena Gibbons
- Department of ImmunobiologyKing's College LondonLondonUK
| | - Maria Deprez
- Center for the Developing BrainSt Thomas' Hospital, King's College LondonLondonUK
| | - Rachel M. Tribe
- Department of Women and Children's HealthSt Thomas' Hospital, King's College LondonLondonUK
| | - Andrew Shennan
- Department of Women and Children's HealthSt Thomas' Hospital, King's College LondonLondonUK
| | - Mary Rutherford
- Center for the Developing BrainSt Thomas' Hospital, King's College LondonLondonUK
| | - Lisa Story
- Center for the Developing BrainSt Thomas' Hospital, King's College LondonLondonUK
- Department of Women and Children's HealthSt Thomas' Hospital, King's College LondonLondonUK
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Challacombe FL, Suchomelova Z, Zampieri C, Hall M, Curran C, Shennan A, Story L. Preterm premature rupture of the membranes (PPROM): a study of patient experiences and support needs. J Reprod Infant Psychol 2024:1-18. [PMID: 38361489 DOI: 10.1080/02646838.2024.2314179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Preterm prelabour rupture of membranes (PPROM) is a common obstetric condition but outcomes can vary depending on gestation. Significant maternal and foetal complications occur including preterm birth, infection, abruption, cord prolapse, pulmonary hypoplasia and even death. Although the need for psychological support is recognised it is unclear how much is actually offered to women and their families. This study aimed to survey the views of women and their families who have undergone PPROM in order to understand the care and psychological burden these families face. METHODS An online survey was conducted, recruiting women via social media with collaboration from the patient advocacy support group Little Heartbeats. Responses were collated where fields were binary or mean and standard deviations calculated. Framework analysis was used to identify and analyse themes in free text responses. RESULTS 180PPROM pregnancies were described from 177 respondents. Although carewas variable and respondents were from across the world there werecommon themes. Five themes were highlighted which were: a lack ofbalanced information regarding the condition, support in decisionmaking and support with the process, specific psychological supportand ongoing psychological consequences of PPROM. CONCLUSION This survey highlights areas in which care needs to be improved for women with PPROM. Previous studies have shown that providing good care during the antenatal period reduces long-term psychological morbidity for the whole family. The need for support, with regard both to information provided to women and their families and their psychological support needs to be addressed urgently.
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Affiliation(s)
- Fiona L Challacombe
- Section of Women's Mental Health, HSPR, Institute of Psychology and Psychiatry and Neurosciences, King's College London, London, UK
| | - Zuzana Suchomelova
- Institute of Psychology and Psychiatry and Neurosciences, King's College London, London, UK
| | - Carla Zampieri
- Department of Women and Children's Health, King's College London, London, UK
| | - Megan Hall
- Department of Women and Children's Health, King's College London, London, UK
| | - Ciara Curran
- Littleheartbeats, Preterm Prelabour Rupture of the Membranes Patient Support Group, UK
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK
| | - Lisa Story
- Department of Women and Children's Health, King's College London, London, UK
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9
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Avena-Zampieri CL, Hutter J, Uus A, Deprez M, Payette K, Hall M, Bafadhel M, Russell REK, Milan A, Rutherford M, Shennan A, Greenough A, Story L. Functional MRI assessment of the lungs in fetuses that deliver very Preterm: An MRI pilot study. Eur J Obstet Gynecol Reprod Biol 2024; 293:106-114. [PMID: 38141484 PMCID: PMC10929943 DOI: 10.1016/j.ejogrb.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES To compare mean pulmonary T2* values and pulmonary volumes in fetuses that subsequently spontaneously delivered before 32 weeks with a control cohort with comparable gestational ages and to assess the value of mean pulmonary T2* as a predictor of preterm birth < 32 weeks' gestation. METHODS MRI datasets scanned at similar gestational ages were selected from fetuses who spontaneously delivered < 32 weeks of gestation and a control group who subsequently delivered at term with no complications. All women underwent a fetal MRI on a 3 T MRI imaging system. Sequences included T2-weighted single shot fast spin echo and T2* sequences, using gradient echo single shot echo planar sequencing of the fetal thorax. Motion correction was performed using slice-to-volume reconstruction and T2* maps generated using in-house pipelines. Lungs were manually segmented and volumes and mean T2* values calculated for both lungs combined and left and right lung separately. Linear regression was used to compare values between the preterm and control cohorts accounting for the effects of gestation. Receiver operating curves were generated for mean T2* values and pulmonary volume as predictors of preterm birth < 32 weeks' gestation. RESULTS Datasets from twenty-eight preterm and 74 control fetuses were suitable for analysis. MRI images were taken at similar fetal gestational ages (preterm cohort (mean ± SD) 24.9 ± 3.3 and control cohort (mean ± SD) 26.5 ± 3.0). Mean gestational age at delivery was 26.4 ± 3.3 for the preterm group and 39.9 ± 1.3 for the control group. Mean pulmonary T2* values remained constant with increasing gestational age while pulmonary volumes increased. Both T2* and pulmonary volumes were lower in the preterm group than in the control group for all parameters (both combined, left, and right lung (p < 0.001 in all cases). Adjusted for gestational age, pulmonary volumes and mean T2* values were good predictors of premature delivery in fetuses < 32 weeks (area under the curve of 0.828 and 0.754 respectively). CONCLUSION These findings indicate that mean pulmonary T2* values and volumes were lower in fetuses that subsequently delivered very preterm. This may suggest potentially altered oxygenation and indicate that pulmonary morbidity associated with prematurity has an antenatal antecedent. Future work should explore these results correlating antenatal findings with long term pulmonary outcomes.
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Affiliation(s)
- Carla L Avena-Zampieri
- Department of Women and Children's Health King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom.
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Maria Deprez
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Kelly Payette
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Megan Hall
- Department of Women and Children's Health King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Mona Bafadhel
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Richard E K Russell
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Anna Milan
- Neonatal Unit, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Andrew Shennan
- Department of Women and Children's Health King's College London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health King's College London, United Kingdom
| | - Lisa Story
- Department of Women and Children's Health King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
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10
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Story L, Uus A, Hall M, Payette K, Bakalis S, Arichi T, Shennan A, Rutherford M, Hutter J. Functional assessment of brain development in fetuses that subsequently deliver very preterm: An MRI pilot study. Prenat Diagn 2024; 44:49-56. [PMID: 38126921 PMCID: PMC10952951 DOI: 10.1002/pd.6498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/14/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To evaluate changes occurring in the fetal brain prior to very preterm delivery using MRI T2* relaxometry, an indirect assessment of tissue perfusion. METHOD Fetuses that subsequently delivered spontaneously <32 weeks gestation and a control cohort were identified from pre-existing datasets. Participants had undergone a 3T MRI assessment including T2* relaxometry of the fetal brain using a 2D multi-slice gradient echo single shot echo planar imaging sequence. T2* maps were generated, supratentorial brain tissue was manually segmented and mean T2* values were generated. Groups were compared using quadratic regression. RESULTS Twenty five fetuses that subsequently delivered <32 weeks and 67 that delivered at term were included. Mean gestation at MRI was 24.5 weeks (SD 3.3) and 25.4 weeks (SD 3.1) and gestation at delivery 25.5 weeks (SD 3.4) and 39.7 weeks (SD 1.2) in the preterm and term cohorts respectively. Brain mean T2* values were significantly lower in fetuses that subsequently delivered before 32 weeks gestation (p < 0.001). CONCLUSION Alterations in brain maturation appear to occur prior to preterm delivery. Further work is required to explore these associations, but these findings suggest a potential window for therapeutic neuroprotective agents in fetuses at high risk of preterm delivery in the future.
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Affiliation(s)
- Lisa Story
- Department of Women's and Children's HealthKing's College LondonSt Thomas' Hospital LondonLondonUK
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing's College LondonSt Thomas' Hospital LondonLondonUK
- Fetal Medicine UnitSt Thomas' Hospital LondonLondonUK
| | - Alena Uus
- Department of Women's and Children's HealthKing's College LondonSt Thomas' Hospital LondonLondonUK
| | - Megan Hall
- Department of Women's and Children's HealthKing's College LondonSt Thomas' Hospital LondonLondonUK
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing's College LondonSt Thomas' Hospital LondonLondonUK
| | - Kelly Payette
- Department of Women's and Children's HealthKing's College LondonSt Thomas' Hospital LondonLondonUK
| | | | - Tomoki Arichi
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing's College LondonSt Thomas' Hospital LondonLondonUK
| | - Andrew Shennan
- Department of Women's and Children's HealthKing's College LondonSt Thomas' Hospital LondonLondonUK
| | - Mary Rutherford
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing's College LondonSt Thomas' Hospital LondonLondonUK
| | - Jana Hutter
- Centre for the Developing BrainSchool of Biomedical Engineering and Imaging SciencesKing's College LondonSt Thomas' Hospital LondonLondonUK
- Radiological InstituteUniversity Hospital ErlangenErlangenGermany
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11
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Hall M, Wu L, Nanda S, Bakalis S, Shennan A, Story L. Fetal growth restriction: How reliable is information available to patients on Google? A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 292:133-137. [PMID: 38000107 DOI: 10.1016/j.ejogrb.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/17/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES To review systematically the quality, readability and credibility of English language webpages offering patient information on fetal growth restriction. STUDY DESIGN A systematic review of patient information was undertaken on Google with location services and browser history disabled. Websites from the first page were included providing they gave at least 300 words of health information on fetal growth restriction aimed at patients. Validated assessment of readability, credibility and quality were undertaken. An accuracy assessment was performed based on international guidance. Characteristics were tabulated. RESULTS Thirty-one websites including 30 different texts were included. No pages had a reading age of 11 years or less, none were credible, and only one was of high quality. Median accuracy rating was 9/24. CONCLUSION Patients cannot rely on Google as a source of information on fetal growth restriction. As well as being difficult to read, information tends to be low quality, low accuracy and not credible. Healthcare professionals must consider how to enable access to high-quality patient information and give time for discussion of information patients have found: failure to do so may disenfranchise patients.
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Affiliation(s)
- Megan Hall
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, UK; Department of Perinatal Imaging, St Thomas' Hospital, King's College London, UK.
| | - Lindsay Wu
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, UK
| | - Surabhi Nanda
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, UK; Department of Fetal Medicine, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Spyros Bakalis
- Department of Fetal Medicine, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, UK
| | - Lisa Story
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, UK; Department of Perinatal Imaging, St Thomas' Hospital, King's College London, UK; Department of Fetal Medicine, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Neves Silva S, Aviles Verdera J, Tomi‐Tricot R, Neji R, Uus A, Grigorescu I, Wilkinson T, Ozenne V, Lewin A, Story L, De Vita E, Rutherford M, Pushparajah K, Hajnal J, Hutter J. Real-time fetal brain tracking for functional fetal MRI. Magn Reson Med 2023; 90:2306-2320. [PMID: 37465882 PMCID: PMC10952752 DOI: 10.1002/mrm.29803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To improve motion robustness of functional fetal MRI scans by developing an intrinsic real-time motion correction method. MRI provides an ideal tool to characterize fetal brain development and growth. It is, however, a relatively slow imaging technique and therefore extremely susceptible to subject motion, particularly in functional MRI experiments acquiring multiple Echo-Planar-Imaging-based repetitions, for example, diffusion MRI or blood-oxygen-level-dependency MRI. METHODS A 3D UNet was trained on 125 fetal datasets to track the fetal brain position in each repetition of the scan in real time. This tracking, inserted into a Gadgetron pipeline on a clinical scanner, allows updating the position of the field of view in a modified echo-planar imaging sequence. The method was evaluated in real-time in controlled-motion phantom experiments and ten fetal MR studies (17 + 4-34 + 3 gestational weeks) at 3T. The localization network was additionally tested retrospectively on 29 low-field (0.55T) datasets. RESULTS Our method achieved real-time fetal head tracking and prospective correction of the acquisition geometry. Localization performance achieved Dice scores of 84.4% and 82.3%, respectively for both the unseen 1.5T/3T and 0.55T fetal data, with values higher for cephalic fetuses and increasing with gestational age. CONCLUSIONS Our technique was able to follow the fetal brain even for fetuses under 18 weeks GA in real-time at 3T and was successfully applied "offline" to new cohorts on 0.55T. Next, it will be deployed to other modalities such as fetal diffusion MRI and to cohorts of pregnant participants diagnosed with pregnancy complications, for example, pre-eclampsia and congenital heart disease.
