In vivo assessment of placental and brain volumes in growth-restricted fetuses with and without fetal Doppler changes using quantitative 3D MRI

Andescavage, Nickie; duPlessis, Adré J.; Metzler, Marina; Bulas, Dorothy; Vézina, Gilbert; Jacobs, Marni; Iqbal, Sara; Baschat, Ahmet; Limperopoulos, Catherine

doi:10.1038/jp.2017.129

Cited by 41 publications

(44 citation statements)

References 49 publications

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“…Our study is supported by our prior work investigating MRI-based placental perfusion deficits following the exposure to IUI [44]. Specifically, we used MRI to examine placental damage following IUI and found a significant decrease in capillary blood volume and velocity, suggestive of vascular damage and blood flow disruption [44,45,46]. We speculate that these effects may contribute to the formation of a clot, subsequently decreasing placental volume.…”

Section: Discussionsupporting

confidence: 78%

Placental malperfusion in response to intrauterine inflammation and its connection to fetal sequelae

Eloundou

Lee

et al. 2019

PLoS ONE

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Exposure to intrauterine inflammation (IUI) is associated with short- and long-term adverse perinatal outcomes. However, little data exist on utilizing placenta to prognosticate fetal injury in this scenario. Our study aimed to utilize imaging modalities to evaluate mechanisms contributing to placental injury following IUI exposure and correlated it to concomitant fetal brain injury. CD1 pregnant dams underwent laparotomies and received intrauterine injections of either lipopolysaccharide (LPS; a model of IUI) or phosphate-buffered saline (PBS). In utero ultrasound Doppler velocimetry of uterine and umbilical arteries and magnetic resonance imaging (MRI) of placental volumes with confirmatory immunohistochemical (vimentin) and histochemistry (fibrin) analyses were performed. ELISA for thrombosis markers, fibrinogen and fibrin was performed to analyze thrombi in placenta. Fetal brain immunohistochemistry was performed to detect microglial activation (ionized calcium-binding adaptor molecule 1, Iba1). On ultrasound, LPS group demonstrated elevated resistance indices, pulsatility indices and a greater occurrence of absent end-diastolic flow in the umbilical and uterine arteries. In the fetus, there was an increased cardiac Tei indices in the LPS group. MRI revealed decreased volume of placenta in the LPS group associated with placental thinning and placental endothelial damage on immunohistochemistry. Decreased fibrinogen content and more thrombi staining in placenta exposed to maternal LPS indicated the hypercoagulability. Furthermore, the expression of Iba1was significantly associated with placental thickness (r = -0.7890, Pearson correlation coefficient). Our data indicate that IUI can trigger events leading to maternal placental malperfusion and fetal vessel resistance, as well as predispose the developing fetus to cardiac dysfunction and brain damage. Furthermore, our data suggest that prenatal ultrasound can be a real-time clinical tool for assessing fetal risk for adverse neurologic outcomes following the potential IUI exposure.

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Section: Discussionsupporting

confidence: 78%

Placental malperfusion in response to intrauterine inflammation and its connection to fetal sequelae

Eloundou

Lee

et al. 2019

PLoS ONE

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“…This technique has been applied widely to the fetal brain, and extensions of this technique, although made substantially more complicated by non‐rigid motion, are being used for other abdominal organs . For placenta size, shape, and thickness estimation, these techniques are likely to represent the best way to acquire data . 3D reconstruction of structural MRI data has already been shown to have potential in surgical planning for laser division in TTTS, and as imaging and reconstruction techniques improve is likely to play an increasingly important role.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…FGR can be challenging to diagnose as placental function cannot currently be directly measured. Surrogate markers, such as abnormal fetal growth trajectory or abnormal blood flow to the placenta, are used with varying success. At present, there is no treatment for FGR, or the associated condition pre‐eclampsia; however, trials are exploring several new therapeutic avenues, including sildenafil, esomeprazole, metformin, pravastatin, and vascular endothelial growth factor maternal gene therapy .…”

