Determining uterine blood flow in pregnancy with magnetic resonance imaging

Pates, Jason A.; Hatab, Mustapha R.; McIntire, Donald D.; Cunningham, F. Gary; Twickler, Diane M.

doi:10.1016/j.mri.2009.12.009

Cited by 14 publications

(18 citation statements)

References 18 publications

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“…Nevertheless, our 4D flow acquisition has a spatial resolution that is superior to the state‐of‐the‐art of 2D PC acquired of the UtA reported in Pates et al Respiratory gating was not performed in our subjects to reduce scan time as much as possible. Consequently, potential sources of artifacts include fetal and peristaltic motion.…”

Section: Discussionmentioning

confidence: 89%

Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4d flow mri and its correlation with doppler ultrasound

Hwuang

Vidorreta

Schwartz

et al. 2018

Magnetic Resonance Imaging

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Background: Uterine artery (UtA) hemodynamics might be used to predict risk of hypertensive pregnancy disorders, including preeclampsia and intrauterine growth restriction. Purpose or Hypothesis: To determine the feasibility of 4D flow MRI in pregnant subjects by characterizing UtA anatomy, computing UtA flow, and comparing UtA velocity, and pulsatility and resistivity indices (PI, RI) with transabdominal Doppler ultrasound (US). Study Type: Prospective cross-sectional study from June 6, 2016, to May 2, 2018. Population or Subjects or Phantom or Specimen or Animal Model: Forty-one singleton pregnant subjects (age [range] = 27.0 ± 5.9 [18–41] years) in their second or third trimester. We additionally scanned three subjects who had prepregnancy diabetes or chronic hypertension. Field Strength/Sequence: The subjects underwent UtA and placenta MRI using noncontrast angiography and 4D flow at 1.5T. Assessment: UtA anatomy was described based on 4D flow-derived noncontrast angiography, while UtA flow properties were characterized by net flow, systolic/mean/diastolic velocity, PI and RI through examination of 4D flow data. PI and RI are standard hemodynamic parameters routinely reported on Doppler US. Statistical Tests: Spearman’s rank correlation, Wilcoxon signed rank tests, and Bland-Altman plots were used to preliminarily investigate the relationships between flow parameters, gestational age, and Doppler US. Results: 4D flow MRI and UtA flow quantification was feasible in all subjects. There was considerable heterogeneity in UtA geometry in each subject between left and right UtAs and between subjects. Mean 4D flow-based parameters were: mean bilateral flow rate = 605.6 ± 220.5 mL/min, PI = 0.72 ± 0.2, and RI = 0.47 ± 0.1. Bilateral flow did not change with gestational age. We found that MRI differed from US in terms of lower PI (mean difference −0.1) and RI (mean difference < −0.1) with Wilcoxon signed rank test P = 0.05 and P = 0.13, respectively. Data Conclusion: 4D flow MRI is a feasible approach for describing UtA anatomy and flow in pregnant subjects. Level of Evidence: Technical Efficacy: Stage 1

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Section: Discussionmentioning

confidence: 89%

Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4d flow mri and its correlation with doppler ultrasound

Hwuang

Vidorreta

Schwartz

et al. 2018

Magnetic Resonance Imaging

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“…DUS is used clinically to detect the fetal heartbeat and to assess changes in blood flow in the uterine artery during pregnancy in women (14–16). However, changes in the resistivity and/or pulsatility indices of the uterine artery may not accurately reflect vascular changes occurring in the intrauterine vessels (17), therefore clinicians do not routinely use DUS to measure intrauterine blood flow (18, 19). On the other hand, CEU has been used to quantify changes in microvascular blood flow in multiple organs distributed throughout the body (20–23), and in this study CEU uncovered dynamic differences in the vascular perfusion profiles of the intrauterine vessels within the macaque uterus.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound reveals real-time spatial changes in vascular perfusion during early implantation in the macaque uterus