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Affiliation(s)
- Sara Neves Silva
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Jordina Aviles Verdera
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Raphael Tomi‐Tricot
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- MR Research CollaborationsSiemens Healthcare LimitedCamberleyUK
| | - Radhouene Neji
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- MR Research CollaborationsSiemens Healthcare LimitedCamberleyUK
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Irina Grigorescu
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Thomas Wilkinson
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Valery Ozenne
- CNRS, CRMSB, UMR 5536, IHU LirycUniversité de BordeauxBordeauxFrance
| | - Alexander Lewin
- Institute of Neuroscience and Medicine 11, INM‐11Forschungszentrum JülichJülichGermany
- RWTHAachen UniversityAachenGermany
| | - Lisa Story
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Department of Women & Children's HealthKing's College LondonLondonUK
| | - Enrico De Vita
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- MRI Physics GroupGreat Ormond Street HospitalLondonUK
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Kuberan Pushparajah
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Jo Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
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13
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Slator PJ, Cromb D, Jackson LH, Ho A, Counsell SJ, Story L, Chappell LC, Rutherford M, Hajnal JV, Hutter J, Alexander DC. Non-invasive mapping of human placenta microenvironments throughout pregnancy with diffusion-relaxation MRI. Placenta 2023; 144:29-37. [PMID: 37952367 DOI: 10.1016/j.placenta.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION In-vivo measurements of placental structure and function have the potential to improve prediction, diagnosis, and treatment planning for a wide range of pregnancy complications, such as fetal growth restriction and pre-eclampsia, and hence inform clinical decision making, ultimately improving patient outcomes. MRI is emerging as a technique with increased sensitivity to placental structure and function compared to the current clinical standard, ultrasound. METHODS We demonstrate and evaluate a combined diffusion-relaxation MRI acquisition and analysis pipeline on a sizable cohort of 78 normal pregnancies with gestational ages ranging from 15 + 5 to 38 + 4 weeks. Our acquisition comprises a combined T2*-diffusion MRI acquisition sequence - which is simultaneously sensitive to oxygenation, microstructure and microcirculation. We analyse our scans with a data-driven unsupervised machine learning technique, InSpect, that parsimoniously identifies distinct components in the data. RESULTS We identify and map seven potential placental microenvironments and reveal detailed insights into multiple microstructural and microcirculatory features of the placenta, and assess their trends across gestation. DISCUSSION By demonstrating direct observation of micro-scale placental structure and function, and revealing clear trends across pregnancy, our work contributes towards the development of robust imaging biomarkers for pregnancy complications and the ultimate goal of a normative model of placental development.
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Affiliation(s)
- Paddy J Slator
- Cardiff University Brain Research Imaging Centre, School of Psychology, Maindy Road, Cardiff, CF24 4HQ, UK; School of Computer Science and Informatics, Cardiff University, Cardiff, UK; Centre for Medical Image Computing and Department of Computer Science, University College London, London, UK.
| | - Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Laurence H Jackson
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alison Ho
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Lisa Story
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, UK
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Hall M, Challacombe F, Curran C, Shennan A, Story L. Googling preterm prelabour rupture of the membranes: A systematic review of patient information available on the internet. BJOG 2023; 130:1298-1305. [PMID: 37077130 DOI: 10.1111/1471-0528.17498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Preterm prelabour rupture of the membranes (PPROM) complicates 3% of pregnancies and is associated with an increased risk of maternal and perinatal morbidity and mortality. In an attempt to better understand this diagnosis, patients routinely resort to the internet for medical information. The lack of governance online leaves patients at risk of relying on low-quality websites. OBJECTIVES To assess systematically the accuracy, quality, readability and credibility of World Wide Web pages on PPROM. SEARCH STRATEGY Five search engines (Google, AOL, Yahoo, Ask and Bing) were searched with location services and browser history disabled. Websites from the first page of all searches were included. SELECTION CRITERIA Websites were included if they provided at least 300 words of health information aimed at patients relating to PPROM. DATA COLLECTION AND ANALYSIS Validated assessments of health information readability, credibility and quality were undertaken, as was an accuracy assessment. Pertinent facts for accuracy assessment were based on feedback from healthcare professionals and patients through a survey. Characteristics were tabulated. MAIN RESULTS In all, 39 websites were included, with 31 different texts. No pages were written with a reading age of 11 years or less, none were considered credible, and only three were high quality. An accuracy score of 50% or more was obtained by 45% of websites. Information that patients considered pertinent was not consistently reported. CONCLUSIONS Search engines produce information on PPROM that is low quality, low accuracy and not credible. It is also difficult to read. This risks disempowerment. Healthcare professionals and researchers must consider how to ensure patients have access to information that they can recognise as high quality.
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Affiliation(s)
- Megan Hall
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
- Department of Perinatal Imaging, St Thomas' Hospital, King's College London, London, UK
| | - Fiona Challacombe
- Centre for Anxiety Disorders and Trauma, Maudsley Hospital, King's College London, London, UK
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ciara Curran
- Little Heartbeats, Patient Advocacy and Support Group for PPROM, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
| | - Lisa Story
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
- Department of Perinatal Imaging, St Thomas' Hospital, King's College London, London, UK
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16
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Cromb D, Hall M, Story L, Shangaris P, Al-Adnani M, Rutherford MA, Fox GF, Gupta N. Clinical value of placental examination for paediatricians. Arch Dis Child Fetal Neonatal Ed 2023:fetalneonatal-2023-325674. [PMID: 37751993 DOI: 10.1136/archdischild-2023-325674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
The placenta contains valuable clinical information that is linked to fetal development, neonatal morbidity and mortality, and future health outcomes. Both gross inspection and histopathological examination of the placenta may identify intrinsic or secondary placental lesions, which can contribute directly to adverse neonatal outcomes or indicate the presence of an unfavourable intrauterine environment. Placental examination therefore forms an essential component of the care of high-risk neonates and at perinatal post-mortem examination. In this article, we describe the clinical value of placental examination for paediatricians and perinatal clinicians. We discuss common pathological findings on general inspection of the placenta with photographic examples and provide an overview of the placental pathological examination, including how to interpret key findings. We also address the medico-legal and financial implications of placental examinations and describe current and future clinical considerations for clinicians in regard to placental examination.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Neonatal Unit, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Megan Hall
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lisa Story
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Panicos Shangaris
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mudher Al-Adnani
- Department of Cellular Pathology, St Thomas' Hospital, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Grenville F Fox
- Neonatal Unit, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Neelam Gupta
- Neonatal Unit, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
- GKT School of Medical Education, King's College London, London, UK
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17
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Uus AU, Hall M, Grigorescu I, Zampieri CA, Collado AE, Payette K, Matthew J, Kyriakopoulou V, Hajnal JV, Hutter J, Rutherford MA, Deprez M, Story L. 3D T2w fetal body MRI: automated organ volumetry, growth charts and population-averaged atlas. medRxiv 2023:2023.05.31.23290751. [PMID: 37398121 PMCID: PMC10312818 DOI: 10.1101/2023.05.31.23290751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Structural fetal body MRI provides true 3D information required for volumetry of fetal organs. However, current clinical and research practice primarily relies on manual slice-wise segmentation of raw T2-weighted stacks, which is time consuming, subject to inter- and intra-observer bias and affected by motion-corruption. Furthermore, there are no existing standard guidelines defining a universal approach to parcellation of fetal organs. This work produces the first parcellation protocol of the fetal body organs for motion-corrected 3D fetal body MRI. It includes 10 organ ROIs relevant to fetal quantitative volumetry studies. We also introduce the first population-averaged T2w MRI atlas of the fetal body. The protocol was used as a basis for training of a neural network for automated organ segmentation. It showed robust performance for different gestational ages. This solution minimises the need for manual editing and significantly reduces time. The general feasibility of the proposed pipeline was also assessed by analysis of organ growth charts created from automated parcellations of 91 normal control 3T MRI datasets that showed expected increase in volumetry during 22-38 weeks gestational age range. In addition, the results of comparison between 60 normal and 12 fetal growth restriction datasets revealed significant differences in organ volumes.
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Affiliation(s)
- Alena U. Uus
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Megan Hall
- Centre for the Developing Brain, King’s College London, London, UK
- Department of Women and Children’s Health, King’s College London, London, UK
- Fetal Medicine Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Irina Grigorescu
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Carla Avena Zampieri
- Centre for the Developing Brain, King’s College London, London, UK
- Department of Women and Children’s Health, King’s College London, London, UK
| | | | - Kelly Payette
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
- Centre for the Developing Brain, King’s College London, London, UK
| | - Jacqueline Matthew
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
- Centre for the Developing Brain, King’s College London, London, UK
| | | | - Joseph V. Hajnal
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
- Centre for the Developing Brain, King’s College London, London, UK
| | - Jana Hutter
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
- Centre for the Developing Brain, King’s College London, London, UK
| | | | - Maria Deprez
- School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Lisa Story
- Centre for the Developing Brain, King’s College London, London, UK
- Department of Women and Children’s Health, King’s College London, London, UK
- Fetal Medicine Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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18
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Payette K, Uus A, Verdera JA, Zampieri CA, Hall M, Story L, Deprez M, Rutherford MA, Hajnal JV, Ourselin S, Tomi-Tricot R, Hutter J. An automated pipeline for quantitative T2* fetal body MRI and segmentation at low field. ArXiv 2023:arXiv:2308.04903v1. [PMID: 37608939 PMCID: PMC10441444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Fetal Magnetic Resonance Imaging at low field strengths is emerging as an exciting direction in perinatal health. Clinical low field (0.55T) scanners are beneficial for fetal imaging due to their reduced susceptibility-induced artefacts, increased T2* values, and wider bore (widening access for the increasingly obese pregnant population). However, the lack of standard automated image processing tools such as segmentation and reconstruction hampers wider clinical use. In this study, we introduce a semi-automatic pipeline using quantitative MRI for the fetal body at low field strength resulting in fast and detailed quantitative T2* relaxometry analysis of all major fetal body organs. Multi-echo dynamic sequences of the fetal body were acquired and reconstructed into a single high-resolution volume using deformable slice-to-volume reconstruction, generating both structural and quantitative T2* 3D volumes. A neural network trained using a semi-supervised approach was created to automatically segment these fetal body 3D volumes into ten different organs (resulting in dice values > 0.74 for 8 out of 10 organs). The T2* values revealed a strong relationship with GA in the lungs, liver, and kidney parenchyma (R2 >0.5). This pipeline was used successfully for a wide range of GAs (17-40 weeks), and is robust to motion artefacts. Low field fetal MRI can be used to perform advanced MRI analysis, and is a viable option for clinical scanning.
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Affiliation(s)
- Kelly Payette
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Jordina Aviles Verdera
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Carla Avena Zampieri
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Megan Hall
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Women & Children’s Health, King’s College London, London, UK: MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - Lisa Story
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Maria Deprez
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Mary A. Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Joseph V. Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Sebastien Ourselin
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Raphael Tomi-Tricot
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
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19
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Hutter J, Al-Wakeel A, Kyriakopoulou V, Matthew J, Story L, Rutherford M. Exploring the role of a time-efficient MRI assessment of the placenta and fetal brain in uncomplicated pregnancies and these complicated by placental insufficiency. Placenta 2023; 139:25-33. [PMID: 37295055 DOI: 10.1016/j.placenta.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/24/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The development of placenta and fetal brain are intricately linked. Placental insufficiency is related to poor neonatal outcomes with impacts on neurodevelopment. This study sought to investigate whether simultaneous fast assessment of placental and fetal brain oxygenation using MRI T2* relaxometry can play a complementary role to US and Doppler US. METHODS This study is a retrospective case-control study with uncomplicated pregnancies (n = 99) and cases with placental insufficiency (PI) (n = 49). Participants underwent placental and fetal brain MRI and contemporaneous ultrasound imaging, resulting in quantitative assessment including a combined MRI score called Cerebro-placental-T2*-Ratio (CPTR). This was assessed in comparison with US-derived Cerebro-Placental-Ratio (CPR), placental histopathology, assessed using the Amsterdam criteria [1], and delivery details. RESULTS Pplacental and fetal brain T2* decreased with increasing gestational age in both low and high risk pregnancies and were corrected for gestational-age alsosignificantly decreased in PI. Both CPR and CPTR score were significantly correlated with gestational age at delivery for the entire cohort. CPTR was, however, also correlated independently with gestational age at delivery in the PI cohort. It furthermore showed a correlation to birth-weight-centile in healthy controls. DISCUSSION This study indicates that MR analysis of the placenta and brain may play a complementary role in the investigation of fetal development. The additional correlation to birth-weight-centile in controls may suggest a role in the determination of placental health even in healthy controls. To our knowledge, this is the first study assessing quantitatively both placental and fetal brain development over gestation in a large cohort of low and high risk pregnancies. Future larger prospective studies will include additional cohorts.