Section: Introductionmentioning

confidence: 99%

Placental MRI and its application to fetal intervention

et al. 2019

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Objective Magnetic resonance imaging (MRI) of placental invasion has been part of clinical practice for many years. The possibility of being better able to assess placental vascularization and function using MRI has multiple potential applications. This review summarises up‐to‐date research on placental function using different MRI modalities. Method We discuss how combinations of these MRI techniques have much to contribute to fetal conditions amenable for therapy such as singletons at high risk for fetal growth restriction (FGR) and monochorionic twin pregnancies for planning surgery and counselling for selective growth restriction and transfusion conditions. Results The whole placenta can easily be visualized on MRI, with a clear boundary against the amniotic fluid, and a less clear placental‐uterine boundary. Contrasts such as diffusion weighted imaging, relaxometry, blood oxygenation level dependent MRI and flow and metabolite measurement by dynamic contrast enhanced MRI, arterial spin labeling, or spectroscopic techniques are contributing to our wider understanding of placental function. Conclusion The future of placental MRI is exciting, with the increasing availability of multiple contrasts and new models that will boost the capability of MRI to measure oxygen saturation and placental exchange, enabling examination of placental function in complicated pregnancies.

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“…Three studies (Damodaram et al, 2010; Ohgiya et al, 2016; Andescavage et al, 2017) investigated placental morphometry measurements in a FGR population compared to healthy controls. Although different definitions of FGR have been used (see Table 2), they all showed significantly reduced placental volume in the FGR population compared to the healthy pregnant population.…”

Section: Clinical Relevance Of Antenatal and Postnatal Assessment Ofmentioning

confidence: 99%

“…Furthermore, Damodaram et al showed that the placental volume remained significantly smaller throughout gestation in the FGR group, and that a lower placental volume was also associated with the severity of the FGR (detailed information on the severity subgroups can be found in Table 2) (Damodaram et al, 2010). Finally, Andescavage et al described that the placental volume was significantly lower in a subgroup of the FGR-population with abnormal umbilical artery Doppler (Andescavage et al, 2017). Higher mean placental thickness, lower macroscopic placental surface area and increase in max placental thickness/placental volume (PT/PV) ratio, were placental morphometry parameters that were significantly associated with FGR (Damodaram et al, 2010; Ohgiya et al, 2016).…”

Section: Clinical Relevance Of Antenatal and Postnatal Assessment Ofmentioning

confidence: 99%

The Possible Role of Placental Morphometry in the Detection of Fetal Growth Restriction

et al. 2019

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Fetal growth restriction (FGR) is often the result of placental insufficiency and is characterized by insufficient transplacental transport of nutrients and oxygen. The main underlying entities of placental insufficiency, the pathophysiologic mechanism, can broadly be divided into impairments in blood flow and exchange capacity over the syncytiovascular membranes of the fetal placenta villi. Fetal growth restriction is not synonymous with small for gestational age and techniques to distinguish between both are needed. Placental insufficiency has significant associations with adverse pregnancy outcomes (perinatal mortality and morbidity). Even in apparently healthy survivors, altered fetal programming may lead to long-term neurodevelopmental and metabolic effects. Although the concept of fetal growth restriction is well appreciated in contemporary obstetrics, the appropriate detection of FGR remains an issue in clinical practice. Several approaches have aimed to improve detection, e.g., uniform definition of FGR, use of Doppler ultrasound profiles and use of growth trajectories by ultrasound fetal biometry. However, the role of placental morphometry (placental dimensions/shape and weight) deserves further exploration. This review article covers the clinical relevance of placental morphometry during pregnancy and at birth to help recognize fetuses who are growth restricted. The assessment has wide intra- and interindividual variability with various consequences. Previous studies have shown that a small placental surface area and low placental weight are associated with a slower growth of the fetus. Parameters such as placental surface area, placental volume and placental weight in relation to birth weight can help to identify FGR. In the future, a model including sophisticated antenatal placental morphometry may prove to be a clinically useful method for screening or diagnosing growth restricted fetuses, in order to provide optimal monitoring.

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In vivo assessment of placental and brain volumes in growth-restricted fetuses with and without fetal Doppler changes using quantitative 3D MRI

Cited by 41 publications

References 49 publications

Placental malperfusion in response to intrauterine inflammation and its connection to fetal sequelae

Placental malperfusion in response to intrauterine inflammation and its connection to fetal sequelae

Placental MRI and its application to fetal intervention

The Possible Role of Placental Morphometry in the Detection of Fetal Growth Restriction

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