Keator

Lindner

Belcik

et al. 2011

Fertility and Sterility

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Objective To use contrast enhanced ultrasound (CEU) to quantify blood flow in the macaque uterus during early pregnancy. Design Prospective nonhuman primate study. Setting National Primate Research Center. Animals Naturally cycling female rhesus macaques (Macaca mulatta). Interventions Female macaques were mated on days 11–14 of the cycle. Females were then imaged by CEU and Doppler ultrasound (DUS) once every 3 days from day 21 through day 39 of the fertile cycle. Main Outcome Measures Visualization and quantification of uterine vascular perfusion. Results CEU identified the primary placental disc and underlying vessels ~2 days earlier than DUS was able to observe endometrial thickening. CEU revealed spatial differences in vascular perfusion between the endometrium, myometrium, and the endometrial-myometrial (junctional) zone. Myometrium displayed the highest rate of blood flow (>10 mL/min/g tissue). There was less blood flow in the endometrium and junctional zone (<3 mL/min/g). A brief fall in progesterone was observed during early implantation, which was correlated with reduced blood flow to all three uterine compartments, but did not reduce flow to the placenta. Conclusions CEU provides a sensitive, non-invasive method to assess vascular perfusion of the uterus during embryo implantation in macaques. We propose CEU as a new diagnostic tool to monitor vascular changes associated with early pregnancy in women.

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“…mesometrial) arteries arching over the uterus, which then branch centripetally into myometrial (syn. radial) arteries that penetrate the myometrium and, at the level of the decidua, terminate in approximately 200 spiral arterioles supplying blood to the intervillous space [10]. Only the contributions of the UtA to total uteroplacental blood flow have been studied to date; a recent attempt to measure simultaneous flow in the UtA and OA branches using magnetic resonance imaging concluded that the complexity of pelvic blood flow prevented its accurate assessment [11].…”

Section: (B) Determinants Of Uterine Artery Blood Flowmentioning

confidence: 99%

“…This process, well described elsewhere in this issue, exerts important influences on maternal vascular responses to pregnancy as it effectively moves the site of vascular resistance upstream to the myometrial, arcuate and main UtA vessels. This creates a circumstance unique to pregnancy in which the limitation to blood flow is not in the end-arterioles but rather, the conduit vessels [10]. 1 It is often assumed that placental influences are wholly responsible for the maternal vascular responses to pregnancy (e.g.…”

Section: (B) Determinants Of Uterine Artery Blood Flowmentioning

confidence: 99%

Uterine artery blood flow, fetal hypoxia and fetal growth

Browne

Julian

Toledo-Jaldin

et al. 2015

Phil. Trans. R. Soc. B

109

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Evolutionary trade-offs required for bipedalism and brain expansion influence the pregnancy rise in uterine artery (UtA) blood flow and, in turn, reproductive success. We consider the importance of UtA blood flow by reviewing its determinants and presenting data from 191 normotensive (normal, n ¼ 125) or hypertensive ( preeclampsia (PE) or gestational hypertension (GH), n ¼ 29) Andean residents of very high (4100-4300 m) or low altitude (400 m, n ¼ 37). Prior studies show that UtA blood flow is reduced in pregnancies with intrauterine growth restriction (IUGR) but whether the IUGR is due to resultant fetal hypoxia is unclear. We found higher UtA blood flow and Doppler indices of fetal hypoxia in normotensive women at high versus low altitude but similar fetal growth. UtA blood flow was markedly lower in early-onset PE versus normal high-altitude women, and their fetuses more hypoxic as indicated by lower fetal heart rate, Doppler indices and greater IUGR. We concluded that, despite greater fetal hypoxia, fetal growth was well defended by higher UtA blood flows in normal Andeans at high altitude but when compounded by lower UtA blood flow in early-onset PE, exaggerated fetal hypoxia caused the fetus to respond by decreasing cardiac output and redistributing blood flow to help maintain brain development at the expense of growth elsewhere. We speculate that UtA blood flow is not only an important supply line but also a trigger for stimulating the metabolic and other processes regulating feto-placental metabolism and growth. Studies using the natural laboratory of high altitude are valuable for identifying the physiological and genetic mechanisms involved in human reproductive success.

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Determining uterine blood flow in pregnancy with magnetic resonance imaging

Cited by 14 publications

References 18 publications

Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4d flow mri and its correlation with doppler ultrasound

Assessment of uterine artery geometry and hemodynamics in human pregnancy with 4d flow mri and its correlation with doppler ultrasound

Contrast-enhanced ultrasound reveals real-time spatial changes in vascular perfusion during early implantation in the macaque uterus

Uterine artery blood flow, fetal hypoxia and fetal growth

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