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Affiliation(s)
- Jana Hutter
- Centre for the Developing Brain, King's College London, UK; Centre for Medical Engineering, King's College London, UK.
| | - Ayman Al-Wakeel
- GKT School of Medical Education, King's College London, London, UK
| | - Vanessa Kyriakopoulou
- Centre for the Developing Brain, King's College London, UK; Centre for Medical Engineering, King's College London, UK
| | - Jacqueline Matthew
- Centre for the Developing Brain, King's College London, UK; Centre for Medical Engineering, King's College London, UK
| | - Lisa Story
- Centre for the Developing Brain, King's College London, UK; Institute for Women's and Children's Health, King's College London, UK; Fetal Medicine Unit, St Thomas' Hospital, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, UK; Centre for Medical Engineering, King's College London, UK
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20
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Avena-Zampieri CL, Hutter J, Deprez M, Payette K, Hall M, Uus A, Nanda S, Milan A, Seed PT, Rutherford M, Greenough A, Story L. Assessment of normal pulmonary development using functional magnetic resonance imaging techniques. Am J Obstet Gynecol MFM 2023; 5:100935. [PMID: 36933803 PMCID: PMC10711505 DOI: 10.1016/j.ajogmf.2023.100935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The mainstay of assessment of the fetal lungs in clinical practice is via evaluation of pulmonary size, primarily using 2D ultrasound and more recently with anatomical magnetic resonance imaging. The emergence of advanced magnetic resonance techniques such as T2* relaxometry in combination with the latest motion correction post-processing tools now facilitates assessment of the metabolic activity or perfusion of fetal pulmonary tissue in vivo. OBJECTIVE This study aimed to characterize normal pulmonary development using T2* relaxometry, accounting for fetal motion across gestation. METHODS Datasets from women with uncomplicated pregnancies that delivered at term, were analyzed. All subjects had undergone T2-weighted imaging and T2* relaxometry on a Phillips 3T magnetic resonance imaging system antenatally. T2* relaxometry of the fetal thorax was performed using a gradient echo single-shot echo planar imaging sequence. Following correction for fetal motion using slice-to-volume reconstruction, T2* maps were generated using in-house pipelines. Lungs were manually segmented and mean T2* values calculated for the right and left lungs individually, and for both lungs combined. Lung volumes were generated from the segmented images, and the right and left lungs, as well as both lungs combined were assessed. RESULTS Eighty-seven datasets were suitable for analysis. The mean gestation at scan was 29.9±4.3 weeks (range: 20.6-38.3) and mean gestation at delivery was 40±1.2 weeks (range: 37.1-42.4). Mean T2* values of the lungs increased over gestation for right and left lungs individually and for both lungs assessed together (P=.003; P=.04; P=.003, respectively). Right, left, and total lung volumes were also strongly correlated with increasing gestational age (P<.001 in all cases). CONCLUSION This large study assessed developing lungs using T2* imaging across a wide gestational age range. Mean T2* values increased with gestational age, which may reflect increasing perfusion and metabolic requirements and alterations in tissue composition as gestation advances. In the future, evaluation of findings in fetuses with conditions known to be associated with pulmonary morbidity may lead to enhanced prognostication antenatally, consequently improving counseling and perinatal care planning.
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Affiliation(s)
- Carla L Avena-Zampieri
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story).
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story)
| | - Maria Deprez
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Deprez, Ms Payette, and Ms Uus)
| | - Kelly Payette
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Deprez, Ms Payette, and Ms Uus)
| | - Megan Hall
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Hall, Dr Nanda, and Dr Story)
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Deprez, Ms Payette, and Ms Uus)
| | - Surabhi Nanda
- Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Hall, Dr Nanda, and Dr Story)
| | - Anna Milan
- Neonatal Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Milan)
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story)
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story)
| | - Anne Greenough
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Neonatal Unit, King's College Hospital, London, United Kingdom (Prof Greenough); National Institute for Health and Care Research Biomedical Research Centre based at Guy's & St Thomas NHS Foundation Trusts and King's College London, London, United Kingdom (Prof Greenough)
| | - Lisa Story
- Department of Women and Children's Health, King's College London, London, United Kingdom (XX Avena-Zampieri, XX Hall, XX Seed, XX Greenough, and XX Story); Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom (Ms Avena-Zampieri, Dr Hutter, Mr Deprez, Ms Payette, Dr Hall, Ms Uus, Prof Rutherford, and Dr Story); Fetal Medicine Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Dr Hall, Dr Nanda, and Dr Story)
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21
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Uus AU, Kyriakopoulou V, Makropoulos A, Fukami-Gartner A, Cromb D, Davidson A, Cordero-Grande L, Price AN, Grigorescu I, Williams LZJ, Robinson EC, Lloyd D, Pushparajah K, Story L, Hutter J, Counsell SJ, Edwards AD, Rutherford MA, Hajnal JV, Deprez M. BOUNTI: Brain vOlumetry and aUtomated parcellatioN for 3D feTal MRI. bioRxiv 2023:2023.04.18.537347. [PMID: 37131820 PMCID: PMC10153133 DOI: 10.1101/2023.04.18.537347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Fetal MRI is widely used for quantitative brain volumetry studies. However, currently, there is a lack of universally accepted protocols for fetal brain parcellation and segmentation. Published clinical studies tend to use different segmentation approaches that also reportedly require significant amounts of time-consuming manual refinement. In this work, we propose to address this challenge by developing a new robust deep learning-based fetal brain segmentation pipeline for 3D T2w motion corrected brain images. At first, we defined a new refined brain tissue parcellation protocol with 19 regions-of-interest using the new fetal brain MRI atlas from the Developing Human Connectome Project. This protocol design was based on evidence from histological brain atlases, clear visibility of the structures in individual subject 3D T2w images and the clinical relevance to quantitative studies. It was then used as a basis for developing an automated deep learning brain tissue parcellation pipeline trained on 360 fetal MRI datasets with different acquisition parameters using semi-supervised approach with manually refined labels propagated from the atlas. The pipeline demonstrated robust performance for different acquisition protocols and GA ranges. Analysis of tissue volumetry for 390 normal participants (21-38 weeks gestational age range), scanned with three different acquisition protocols, did not reveal significant differences for major structures in the growth charts. Only minor errors were present in < 15% of cases thus significantly reducing the need for manual refinement. In addition, quantitative comparison between 65 fetuses with ventriculomegaly and 60 normal control cases were in agreement with the findings reported in our earlier work based on manual segmentations. These preliminary results support the feasibility of the proposed atlas-based deep learning approach for large-scale volumetric analysis. The created fetal brain volumetry centiles and a docker with the proposed pipeline are publicly available online at https://hub.docker.com/r/fetalsvrtk/segmentation (tag brain_bounti_tissue).
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Affiliation(s)
- Alena U Uus
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | | | | | | | - Daniel Cromb
- Centre for the Developing Brain, King's College London, London, UK
| | - Alice Davidson
- Centre for the Developing Brain, King's College London, London, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, King's College London, London, UK
- Biomedical Image Technologies, ETSI Telecomunicacion, Universidad Politécnica de Madrid and CIBER-BBN, ISCII, Madrid, Spain
| | - Anthony N Price
- Centre for the Developing Brain, King's College London, London, UK
| | - Irina Grigorescu
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Logan Z J Williams
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Emma C Robinson
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - David Lloyd
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Kuberan Pushparajah
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Lisa Story
- Centre for the Developing Brain, King's College London, London, UK
| | - Jana Hutter
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | | | - A David Edwards
- Centre for the Developing Brain, King's College London, London, UK
| | | | - Joseph V Hajnal
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Centre for the Developing Brain, King's College London, London, UK
| | - Maria Deprez
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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22
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Hall M, de Marvao A, Schweitzer R, Cromb D, Colford K, Jandu P, O'Regan DP, Ho A, Price A, Chappell LC, Rutherford MA, Story L, Lamata P, Hutter J. Characterisation of placental, fetal brain and maternal cardiac structure and function in pre-eclampsia using MRI. medRxiv 2023:2023.04.24.23289069. [PMID: 37163073 PMCID: PMC10168502 DOI: 10.1101/2023.04.24.23289069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Pre-eclampsia is a multiorgan disease of pregnancy that has short- and long-term implications for the woman and fetus, whose immediate impact is poorly understood. We present a novel multi-system approach to MRI investigation of pre-eclampsia, with acquisition of maternal cardiac, placental, and fetal brain anatomical and functional imaging. Methods A prospective study was carried out recruiting pregnant women with pre-eclampsia, chronic hypertension, or no medical complications, and a non-pregnant female cohort. All women underwent a cardiac MRI, and pregnant women underwent a fetal-placental MRI. Cardiac analysis for structural, morphological and flow data was undertaken; placenta and fetal brain volumetric and T2* data were obtained. All results were corrected for gestational age. Results Seventy-eight MRIs were obtained during pregnancy. Pregnancies affected by pre-eclampsia demonstrated lower placental and fetal brain T2*. Within the pre-eclampsia group, three placental T2* results were within the normal range, these were the only cases with normal placental histopathology. Similarly, three fetal brain T2* results were within the normal range; these cases had no evidence of cerebral redistribution on fetal Dopplers. Cardiac MRI analysis demonstrated higher left ventricular mass in pre-eclampsia with 3D modelling revealing additional specific characteristics of eccentricity and outflow track remodelling. Conclusions We present the first holistic assessment of the immediate implications of pre-eclampsia on the placenta, maternal heart, and fetal brain. As well as having potential clinical implications for the risk-stratification and management of women with pre-eclampsia, this gives an insight into disease mechanism.
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Affiliation(s)
- Megan Hall
- Department of Women and Children’s Health, King’s College London, UK
- Centre for the Developing Brain, King’s College London, UK
| | - Antonio de Marvao
- Department of Women and Children’s Health, King’s College London, UK
- School of Cardiovascular Medicine, King’s College London, UK
- MRC London Institute of Medical Sciences, Imperial College London, UK
| | - Ronny Schweitzer
- School of Cardiovascular Medicine, King’s College London, UK
- MRC London Institute of Medical Sciences, Imperial College London, UK
| | - Daniel Cromb
- Centre for the Developing Brain, King’s College London, UK
| | | | - Priya Jandu
- GKT School of Medical Education, King’s College London, UK
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, UK
| | - Alison Ho
- Department of Women and Children’s Health, King’s College London, UK
- Centre for the Developing Brain, King’s College London, UK
| | - Anthony Price
- Centre for the Developing Brain, King’s College London, UK
- Centre for Medical Engineering, King’s College London, UK
| | - Lucy C. Chappell
- Department of Women and Children’s Health, King’s College London, UK
| | | | - Lisa Story
- Department of Women and Children’s Health, King’s College London, UK
- Centre for the Developing Brain, King’s College London, UK
| | - Pablo Lamata
- Centre for Medical Engineering, King’s College London, UK
| | - Jana Hutter
- Centre for the Developing Brain, King’s College London, UK
- Centre for Medical Engineering, King’s College London, UK
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23
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Hutter J, Slator PJ, Avena Zampieri C, Hall M, Rutherford M, Story L. Multi-modal MRI reveals changes in placental function following preterm premature rupture of membranes. Magn Reson Med 2023; 89:1151-1159. [PMID: 36255151 PMCID: PMC10091779 DOI: 10.1002/mrm.29483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Preterm premature rupture of membranes complicates up to 40% of premature deliveries. Fetal infection may occur in the absence of maternal symptoms, delaying diagnosis and increasing morbidity and mortality. A noninvasive antenatal assessment of early signs of placental inflammation is therefore urgently required. METHODS Sixteen women with preterm premature rupture of membranes < 34 weeks gestation and 60 women with uncomplicated pregnancies were prospectively recruited. A modified diffusion-weighted spin-echo single shot EPI sequence with a diffusion preparation acquiring 264 unique parameter combinations in < 9 min was obtained on a clinical 3 Tesla MRI scanner. The data was fitted to a 2-compartment T 2 * $$ {\mathrm{T}}_2^{\ast } $$ -intravoxel incoherent motion model comprising fast and slowly circulating fluid pools to obtain quantitative information on perfusion, density, and tissue composition. Z values were calculated, and correlation with time from between the rupture of membranes and the scan, gestational age at delivery, and time between scan and delivery assessed. RESULTS Placental T 2 * $$ {\mathrm{T}}_2^{\ast } $$ was significantly reduced in preterm premature rupture of membranes, and the 2-compartmental model demonstrated that this decline is mainly linked to the perfusion component observed in the placental parenchyma. Multi-modal MRI measurement of placental function is linked to gestational age at delivery and time from membrane rupture. CONCLUSION More complex models and data acquisition can potentially improve fitting of the underlying etiology of preterm birth compared with individual single-contrast models and contribute to additional insights in the future. This will need validation in larger cohorts. A multi-modal MRI acquisition between rupture of the membranes and delivery can be used to measure placental function and is linked to gestational age at delivery.
