Purpose A combined diffusion‐relaxometry MR acquisition and analysis pipeline for in vivo human placenta, which allows for exploration of coupling between and apparent diffusion coefficient (ADC) measurements in a sub 10‐minute scan time. Methods We present a novel acquisition combining a diffusion prepared spin echo with subsequent gradient echoes. The placentas of 17 pregnant women were scanned in vivo, including both healthy controls and participants with various pregnancy complications. We estimate the joint ‐ADC spectra using an inverse Laplace transform. Results ‐ADC spectra demonstrate clear quantitative separation between normal and dysfunctional placentas. Conclusions Combined ‐diffusivity MRI is promising for assessing fetal and maternal health during pregnancy. The ‐ADC spectrum potentially provides additional information on tissue microstructure, compared to measuring these two contrasts separately. The presented method is immediately applicable to the study of other organs.

Purpose To investigate, visualize and quantify the physiology of the human placenta in several dimensions ‐ functional, temporal over gestation, and spatial over the whole organ. Methods Bespoke MRI techniques, combining a rich diffusion protocol, anatomical data and T2* mapping together with a multi‐modal pipeline including motion correction and extracted quantitative features were developed and employed on pregnant women between 22 and 38 weeks gestational age including two pregnancies diagnosed with pre‐eclampsia. Results A multi‐faceted assessment was demonstrated showing trends of increasing lacunarity, and decreasing T2* and diffusivity over gestation. Conclusions The obtained multi‐modal acquisition and quantification shows promising opportunities for studying evolution, adaptation and compensation processes.

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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