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Affiliation(s)
- Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom.,Centre for Medical Engineering, King's College London, London, United Kingdom
| | | | - Carla Avena Zampieri
- Centre for the Developing Brain, King's College London, London, United Kingdom.,Centre for Medical Engineering, King's College London, London, United Kingdom
| | - Megan Hall
- Centre for the Developing Brain, King's College London, London, United Kingdom.,Institute for Women's and Children's Health, King's College London, London, United Kingdom.,Fetal Medicine Unit, St Thomas' Hospital, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom.,Centre for Medical Engineering, King's College London, London, United Kingdom
| | - Lisa Story
- Centre for the Developing Brain, King's College London, London, United Kingdom.,Institute for Women's and Children's Health, King's College London, London, United Kingdom.,Fetal Medicine Unit, St Thomas' Hospital, London, United Kingdom
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24
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Lovell H, Silverio SA, Story L, Skelton E, Matthew J. Factors which influence ethnic minority women's participation in maternity research: A systematic review of quantitative and qualitative studies. PLoS One 2023; 18:e0282088. [PMID: 36827386 PMCID: PMC9956875 DOI: 10.1371/journal.pone.0282088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Women from Black, Asian and mixed ethnicity backgrounds in the UK experience higher rates of maternal and neonatal mortality and morbidity, and report poorer experiences of maternity care. Research is required to understand how to reduce these disparities, however, it is acknowledged these groups of women are under-represented in clinical research. AIM To investigate factors which influence participation in maternity research for women from an ethnic minority background. METHODS A systematic review was conducted to examine influencing factors for research participation. MEDLINE/CINHAL/PsycInfo/EMBASE databases were systematically searched in March 2021 and updated in March 2022. Papers were eligible if they explored maternal research participation and identified a woman's ethnicity in the results. No restrictions were placed on methodology. A convergent integrated approach was used to synthesise findings. FINDINGS A total of 14 papers met the inclusion criteria. Results were divided into eight overarching themes. A personalised approach to recruitment and incorporating culturally sensitive communication and considerations enhanced research participation. Distrust around sharing data, a perception of risk to research participation, and research lacking in personal relevance adversely affected the decision to participate. Large variation existed in the quality of the studies reviewed. CONCLUSIONS Consideration of a woman's culture and background in the design and the delivery of a maternity research study may facilitate participation, particularly when sampling from a specific population. Further research, informed by women from ethnic minority backgrounds is warranted to develop women-centred recommendations for conducting inclusive maternity research. Prospero registration: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021261686.
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Affiliation(s)
- Holly Lovell
- Maternity Services, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Lisa Story
- Maternity Services, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Emily Skelton
- Division of Radiography and Midwifery, City University of London, London, United Kingdom
| | - Jacqueline Matthew
- Maternity Services, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Perinatal Imaging and Health, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- * E-mail:
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25
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Jeyaseelan T, Shangaris P, Efthymiou A, Martin L, Story L, Nanda S, Gupta N, Al-Adnani M, Marnerides A, Nicolaides KH, Sankaran S. Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report. J Med Case Rep 2023; 17:28. [PMID: 36709312 PMCID: PMC9884182 DOI: 10.1186/s13256-023-03766-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/06/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Twin anemia polycythemia sequence is a rare complication in monochorionic twin pregnancy. CASE PRESENTATION We describe a case of dichorionic twin pregnancy presenting with suspected twin anemia polycythemia sequence. A 31-year-old White female, on her third pregnancy, had a routine ultrasound scan at 12 weeks gestation, which demonstrated a dichorionic twin pregnancy with one placenta located in the anterior wall and the other in the posterior wall of the uterus. At 21 weeks, a scan demonstrated a 24% growth discordance between the two fetuses with normal Doppler studies and amniotic fluid. At 27 weeks, one twin showed signs of anemia and the other polycythemia; the fetal middle cerebral artery peak systolic velocity was high in the anemic fetus and low in the polycythemic twin (1.8 and 0.5 multiples of the median). An intrauterine blood transfusion was carried out and this increased the fetal hemoglobin concentration in the anemic twin from 3.5 to 12.5 g/dL. At 29 weeks, delivery by cesarean section was carried out because of evidence from middle cerebral artery peak systolic velocity of recurrence of anemia in one twin and worsening polycythemia in the co-twin; at birth the hemoglobin concentrations were 5.6 and 24.9 g/dL, respectively. Histopathological examination confirmed dichorionicity with no communicating vessels between the two placentas. CONCLUSIONS This is the first case of twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy where intrauterine blood transfusion was used to prolong the pregnancy by almost 2 weeks in a "twin anemia polycythemia sequence-like" setting.
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Affiliation(s)
- Tania Jeyaseelan
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
| | - Panicos Shangaris
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK ,grid.13097.3c0000 0001 2322 6764Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, SE1 1UL UK
| | - Athina Efthymiou
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.46699.340000 0004 0391 9020Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, SE5 8BB UK
| | - Linzi Martin
- grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
| | - Lisa Story
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
| | - Surabhi Nanda
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
| | - Neelam Gupta
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
| | - Mudher Al-Adnani
- grid.425213.3Department of Histopathology, St Thomas Hospital, Westminster Bridge Road, London, SE17EH UK
| | - Andreas Marnerides
- grid.425213.3Department of Histopathology, St Thomas Hospital, Westminster Bridge Road, London, SE17EH UK
| | - Kypros H. Nicolaides
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.46699.340000 0004 0391 9020Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, SE5 8BB UK
| | - Srividhya Sankaran
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
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Jaufuraully S, Dromey B, Story L, David AL, Attilakos G, Siassakos D. Magnetic resonance imaging in late pregnancy to improve labour and delivery outcomes - a systematic literature review. BMC Pregnancy Childbirth 2022; 22:949. [PMID: 36536322 PMCID: PMC9761997 DOI: 10.1186/s12884-022-05290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) provides excellent soft tissue visualisation which may be useful in late pregnancy to predict labour outcome and maternal/neonatal birth trauma. OBJECTIVE To study if MRI in late pregnancy can predict maternal and neonatal outcomes of labour and birth. METHODS Systematic review of studies that performed MRI in late pregnancy or immediately postpartum. Studies were included if they imaged maternal pelvic or neonatal structures and assessed birth outcome. Meta-analysis was not performed due to the heterogeneity of studies. RESULTS Eighteen studies were selected. Twelve studies explored the value of MRI pelvimetry measurement and its utility to predict cephalopelvic disproportion (CPD) and vaginal breech birth. Four explored cervical imaging in predicting time interval to birth. Two imaged women in active labour and assessed mouldability of the fetal skull. No marker of CPD had both high sensitivity and specificity for predicting labour outcome. The fetal pelvic index yielded sensitivities between 59 and 60%, and specificities between 34 to 64%. Similarly, although the sensitivity of the cephalopelvic disproportion index in predicting labour outcome was high (85%), specificity was only 56%. In women with breech presentation, MRI was demonstrated to reduce the rates of emergency caesarean section from 35 to 19%, and allowed better selection of vaginal breech birth. Live birth studies showed that the fetal head undergoes a substantial degree of moulding and deformation during cephalic vaginal birth, which is not considered during pelvimetry. There are conflicting studies on the role of MRI in cervical imaging and predicting time interval to birth. CONCLUSION MRI is a promising imaging modality to assess aspects of CPD, yet no current marker of CPD accurately predicts labour outcome. With advances in MRI, it is hoped that novel methods can be developed to better identify individuals at risk of obstructed or pathological labour. Its role in exploring fetal head moulding as a marker of CPD should be further explored.
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Affiliation(s)
- Shireen Jaufuraully
- grid.83440.3b0000000121901201Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK ,grid.83440.3b0000000121901201Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Brian Dromey
- grid.83440.3b0000000121901201Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK ,grid.83440.3b0000000121901201Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Lisa Story
- grid.13097.3c0000 0001 2322 6764Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK ,grid.425213.3Fetal Medicine Unit, St Thomas’ Hospital, London, UK
| | - Anna L David
- grid.83440.3b0000000121901201Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK ,grid.83440.3b0000000121901201Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK ,grid.451056.30000 0001 2116 3923National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (BRC), 149 Tottenham Court Road, London, UK
| | - George Attilakos
- grid.83440.3b0000000121901201Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Dimitrios Siassakos
- grid.83440.3b0000000121901201Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK ,grid.83440.3b0000000121901201Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK ,grid.451056.30000 0001 2116 3923National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (BRC), 149 Tottenham Court Road, London, UK
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Avena-Zampieri CL, Hutter J, Rutherford M, Milan A, Hall M, Egloff A, Lloyd DFA, Nanda S, Greenough A, Story L. Assessment of the fetal lungs in utero. Am J Obstet Gynecol MFM 2022; 4:100693. [PMID: 35858660 PMCID: PMC9811184 DOI: 10.1016/j.ajogmf.2022.100693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023]
Abstract
Antenatal diagnosis of abnormal pulmonary development has improved significantly over recent years because of progress in imaging techniques. Two-dimensional ultrasound is the mainstay of investigation of pulmonary pathology during pregnancy, providing good prognostication in conditions such as congenital diaphragmatic hernia; however, it is less validated in other high-risk groups such as those with congenital pulmonary airway malformation or preterm premature rupture of membranes. Three-dimensional assessment of lung volume and size is now possible using ultrasound or magnetic resonance imaging; however, the use of these techniques is still limited because of unpredictable fetal motion, and such tools have also been inadequately validated in high-risk populations other than those with congenital diaphragmatic hernia. The advent of advanced, functional magnetic resonance imaging techniques such as diffusion and T2* imaging, and the development of postprocessing pipelines that facilitate motion correction, have enabled not only more accurate evaluation of pulmonary size, but also assessment of tissue microstructure and perfusion. In the future, fetal magnetic resonance imaging may have an increasing role in the prognostication of pulmonary abnormalities and in monitoring current and future antenatal therapies to enhance lung development. This review aims to examine the current imaging methods available for assessment of antenatal lung development and to outline possible future directions.
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Affiliation(s)
- Carla L Avena-Zampieri
- Department of Women and Children's Health, King's College London, London, United Kingdom; Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Anna Milan
- Neonatal Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Megan Hall
- Department of Women and Children's Health, King's College London, London, United Kingdom; Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Alexia Egloff
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - David F A Lloyd
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Surabhi Nanda
- Fetal Medicine Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health, King's College London, London, United Kingdom; Neonatal Unit, King's College Hospital, London, United Kingdom; Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom; National Institute for Health and Care Research Biomedical Research Centre, Guy's & St Thomas National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Lisa Story
- Department of Women and Children's Health, King's College London, London, United Kingdom; Centre for the Developing Brain, King's College London, London, United Kingdom; Fetal Medicine Unit, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.
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Hall M, Hutter J, Suff N, Zampieri CA, Tribe RM, Shennan A, Rutherford M, Story L. Antenatal diagnosis of chorioamnionitis: A review of the potential role of fetal and placental imaging. Prenat Diagn 2022; 42:1049-1058. [PMID: 35670265 PMCID: PMC9543023 DOI: 10.1002/pd.6188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 11/12/2022]
Abstract
Chorioamnionitis is present in up to 70% of spontaneous preterm births. It is defined as an acute inflammation of the chorion, with or without involvement of the amnion, and is evidence of a maternal immunological response to infection. A fetal inflammatory response can coexist and is diagnosed on placental histopathology postnatally. Fetal inflammatory response syndrome (FIRS) is associated with poorer fetal and neonatal outcomes. The only antenatal diagnostic test is amniocentesis which carries risks of miscarriage or preterm birth. Imaging of the fetal immune system, in particular the thymus and the spleen, and the placenta may give valuable information antenatally regarding the diagnosis of fetal inflammatory response. While ultrasound is largely limited to structural information, MRI can complement this with functional information that may provide insight into the metabolic activities of the fetal immune system and placenta. This review discusses fetal and placental imaging in pregnancies complicated by chorioamnionitis and their potential future use in achieving non-invasive antenatal diagnosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Megan Hall
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK.,Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK
| | - Natalie Suff
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
| | - Carla Avena Zampieri
- Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK
| | - Rachel M Tribe
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK
| | - Lisa Story
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK.,Centre for the Developing Brain, St Thomas' Hospital, King's College London, London, UK
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Colford K, Price AN, Sigurdardottir J, Fotaki A, Steinweg J, Story L, Ho A, Chappell LC, Hajnal JV, Rutherford M, Pushparajah K, Lamata P, Hutter J. Cardiac and placental imaging (CARP) in pregnancy to assess aetiology of preeclampsia. Placenta 2022; 122:46-55. [PMID: 35430505 PMCID: PMC9810538 DOI: 10.1016/j.placenta.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/12/2022] [Accepted: 03/01/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The CARP study aims to investigate placental function, cardiac function and fetal growth comprehensively during pregnancy, a time of maximal cardiac stress, to work towards disentangling the complex cardiac and placental interactions presenting in the aetiology of pre-eclampsia as well as predicting maternal Cardiovascular Disease (CVD) risk in later life. BACKGROUND The involvement of the cardiovascular system in pre-eclampsia, one of the most serious complications of pregnancy, is evident. While the manifestations of pre-eclampsia during pregnancy (high blood pressure, multi-organ disease, and placental dysfunction) resolve after delivery, a lifelong elevated CVD risk remains. METHOD An assessment including both cardiac and placental Magnetic Resonance Imaging (MRI) optimised for use in pregnancy and bespoke to the expected changes was developed. Simultaneous structural and functional MRI data from the placenta, the heart and the fetus were obtained in a total of 32 pregnant women (gestational ages from 18.1 to 37.5 weeks), including uncomplicated pregnancies and five cases with early onset pre-eclampsia. RESULTS The achieved comprehensive MR acquisition was able to demonstrate a phenotype associated with pre-eclampsia linking both placental and cardiac factors, reduced mean T2* (p < 0.005), increased heterogeneity (p < 0.005) and a trend towards an increase in cardiac work, larger average mass (109.4 vs 93.65 gr), wall thickness (7.0 vs 6.4 mm), blood pool volume (135.7 vs 127.48 mL) and mass to volume ratio (0.82 vs 0.75). The cardiac output in the controls was, controlling for gestational age, positively correlated with placental volume (p < 0.05). DISCUSSION The CARP study constitutes the first joint assessment of functional and structural properties of the cardiac system and the placenta during pregnancy. Early indications of cardiac remodelling in pre-eclampsia were demonstrated paving the way for larger studies.
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Affiliation(s)
- Kathleen Colford
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Anthony N. Price
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Julie Sigurdardottir
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Anastasia Fotaki
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Johannes Steinweg
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Lisa Story
- Academic Women's Health Department, King's College London, London, UK
| | - Alison Ho
- Academic Women's Health Department, King's College London, London, UK
| | - Lucy C. Chappell
- Academic Women's Health Department, King's College London, London, UK
| | - Joseph V. Hajnal
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Mary Rutherford
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Kuberan Pushparajah
- Centre for Medical Engineering, King's College London, London, UK,Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Pablo Lamata
- Centre for Medical Engineering, King's College London, London, UK
| | - Jana Hutter
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK,Corresponding author. Perinatal Imaging, 1st Floor South Wing, St THomas' Hospital, Westminster Bridge Road, SE17EH, London, UK.
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Ho A, Chappell LC, Story L, Al-Adnani M, Egloff A, Routledge E, Rutherford M, Hutter J. Corrigendum to "Visual assessment of the placenta in antenatal magnetic resonance imaging across gestation in normal and compromised pregnancies: Observations from a large cohort study" [117 January 2022 29-38]. Placenta 2022; 119:31. [PMID: 35078025 DOI: 10.1016/j.placenta.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Alison Ho
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Lisa Story
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Mudher Al-Adnani
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Alexia Egloff
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Emma Routledge
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom; Biomedical Engineering Department, King's College London, London, United Kingdom
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Ho A, Chappell LC, Story L, Al-Adnani M, Egloff A, Routledge E, Rutherford M, Hutter J. Visual assessment of the placenta in antenatal magnetic resonance imaging across gestation in normal and compromised pregnancies: Observations from a large cohort study. Placenta 2022; 117:29-38. [PMID: 34768166 PMCID: PMC8761363 DOI: 10.1016/j.placenta.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 09/12/2021] [Accepted: 10/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Visual assessment of the placenta in antenatal magnetic resonance imaging is important to confirm healthy appearances or to identify pathology complicating fetal anomaly or maternal disease. METHODS We assessed the placenta in a large cohort of 228 women with low and high risk pregnancies across gestation. All women gave written informed consent and were imaged using either a 3T Philips Achieva or 1.5T Philips Ingenia scanner. Images were acquired with a T2-weighted single shot turbo spin echo sequence of the whole uterus (thereby including placenta) for anatomical information. RESULTS A structured approach to visual assessment of the placenta on T2-weighted imaging has been provided including determination of key anatomical landmarks to aid orientation, placental shape, signal intensity, lobularity and granularity. Transient factors affecting imaging are shown including the effect of fetal movement, gross fetal motion and contractions. Placental appearances across gestation in low risk pregnancies are shown and compared to pregnancies complicated by preeclampsia and chronic hypertension. The utility of other magnetic resonance techniques (T2* mapping as an indirect marker for quantifying oxygenation) and histological assessment alongside visual assessment of placental T2-weighted imaging are demonstrated. DISCUSSION A systematic approach with qualitative descriptors for placental visual assessment using T2-weighted imaging allows confirmation of normal placental development and can detect placental abnormalities in pregnancy complications. T2-weighted imaging can be visually assessed alongside functional imaging (such as T2* maps) in order to further probe the visual characteristics seen.
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Affiliation(s)
- Alison Ho
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Lucy C. Chappell
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Lisa Story
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Mudher Al-Adnani
- Department of Cellular Pathology, Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - Alexia Egloff
- Centre for the Developing Brain, King’s College London, London, United Kingdom
| | - Emma Routledge
- Centre for the Developing Brain, King’s College London, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King’s College London, London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain, King’s College London, London, United Kingdom,Biomedical Engineering Department, King’s College London, London, United Kingdom
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Nzelu D, Shangaris P, Story L, Smith F, Piyasena C, Alamelu J, Elmakky A, Pelidis M, Mayhew R, Sankaran S. X-linked sideroblastic anaemia in a female fetus: a case report and a literature review. BMC Med Genomics 2021; 14:296. [PMID: 34930268 PMCID: PMC8686580 DOI: 10.1186/s12920-021-01146-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023] Open
Abstract
Background X-linked sideroblastic anaemia (XLSA) is commonly due to mutations in the ALAS2 gene and predominantly affects hemizygous males. Heterozygous female carriers of the ALAS2 gene mutation are often asymptomatic or only mildly anaemic. XLSA is usually characterized by microcytic erythrocytes (reduced mean corpuscular volume (MCV)) and hypochromia, along with increased red cell distribution width. However, in females with XLSA the characteristic laboratory findings can be dimorphic and present with macrocytic (elevated MCV) in addition to microcytic red cells. Case presentation We report a case of fetal anaemia, presenting in the early third trimester of pregnancy, in a female fetus. Ultrasound findings at 29 weeks were of cardiomegaly, prominent umbilical veins, a small rim of ascites, and mean cerebral artery peak systolic velocity (PSV) value above 1.5 Multiples of the Median (MoM). She underwent non-invasive prenatal testing that determined the rhesus genotype of the fetus to be rhesus B negative. No red blood cell antibodies were reported. Other investigations to determine the underlying cause of fetal anaemia included microarray comparative genomic hybridization, serology to exclude congenital infection and a peripheral blood film and fetal bilirubin to detect haemolysis. The maternal grandmother had a history of sideroblastic anaemia diagnosed at the age of 17 years. The mother had mild macrocytic anaemia with haemoglobin of 10.4 g/dl and MCV of 104 fl. The fetal anaemia was successfully treated with two in utero transfusions (IUTs), and delivery occurred via caesarean section at 37 weeks of gestation. The red cell gene sequencing in both the mother and fetus were heterozygous for an ALAS2 mutation causing in utero manifestations of XLSA. The haemoglobin on discharge to the local hospital at five days of age was 19.1 g/dl. Subsequently, the infant became anaemic, requiring regular 3–4 monthly blood transfusions and demonstrating overall normal development. Her anaemia was unresponsive to pyridoxine. Conclusions This is one of four cases reporting multiple female members presenting with discordant clinical features of XLSA from being entirely asymptomatic to hydropic in utero. Our report is novel in that there are no previous cases in the literature of anaemia in a female fetus heterozygous for ALAS2 mutation.
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Affiliation(s)
- Diane Nzelu
- Guy's & St. Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Panicos Shangaris
- Guy's & St. Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK. .,Department of Women and Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London, SE1 7EH, UK.
| | - Lisa Story
- Guy's & St. Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.,Department of Women and Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London, SE1 7EH, UK
| | - Frances Smith
- Viapath at King's College Hospital, Bessemer Wing, Denmark Hill, London, SE5 9RS, UK
| | - Chinthika Piyasena
- Guy's & St. Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jayanthi Alamelu
- Guy's & St. Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Amira Elmakky
- Guy's & St. Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Maria Pelidis
- Guy's & St. Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Rachel Mayhew
- Viapath at King's College Hospital, Bessemer Wing, Denmark Hill, London, SE5 9RS, UK
| | - Srividhya Sankaran
- Guy's & St. Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.,Department of Women and Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London, SE1 7EH, UK
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Story L, Rafique S, Samadi N, Mawdsley J, Singh B, Banerjee A. Lower gastrointestinal bleeding in pregnancy: Differential diagnosis, assessment and management. Obstet Med 2021; 14:129-134. [PMID: 34646340 PMCID: PMC8504301 DOI: 10.1177/1753495x20948300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022] Open
Abstract
Rectal bleeding is a common symptom experienced by pregnant women. Although the majority of cases are attributable to benign conditions such as haemorrhoids and anal fissures, other more serious diagnoses such as inflammatory bowel disease and malignancy should not be overlooked. Most investigations are safe during pregnancy and these should not be withheld as significant implications on both fetal and maternal morbidity may result. In these cases, a multidisciplinary team approach is essential. This review explores the differential diagnosis, investigation and management of rectal bleeding during pregnancy.
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Affiliation(s)
- L Story
- Department of Women and Children's Health King's College, London, UK.,Women's Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Rafique
- King's College London Medical School, London, UK
| | - N Samadi
- King's College London Medical School, London, UK
| | - J Mawdsley
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B Singh
- Department of Surgery, University Hospitals Leicester, Leicester, UK
| | - A Banerjee
- Women's Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Hutter J, Jackson L, Ho A, Avena Zampieri C, Hajnal JV, Al-Adnani M, Nanda S, Shennan AH, Tribe RM, Gibbons D, Rutherford MA, Story L. The use of functional placental magnetic resonance imaging for assessment of the placenta after prolonged preterm rupture of the membranes in vivo: A pilot study. Acta Obstet Gynecol Scand 2021; 100:2244-2252. [PMID: 34546571 DOI: 10.1111/aogs.14267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/18/2021] [Accepted: 08/31/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Preterm prelabor rupture of membranes (PPROM) complicates 3% of pregnancies in the UK. Where delivery does not occur spontaneously, expectant management until 37 weeks of gestation is advocated, unless signs of maternal infection develop. However, clinical presentation of maternal infection can be a late sign and injurious fetal inflammatory responses may already have been activated. There is therefore a need for more sensitive markers to aid optimal timing of interventions. At present there is no non-invasive test in clinical practice to assess for infection in the fetal compartment and definitive diagnosis of chorioamnionitis is by histological assessment of the placenta after delivery. This study presents comprehensive functional placental magnetic resonance imaging (MRI) quantification, already used in other organ systems, to assess for infection/inflammation, in women with and without PPROM aiming to explore its use as a biomarker for inflammation within the feto-placental compartment in vivo. MATERIAL AND METHODS Placental MRI scans were performed in a cohort of 12 women (with one having two scans) with PPROM before 34 weeks of gestation (selected because of their high risk of infection), and in a control group of 87 women. Functional placental assessment was performed with magnetic resonance techniques sensitive to changes in the microstructure (diffusion) and tissue composition (relaxometry), with quantification performed both over the entire organ and in regions of interest between the basal and chorionic plate. Placental histology was analyzed after delivery where available. RESULTS Normative evolution of functional magnetic resonance biomarkers over gestation was studied. Cases of inflammation, as assessed by histological presence of chorioamnionitis, and umbilical cord vasculitis with or without funisitis, were associated with lower T2* (mean T2* at 30 weeks 50 ms compared with 58 ms in controls) and higher fractional anisotropy (mean at 30 weeks 0.55 compared with 0.45 in controls). These differences did not reach significance and there was substantial heterogeneity both in T2* and Apparent Diffusivitiy across the cohort. CONCLUSIONS This first exploration of functional placental assessment in a cohort of women with PPROM demonstrates that functional placental MRI can reveal a range of placental changes associated with inflammatory processes. It is a promising tool to gain information and in the future to identify inflammation in vivo, and could therefore assist in improving optimal timing for interventions designed to prevent fetal injury.
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Affiliation(s)
- Jana Hutter
- Centre for Medical Engineering, King's College London, London, UK
| | - Laurence Jackson
- Centre for Medical Engineering, King's College London, London, UK
| | - Alison Ho
- Centre for Medical Engineering, King's College London, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Carla Avena Zampieri
- Centre for Medical Engineering, King's College London, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for Medical Engineering, King's College London, London, UK
| | | | - Surabhi Nanda
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Rachel M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Deena Gibbons
- Peter Gorer Department of Immunobiology, King's College London, London, UK
| | | | - Lisa Story
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Fetal Medicine Unit, St Thomas' Hospital, London, UK
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Abstract
Cervical cerclage is an intervention which when given to the right women can prevent preterm birth and second‐trimester fetal losses. A history‐indicated cerclage should be offered to women who have had three or more preterm deliveries and/or mid‐trimester losses. An ultrasound‐indicated cerclage should be offered to women with a cervical length <25 mm if they have had one or more spontaneous preterm birth and/or mid‐trimester loss. In high‐risk women who have not had a previous mid‐trimester loss or preterm birth, an ultrasound‐indicated cerclage does not have a clear benefit in women with a short cervix. However, for twins, the advantage seems more likely at shorter cervical lengths (<15 mm). In women who present with exposed membranes prolapsing through the cervical os, a rescue cerclage can be considered on an individual case basis, taking into account the high risk of infective morbidity to mother and baby. An abdominal cerclage can be offered in women who have had a failed cerclage (delivery before 28 weeks after a history or ultrasound‐indicated [but not rescue] cerclage). If preterm birth has not occurred, removal is considered at 36–37 weeks in women anticipating a vaginal delivery. Cervical cerclage given to the right women can prevent preterm birth and second‐trimester fetal losses.
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Affiliation(s)
- Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK
| | - Lisa Story
- Department of Women and Children's Health, King's College London, London, UK
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Karavadara D, Davidson JR, Story L, Diab Y, Upadhyaya M. Missed opportunities for ovarian salvage in children: an 8-year review of surgically managed ovarian lesions at a tertiary pediatric surgery centre. Pediatr Surg Int 2021; 37:1281-1286. [PMID: 34235545 PMCID: PMC8325645 DOI: 10.1007/s00383-021-04935-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aetiology and management of ovarian pathology in children differs between antenatal and postnatal lesions. However, all lesions may present acutely due to adnexal torsion. In this setting, opportunities to preserve fertility with ovary-sparing surgery (OSS) may be missed. Some studies suggest that pediatric and adolescent gynaecology (PAG) input in care is associated with OSS. METHODS A retrospective cohort study of children undergoing surgery for ovarian pathology at a tertiary pediatric surgery centre over an 8-year period (2011-2018). Patient factors, lesion characteristics and PAG involvement were examined for association with OSS using multivariate logistic regression. RESULTS Thirty-five patients with ovarian pathology managed surgically were included. Ten were infants with lesions detected antenatally; all were managed by pediatric surgeons (PS) alone at median age 2 weeks (1 day-25 weeks). Twenty-five patients presented postnatally at median age 11 (0.75-15) years. In total, there were 16 cases of adnexal torsion, each managed primarily by PS. Twelve underwent oophorectomy and six (50%) of these cases had viable ovarian tissue on histology. Furthermore, two infants with large simple cysts were similarly managed by unnecessary oophorectomy based on histology. Overall rate of OSS was 46% and PAG involvement was the only factor associated with ovarian salvage. CONCLUSION Differences in surgical management between PAGs and PS may be attributable to the different patient populations they serve. We recommend improving the knowledge of PS trainees in OSS approaches for adnexal torsion and large benign lesions.
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Affiliation(s)
- D Karavadara
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth Palace Road, London, SE1 7EH, UK
- King's College London School of Medicine, London, UK
| | - J R Davidson
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
- Stem Cells and Regenerative Medicine, GOS-UCL Institute of Child Health, London, UK.
- Prenatal Cell and Gene Therapy, EGA-UCL Institute for Women's Health, London, UK.
| | - L Story
- King's College London School of Medicine, London, UK
- Department of Obstetrics, Gynaecology and Maternal-Fetal Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Y Diab
- Department of Obstetrics, Gynaecology and Maternal-Fetal Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Upadhyaya
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
- King's College London School of Medicine, London, UK.
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Myers R, Hutter J, Matthew J, Zhang T, Uus A, Lloyd D, Egloff A, Deprez M, Nanda S, Rutherford M, Story L. Assessment of the fetal thymus gland: Comparing MRI-acquired thymus volumes with 2D ultrasound measurements. Eur J Obstet Gynecol Reprod Biol 2021; 264:1-7. [PMID: 34246829 DOI: 10.1016/j.ejogrb.2021.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The fetal thymus gland has been shown to involute in response to intrauterine infection, and therefore could be used as a non-invasive marker of fetal compartment infection. The objective of this study was to evaluate how accurately 2D ultrasound-derived measurements of the fetal thymus reflect the 3D volume of the gland derived from motion corrected MRI images. STUDY DESIGN A retrospective study was performed using paired ultrasound and MRI datasets from the iFIND project (http://www.ifindproject.com). To obtain 3D volumetry of the thymus gland, T2-weighted single shot turbo spin echo (ssTSE) sequences of the fetal thorax were acquired. Thymus volumes were manually segmented from deformable slice-to-volume reconstructed images. To obtain 2D ultrasound measurements, previously stored fetal cine loops were used and measurements obtained at the 3-vessel-view (3VV) and 3-vessel-trachea view (3VT): anterior-posterior diameter (APD), intrathoracic diameter (ITD), transverse diameter (TD), perimeter and 3-vessel-edge (3VE). Inter-observer and intra-observer reliability (ICC) was calculated for both MRI and ultrasound measurements. Pearson correlation coefficients (PCC) were used to compare 2D-parameters with acceptable ICC to TV. RESULTS 38 participants were identified. Adequate visualisation was possible on 37 MRI scans and 31 ultrasound scans. Of the 30 datasets where both MRI and ultrasound data were available, MRI had good interobserver reliability (ICC 0.964) and all ultrasound 3VV 2D-parameters and 3VT 3VE had acceptable ICC (>0.75). Four 2D parameters were reflective of the 3D thymus volume: 3VV TD r = 0.540 (P = 0.002); 3VV perimeter r = 0.446 (P = 0.013); 3VV APD r = 0.435 (P = 0.110) and 3VT TD r = 0.544 (P = 0.002). CONCLUSIONS MRI appeared superior to ultrasound for visualization of the thymus gland and reproducibility of measurements. Three 2D US parameters, 3VV TD, perimeter and 3VT APD, correlated well with TV. Therefore, these represent a more accurate reflection of the true size of the gland than other 2D measurements, where MRI is not available.
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Affiliation(s)
- Rebecca Myers
- King's College London School of Bioscience, St George's, University of London, UK
| | - Jana Hutter
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Jacqueline Matthew
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Tong Zhang
- Artificial Intelligence Research Center, Peng Cheng Laboratory, Shenzhen, China
| | - Alena Uus
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - David Lloyd
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Alexia Egloff
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Maria Deprez
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Surabhi Nanda
- Department of Fetal Medicine, St Thomas' Hospital London, UK
| | - Mary Rutherford
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Lisa Story
- Department of Fetal Medicine, St Thomas' Hospital London, UK; Department of Women and Children's Health King's College London, UK.
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Story L, Zhang T, Uus A, Hutter J, Egloff A, Gibbons D, Ho A, Al-Adnani M, Knight CL, Theodoulou I, Deprez M, Seed PT, Tribe RM, Shennan AH, Rutherford M. Antenatal thymus volumes in fetuses that delivered <32 weeks' gestation: An MRI pilot study. Acta Obstet Gynecol Scand 2021; 100:1040-1050. [PMID: 32865812 PMCID: PMC7614117 DOI: 10.1111/aogs.13983] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Infection and inflammation have been implicated in the etiology and subsequent morbidity associated with preterm birth. At present, there are no tests to assess for fetal compartment infection. The thymus, a gland integral in the fetal immune system, has been shown to involute in animal models of antenatal infection, but its response in human fetuses has not been studied. This study aims: (a) to generate magnetic resonance imaging (MRI) -derived fetal thymus volumes standardized for fetal weight; (b) to compare standardized thymus volumes from fetuses that delivered before 32 weeks of gestation with fetuses that subsequently deliver at term; (c) to assess thymus size as a predictor of preterm birth; and (d) to correlate the presence of chorioamnionitis and funisitis at delivery with thymic volumes in utero in fetuses that subsequently deliver preterm. MATERIAL AND METHODS Women at high-risk of preterm birth at 20-32 weeks of gestation were recruited. A control group was obtained from existing data sets acquired as part of three research studies. A fetal MRI was performed on a 1.5T or 3T MRI scanner: T2 weighted images were obtained of the entire uterine content and specifically the fetal thorax. A slice-to-volume registration method was used for reconstruction of three-dimensional images of the thorax. Thymus segmentations were performed manually. Body volumes were calculated by manual segmentation and thymus:body volume ratios were generated. Comparison of groups was performed using multiple regression analysis. Normal ranges were created for thymus volume and thymus:body volume ratios using the control data. Receiver operating curves (ROC) curves were generated for thymus:body volume ratio and gestation-adjusted thymus volume centiles as predictors of preterm birth. Placental histology was analyzed where available from pregnancies that delivered very preterm and the presence of chorioamnionitis/funisitis was noted. RESULTS Normative ranges were created for thymus volume, and thymus volume was standardized for fetal size from fetuses that subsequently delivered at term, but were imaged at 20-32 weeks of gestation. Image data sets from 16 women that delivered <32 weeks of gestation (ten with ruptured membranes and six with intact membranes) and 80 control women that delivered >37 weeks were included. Mean gestation at MRI of the study group was 28+4 weeks (SD 3.2) and for the control group was 25+5 weeks (SD 2.4). Both absolute fetal thymus volumes and thymus:body volume ratios were smaller in fetuses that delivered preterm (P < .001). Of the 16 fetuses that delivered preterm, 13 had placental histology, 11 had chorioamnionitis, and 9 had funisitis. The strongest predictors of prematurity were the thymus volume Z-score and thymus:body volume ratio Z-score (ROC areas 0.915 and 0.870, respectively). CONCLUSIONS We have produced MRI-derived normal ranges for fetal thymus and thymus:body volume ratios between 20 and 32 weeks of gestation. Fetuses that deliver very preterm had reduced thymus volumes when standardized for fetal size. A reduced thymus volume was also a predictor of spontaneous preterm delivery. Thymus volume may be a suitable marker of the fetal inflammatory response, although further work is needed to assess this, increasing the sample size to correlate the extent of chorioamnionitis with thymus size.
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Affiliation(s)
- Lisa Story
- Department of Women and Children’s Health, School of Life Sciences, King’s College London, London, UK,Fetal Medicine Unit, St Thomas’ Hospital, London, UK
| | - Tong Zhang
- Artificial Intelligence Research Center, Peng Cheng Laboratory, Shenzhen, China
| | - Alena Uus
- Centre for the Developing Brain and Centre for Medical Engineering, King’s College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain and Centre for Medical Engineering, King’s College London, London, UK
| | - Alexia Egloff
- Centre for the Developing Brain and Centre for Medical Engineering, King’s College London, London, UK
| | - Deena Gibbons
- Department of Immunobiology, King’s College London, London, UK
| | - Alison Ho
- Department of Women and Children’s Health, School of Life Sciences, King’s College London, London, UK
| | | | - Caroline L. Knight
- Department of Women and Children’s Health, School of Life Sciences, King’s College London, London, UK,Fetal Medicine Unit, St Thomas’ Hospital, London, UK
| | | | - Maria Deprez
- Artificial Intelligence Research Center, Peng Cheng Laboratory, Shenzhen, China
| | - Paul T. Seed
- Department of Women and Children’s Health, School of Life Sciences, King’s College London, London, UK
| | - Rachel M. Tribe
- Department of Women and Children’s Health, School of Life Sciences, King’s College London, London, UK
| | - Andrew H. Shennan
- Department of Women and Children’s Health, School of Life Sciences, King’s College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain and Centre for Medical Engineering, King’s College London, London, UK
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Story L, Davidson A, Patkee P, Fleiss B, Kyriakopoulou V, Colford K, Sankaran S, Seed P, Jones A, Hutter J, Shennan A, Rutherford M. Brain volumetry in fetuses that deliver very preterm: An MRI pilot study. Neuroimage Clin 2021; 30:102650. [PMID: 33838546 PMCID: PMC8045030 DOI: 10.1016/j.nicl.2021.102650] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/10/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022]
Abstract
Fetuses that subsequently deliver very preterm have a reduction in cortical and extra cerebrospinal fluid volumes. If such alterations commence antenatally this suggests a role for earlier administration of neuroprotective agents.
Background Infants born preterm are at increased risk of neurological complications resulting in significant morbidity and mortality. The exact mechanism and the impact of antenatal factors has not been fully elucidated, although antenatal infection/inflammation has been implicated in both the aetiology of preterm birth and subsequent neurological sequelae. It is therefore hypothesized that processes driving preterm birth are affecting brain development in utero. This study aims to compare MRI derived regional brain volumes in fetuses that deliver < 32 weeks with fetuses that subsequently deliver at term. Methods Women at high risk of preterm birth, with gestation 19.4–32 weeks were recruited prospectively. A control group was obtained from existing study datasets. Fetal MRI was performed on a 1.5 T or 3 T MRI scanner: T2-weighted images were obtained of the fetal brain. 3D brain volumetric datsets were produced using slice to volume reconstruction and regional segmentations were produced using multi-atlas approaches for supratentorial brain tissue, lateral ventricles, cerebellum cerebral cortex and extra-cerebrospinal fluid (eCSF). Statistical comparison of control and high-risk for preterm delivery fetuses was performed by creating normal ranges for each parameter from the control datasets and then calculating gestation adjusted z scores. Groups were compared using t-tests. Results Fetal image datasets from 24 pregnancies with delivery < 32 weeks and 87 control pregnancies that delivered > 37 weeks were included. Median gestation at MRI of the preterm group was 26.8 weeks (range 19.4–31.4) and control group 26.2 weeks (range 21.7–31.9). No difference was found in supra-tentorial brain volume, ventricular volume or cerebellar volume but the eCSF and cerebral cortex volumes were smaller in fetuses that delivered preterm (p < 0.001 in both cases). Conclusion Fetuses that deliver preterm have a reduction in cortical and eCSF volumes. This is a novel finding and needs further investigation. If alterations in brain development are commencing antenatally in fetuses that subsequently deliver preterm, this may present a window for in utero therapy in the future.
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Affiliation(s)
- Lisa Story
- Department of Women and Children's Health, King's College London, UK.
| | - Alice Davidson
- Centre for the Developing Brain, King's College London, London, UK
| | - Prachi Patkee
- Centre for the Developing Brain, King's College London, London, UK
| | - Bobbi Fleiss
- Centre for the Developing Brain, King's College London, London, UK; School of Health and Biomedical Sciences, RMIT University, Bundoora 3083, VIC, Australia; Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France
| | | | - Kathleen Colford
- Centre for the Developing Brain, King's College London, London, UK; Centre for Medical Engineering, King's College London, London, UK
| | | | - Paul Seed
- Department of Women and Children's Health, King's College London, UK
| | - Alice Jones
- Centre for the Developing Brain, King's College London, London, UK; Queen Mary University Medical School, UK
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, UK; School of Health and Biomedical Sciences, RMIT University, Bundoora 3083, VIC, Australia
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, UK
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Ho A, Hutter J, Slator P, Jackson L, Seed PT, Mccabe L, Al-Adnani M, Marnerides A, George S, Story L, Hajnal JV, Rutherford M, Chappell LC. Placental magnetic resonance imaging in chronic hypertension: A case-control study. Placenta 2021; 104:138-145. [PMID: 33341490 PMCID: PMC7921773 DOI: 10.1016/j.placenta.2020.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We aimed to explore the use of magnetic resonance imaging (MRI) in vivo as a tool to elucidate the placental phenotype in women with chronic hypertension. METHODS In case-control study, women with chronic hypertension and those with uncomplicated pregnancies were imaged using either a 3T Achieva or 1.5T Ingenia scanner. T2-weighted images, diffusion weighted and T1/T2* relaxometry data was acquired. Placental T2*, T1 and apparent diffusion coefficient (ADC) maps were calculated. RESULTS 129 women (43 with chronic hypertension and 86 uncomplicated pregnancies) were imaged at a median of 27.7 weeks' gestation (interquartile range (IQR) 23.9-32.1) and 28.9 (IQR 26.1-32.9) respectively. Visual analysis of T2-weighted imaging demonstrated placentae to be either appropriate for gestation or to have advanced lobulation in women with chronic hypertension, resulting in a greater range of placental mean T2* values for a given gestation, compared to gestation-matched controls. Both skew and kurtosis (derived from histograms of T2* values across the whole placenta) increased with advancing gestational age at imaging in healthy pregnancies; women with chronic hypertension had values overlapping those in the control group range. Upon visual assessment, the mean ADC declined in the third trimester, with a corresponding decline in placental mean T2* values and showed an overlap of values between women with chronic hypertension and the control group. DISCUSSION A combined placental MR examination including T2 weighted imaging, T2*, T1 mapping and diffusion imaging demonstrates varying placental phenotypes in a cohort of women with chronic hypertension, showing overlap with the control group.
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Affiliation(s)
- Alison Ho
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom; Biomedical Engineering Department, King's College London, London, United Kingdom
| | - Paddy Slator
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Laurence Jackson
- Centre for the Developing Brain, King's College London, London, United Kingdom; Biomedical Engineering Department, King's College London, London, United Kingdom
| | - Paul T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Laura Mccabe
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mudher Al-Adnani
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Andreas Marnerides
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Simi George
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Lisa Story
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, King's College London, London, United Kingdom; Biomedical Engineering Department, King's College London, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
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Matthew J, Skelton E, Story L, Davidson A, Knight CL, Gupta C, Pasupathy D, Rutherford M. MRI-Derived Fetal Weight Estimation in the Midpregnancy Fetus: A Method Comparison Study. Fetal Diagn Ther 2021; 48:708-719. [PMID: 34818233 PMCID: PMC7614116 DOI: 10.1159/000519115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/12/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of this study was to compare the standard ultrasound (US) estimated fetal weight (EFW) and MRI volume-derived methods for the midtrimester fetus. METHODS Twenty-five paired US and MRI scans had the EFW calculated (gestational age [GA] range = 20-26 weeks). The intra- and interobserver variability of each method was assessed (2 operators/modality). A small sub-analysis was performed on 5 fetuses who were delivered preterm (mean GA 29 +3 weeks) and compared to the actual birthweight. RESULTS Two MRI volumetry EFW formulae under-measured compared to US by -10.9% and -14.5% in the midpregnancy fetus (p < 0.001) but had excellent intra- and interobserver agreement (intraclass correlation coefficient = 0.998 and 0.993). In the preterm fetus, the mean relative difference (MRD) between the MRI volume-derived EFW (MRI-EFW) and actual expected birthweight (at the scan GA) was -13.7% (-159.0 g, 95% CI: -341.7 to 23.7 g) and -17.1% (-204.6 g, 95% CI: -380.4 to -28.8 g), for the 2 MRI formulae. The MRD was smaller for US at 5.3% (69.8 g, 95% CI: -34.3 to 173.9). CONCLUSIONS MRI-EFW results should be interpreted with caution in midpregnancy. Despite excellent observer agreement with MRI volumetry, refinement of the EFW formula is needed in the second trimester, for the small and for the GA and preterm fetus to compensate for lower fetal densities.
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Affiliation(s)
- Jacqueline Matthew
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK
| | - Emily Skelton
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK
| | - Lisa Story
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK,Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Alice Davidson
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK
| | - Caroline L. Knight
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK,Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Chandni Gupta
- North Tees and Hartlepool NHS Foundation Trust, London, UK
| | - Dharmintra Pasupathy
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mary Rutherford
- School of Biomedical Engineering and Imaging Sciences and School of Life Course Sciences, Faculty of Life Sciences in Medicine, King’s College London, London, UK,Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
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Story L, Knight CL, Ho A, Arulkumaran S, Matthews J, Lovell H, McCabe L, Byrne M, Egloff A, Jacques AET, Carmichael J, Hajnal J, Shennan A, Rutherford M. Maternal and fetal incidental findings on antenatal magnetic resonance imaging. Pediatr Radiol 2021; 51:1839-1847. [PMID: 34046707 PMCID: PMC8426300 DOI: 10.1007/s00247-021-05074-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/09/2020] [Accepted: 03/28/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) examinations are increasingly used in antenatal clinical practice. Incidental findings are a recognized association with imaging and although in some circumstances their identification can alter management, they are often associated with increased anxiety, for both patient and clinician, as well as increased health care costs. OBJECTIVE This study aimed to evaluate the incidence of unexpected findings in both the mother and fetus during antenatal MRI examinations. MATERIALS AND METHODS A retrospective study was undertaken over a five-year period at St.. Thomas' Hospital in London. Maternal incidental findings were recorded from all clinical reports of all fetal MRIs performed (for clinical reasons and in healthy volunteers) during this period. Fetal incidental findings were recorded only in cases where women with uncomplicated pregnancies were participating as healthy volunteers. RESULTS A total of 2,569 MRIs were included; 17% of women had maternal incidental findings. Of these, 1,099 were women with uncomplicated pregnancies who undertook research MRIs as healthy volunteers; fetal incidental findings were identified in 12.3%. CONCLUSION Incidental findings are a common occurrence in antenatal MRI. Consideration should be given to counseling women appropriately before imaging and ensuring that robust local protocols are in place for follow-up and further management of such cases.
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Affiliation(s)
- Lisa Story
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, SE1 7EH, UK. .,Fetal Medicine Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | - Caroline L. Knight
- Department of Women and Children’s Health, King’s College London, 10th Floor North Wing, St. Thomas’ Hospital, London, SE1 7EH UK ,Fetal Medicine Unit, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Alison Ho
- Department of Women and Children’s Health, King’s College London, 10th Floor North Wing, St. Thomas’ Hospital, London, SE1 7EH UK
| | | | | | - Holly Lovell
- Department of Women and Children’s Health, King’s College London, 10th Floor North Wing, St. Thomas’ Hospital, London, SE1 7EH UK
| | - Laura McCabe
- Centre for the Developing Brain, King’s College, London, London, UK
| | - Megan Byrne
- Fetal Medicine Unit, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Alexia Egloff
- Centre for the Developing Brain, King’s College, London, London, UK
| | | | - Jim Carmichael
- Department of Radiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Jo Hajnal
- Centre for the Developing Brain, King’s College, London, London, UK
| | - Andrew Shennan
- Department of Women and Children’s Health, King’s College London, 10th Floor North Wing, St. Thomas’ Hospital, London, SE1 7EH UK
| | - Mary Rutherford
- Centre for the Developing Brain, King’s College, London, London, UK
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Carlisle N, Glazewska-Hallin A, Story L, Carter J, Seed PT, Suff N, Giblin L, Hutter J, Napolitano R, Rutherford M, Alexander DC, Simpson N, Banerjee A, David AL, Shennan AH. CRAFT (Cerclage after full dilatation caesarean section): protocol of a mixed methods study investigating the role of previous in-labour caesarean section in preterm birth risk. BMC Pregnancy Childbirth 2020; 20:698. [PMID: 33198663 PMCID: PMC7667480 DOI: 10.1186/s12884-020-03375-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Full dilatation caesarean sections are associated with recurrent early spontaneous preterm birth and late miscarriage. The risk following first stage caesarean sections, are less well defined, but appears to be increased in late-first stage of labour. The mechanism for this increased risk of late miscarriage and early spontaneous preterm birth in these women is unknown and there are uncertainties with regards to clinical management. Current predictive models of preterm birth (based on transvaginal ultrasound and quantitative fetal fibronectin) have not been validated in these women and it is unknown whether the threshold to define a short cervix (≤25 mm) is reliable in predicting the risk of preterm birth. In addition the efficacy of standard treatments or whether benefit may be derived from prophylactic interventions such as a cervical cerclage is unknown. METHODS There are three distinct components to the CRAFT project (CRAFT-OBS, CRAFT-RCT and CRAFT-IMG). CRAFT-OBS Observational Study; To evaluate subsequent pregnancy risk of preterm birth in women with a prior caesarean section in established labour. This prospective study of cervical length and quantitative fetal fibronectin data will establish a predictive model of preterm birth. CRAFT-RCT Randomised controlled trial arm; To assess treatment for short cervix in women at high risk of preterm birth following a fully dilated caesarean section. CRAFT-IMG Imaging sub-study; To evaluate the use of MRI and transvaginal ultrasound imaging of micro and macrostructural cervical features which may predispose to preterm birth in women with a previous fully dilated caesarean section, such as scar position and niche. DISCUSSION The CRAFT project will quantify the risk of preterm birth or late miscarriage in women with previous in-labour caesarean section, define the best management and shed light on pathological mechanisms so as to improve the care we offer to women and their babies. TRIAL REGISTRATION CRAFT was prospectively registered on 25th November 2019 with the ISRCTN registry ( https://doi.org/10.1186/ISRCTN15068651 ).
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Affiliation(s)
- Naomi Carlisle
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Agnieszka Glazewska-Hallin
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Lisa Story
- Centre for the Developing Brain, King's College London, 1st Floor South Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Jenny Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Paul T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Natalie Suff
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Lucie Giblin
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, 1st Floor South Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, Room 244, Medical School Building, Huntley Street, London, WC1E 6AU, UK
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, 1st Floor South Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Daniel C Alexander
- Department of Computer Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Nigel Simpson
- Delivery Suite, C Floor, Clarendon Wing, The General Infirmary at Leeds, Belmont Grove, Leeds, LS2 9NS, UK
| | - Amrita Banerjee
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, Room 244, Medical School Building, Huntley Street, London, WC1E 6AU, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, Room 244, Medical School Building, Huntley Street, London, WC1E 6AU, UK.,NIHR University College London Hospitals Biomedical Research Centre, 149 Tottenham Court Road, London, W1T 7DN, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Hickland MM, Story L, Glazewska-Hallin A, Suff N, Cauldwell M, Watson HA, Carter J, Duhig KE, Shennan AH. Efficacy of transvaginal cervical cerclage in women at risk of preterm birth following previous emergency cesarean section. Acta Obstet Gynecol Scand 2020; 99:1486-1491. [PMID: 32777082 DOI: 10.1111/aogs.13972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/04/2020] [Accepted: 08/05/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Emergency cesarean sections (EMCS) are associated with subsequent preterm birth, particularly at full dilation (FDCS), which is a cause of both second trimester miscarriages and early, recurrent spontaneous preterm birth (sPTB). The optimal management for these women in subsequent pregnancies is currently unknown. This study aims to assess efficacy of transvaginal cervical cerclage (TVC) in prevention of preterm birth among women who have had an EMCS followed by a subsequent late miscarriage or sPTB. MATERIAL AND METHODS A historical cohort study was performed assessing outcomes of women attending the Preterm Surveillance Clinic at St Thomas' Hospital, London, who received TVC, with a history of EMCS (pregnancy A) followed by a sPTB/late miscarriage (pregnancy B) and a subsequent pregnancy (pregnancy C). A historical reference group managed in the same clinic was identified comprising women with any risk factor for sPTB, who required TVC. Incidence of delivery >24 to <30 weeks' gestation was compared with relative risk and 95% confidence intervals (CI). Subgroup analysis was carried out assessing women who had a previous FDCS. RESULTS 209 women with a previous EMCS during labor (50 with FDCS), followed by sPTB/late miscarriage were identified. 178 progressed beyond 24 weeks; of these, 56 received TVC and formed the study group. 905 high-risk women were identified; of these, 154 received TVC and formed the reference group. Despite TVC treatment, 17/56 (30%) of the study group delivered <30 weeks' gestation compared with 5/154 (3%) of the reference group (RR 9.4, 95% CI 3.6-24.2, P < .001). In the subset of 17 women in the study group with a previous FDCS, followed by sPTB/late miscarriage, 6/17 (35%) delivered <30 weeks' gestation, significantly higher than the reference group (P < .001) but similar to EMCS at less than full dilation (35% vs 28%, P = .596). Overall, 33/72 (46%) women receiving cerclage with prior EMCS had either a mid-trimester loss or delivery <30 weeks. CONCLUSIONS Transvaginal cervical cerclage appears less effective in preventing preterm birth among pregnant women who have had an EMCS followed by a sPTB/late miscarriage compared with other high-risk women. The lack of efficacy in the subgroup with an FDCS was similar.
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Affiliation(s)
| | - Lisa Story
- Department of Women and Children's Health, King's College London, London, UK
| | | | - Natalie Suff
- Department of Women and Children's Health, King's College London, London, UK
| | | | - Helena A Watson
- Department of Women and Children's Health, King's College London, London, UK
| | - Jenny Carter
- Department of Women and Children's Health, King's College London, London, UK
| | - Kate E Duhig
- Department of Women and Children's Health, King's College London, London, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, King's College London, London, UK
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Ho AEP, Hutter J, Jackson LH, Seed PT, Mccabe L, Al-Adnani M, Marnerides A, George S, Story L, Hajnal JV, Rutherford MA, Chappell LC. T2* Placental Magnetic Resonance Imaging in Preterm Preeclampsia: An Observational Cohort Study. Hypertension 2020; 75:1523-1531. [PMID: 32336233 PMCID: PMC7682790 DOI: 10.1161/hypertensionaha.120.14701] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Placental dysfunction underlies the cause of pregnancies complicated by preeclampsia. The use of placental magnetic resonance imaging to provide an insight into the pathophysiology of preeclampsia and thus assess its potential use to inform prognosis and clinical management was explored. In this prospective observational cohort study, 14 women with preterm preeclampsia and 48 gestation-matched controls using 3-Tesla magnetic resonance imaging at median of 31.6 weeks (interquartile range [IQR], 28.6-34.6) and 32.2 weeks (IQR, 28.6-33.8), respectively, were imaged. The acquired data included T2-weighted images and T2* maps of the placenta, the latter an indicative measure of placental oxygenation. Placentae in women with preeclampsia demonstrated advanced lobulation, varied lobule sizes, high granularity, and substantial areas of low-signal intensity on T2-weighted imaging, with reduced entire placental mean T2* values for gestational age (2 sample t test, t=7.49) correlating with a reduction in maternal PlGF (placental growth factor) concentrations (Spearman rank correlation coefficient 0.76) and increased lacunarity values (t=3.26). Median mean T2* reduced from 67 ms (IQR, 54-73) at 26.0 to 29.8 weeks' gestation to 38 ms (IQR, 28-40) at 34.0 to 37.9 weeks' gestation in the control group. In women with preeclampsia, median T2* was 23 ms (IQR, 20-23) at 26.0 to 29.8 weeks' gestation and remained low (22 ms [IQR, 20-26] at 34.0-37.8 weeks' gestation). Histological features of maternal vascular malperfusion were only found in placentae from women with preeclampsia. Placental volume did not differ between the control group and women with preeclampsia. Placental magnetic resonance imaging allows both objective quantification of placental function in vivo and elucidation of the complex mechanisms underlying preeclampsia development.
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Affiliation(s)
- Alison E P Ho
- From the Department of Women and Children's Health, School of Life Course Sciences (A.E.P.H., P.S., L.S., L.C.C.), King's College London, United Kingdom
| | - Jana Hutter
- Centre for the Developing Brain (J.H., L.H.J., L.M., J.V.H., M.A.R.), King's College London, United Kingdom.,Biomedical Engineering Department (J.H., L.H.J., J.V.H.), King's College London, United Kingdom
| | - Laurence H Jackson
- Centre for the Developing Brain (J.H., L.H.J., L.M., J.V.H., M.A.R.), King's College London, United Kingdom.,Biomedical Engineering Department (J.H., L.H.J., J.V.H.), King's College London, United Kingdom
| | - Paul T Seed
- From the Department of Women and Children's Health, School of Life Course Sciences (A.E.P.H., P.S., L.S., L.C.C.), King's College London, United Kingdom
| | - Laura Mccabe
- Centre for the Developing Brain (J.H., L.H.J., L.M., J.V.H., M.A.R.), King's College London, United Kingdom
| | - Mudher Al-Adnani
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom (M.A.-A., A.M., S.G.)
| | - Andreas Marnerides
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom (M.A.-A., A.M., S.G.)
| | - Simi George
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom (M.A.-A., A.M., S.G.)
| | - Lisa Story
- From the Department of Women and Children's Health, School of Life Course Sciences (A.E.P.H., P.S., L.S., L.C.C.), King's College London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain (J.H., L.H.J., L.M., J.V.H., M.A.R.), King's College London, United Kingdom.,Biomedical Engineering Department (J.H., L.H.J., J.V.H.), King's College London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain (J.H., L.H.J., L.M., J.V.H., M.A.R.), King's College London, United Kingdom
| | - Lucy C Chappell
- From the Department of Women and Children's Health, School of Life Course Sciences (A.E.P.H., P.S., L.S., L.C.C.), King's College London, United Kingdom
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Hutter J, Jackson L, Ho A, Pietsch M, Story L, Chappell LC, Hajnal JV, Rutherford M. T2* relaxometry to characterize normal placental development over gestation in-vivo at 3T. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15451.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: T2* relaxometry has been identified as a non-invasive way to study the placenta in-vivo with good potential to identify placental insufficiency. Typical interpretation links T2* values to oxygen concentrations. This study aimed to comprehensively assess T2* maps as a marker of placental oxygenation in-vivo. Methods: A multi-echo gradient echo echo planar imaging sequence is used in a cohort of 84 healthy pregnant women. Special emphasis is put on spatial analysis: histogram measures, Histogram Asymmetry Measure (HAM) and lacunarity. Influences of maternal, fetal and placental factors and experimental parameters on the proposed measures are evaluated. Results: T2* maps were obtained from each placenta in less than 30sec. The previously reported decreasing trend in mean T2* with gestation was confirmed (3.45 ms decline per week). Factors such as maternal age, BMI, fetal sex, parity, mode of delivery and placental location were shown to be uncorrelated with T2* once corrected for gestational age. Robustness of the obtained values with regard to variation in segmentation and voxel-size were established. The proposed spatially resolved measures reveal a change in T2* in late gestation. Conclusions: T2* mapping is a robust and quick technique allowing quantification of both whole volume and spatial quantification largely independent of confounding factors.
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Glazewska‐Hallin A, Story L, Suff N, Shennan A. Late-stage Cesarean section causes recurrent early preterm birth: how to tackle this problem? Ultrasound Obstet Gynecol 2019; 54:293-296. [PMID: 30937984 PMCID: PMC6771870 DOI: 10.1002/uog.20276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Affiliation(s)
- A. Glazewska‐Hallin
- Department of Women and Children's HealthKing's College London, St Thomas' HospitalLondonUK
| | - L. Story
- Department of Women and Children's HealthKing's College London, St Thomas' HospitalLondonUK
| | - N. Suff
- Department of Women and Children's HealthKing's College London, St Thomas' HospitalLondonUK
| | - A. Shennan
- Department of Women and Children's HealthKing's College London, St Thomas' HospitalLondonUK
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Story L, Simpson NAB, David AL, Alfirevic Z Z, Bennett PR, Jolly M, Shennan AH. Reducing the impact of preterm birth: Preterm birth commissioning in the United Kingdom. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100018. [PMID: 31403111 PMCID: PMC6687377 DOI: 10.1016/j.eurox.2019.100018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/02/2019] [Accepted: 04/03/2019] [Indexed: 11/25/2022] Open
Abstract
Reducing preterm birth is a priority for Maternity and Children’s services. In the recent UK Department of Health publication ‘Safer Maternity Care’ the Secretary of State for Health aimed to achieve the national maternity safety ambition by pledging to reduce the rate of preterm birth from 8% to 6%. It was proposed that specialist preterm birth services should be established in the UK in order to achieve this aim. In response the Preterm Clinical Network has written Commissioning Guidance aimed to establish best practice pathways and agreed models of care to reduce variation nationally. They have been developed by clinical experts in the field, from within the UK, to provide recommendations for commissioning groups and to recommend pathways to organisations with the aim of reducing the incidence of preterm birth. Three key areas of care provision are focused on: prediction, prevention and preparation of women at high risk of PTB. This Expert Opinion, will summarise the Commissioning Guidance.
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Affiliation(s)
- Lisa Story
- Department of Women and Children's Health, School of Life Courses Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Nigel A B Simpson
- Department of Women's and Children's Health, School of Medicine, University of Leeds, LS2 9NL, United Kingdom
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, 74 Huntley Street, London, WC1 6AU, United Kingdom
| | - Zarko Alfirevic Z
- Women and Children's Health, University of Liverpool, L69 3BX, United Kingdom
| | - Phillip R Bennett
- Institute for Reproductive and Developmental Biology, Imperial College, London, Queen Charlotte's and Chelsea Hospital, W12 0HS, United Kingdom
| | - Matthew Jolly
- NHS England, Skipton House, London, SE1 6LH, United Kingdom
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Courses Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
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Abstract
Preterm birth, defined as birth occurring prior to 37 weeks gestation, is a serious obstetric problem accounting for 11% of pregnancies worldwide. It is associated with significant neonatal morbidity and mortality. Predictive tests for preterm birth are incredibly important, given the huge personal, economic, and health impacts of preterm birth. They can provide reassurance for women who are unlikely to deliver early, but they are also important for highlighting those women at higher risk of premature delivery so that we can offer prophylactic interventions and help guide antenatal management decisions. Unfortunately, there is unlikely to be a single test for predicting preterm birth, but a combination of tests is likely to improve clinical prediction. This review explores the clinical utility of the currently marketed predictive tests for preterm birth in both singleton and multiple pregnancies, as well as discussing novel predictive tests that may be useful in the future.
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Affiliation(s)
- Natalie Suff
- Department of Women's Health, King's College London, St Thomas' Hospital, London, UK.
| | - Lisa Story
- Department of Women's Health, King's College London, St Thomas' Hospital, London, UK; Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, UK
| | - Andrew Shennan
- Department of Women's Health, King's College London, St Thomas' Hospital, London, UK
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