729 Placental elasticity imaging: location-informed interpretation may be required for disease state discrimination

Abstract

To demonstrate the diagnostic potential of elasticity imaging to discriminate the characteristics of placentae in health and disease. While the clinical burden of placental dysfunction is high, there are no standard clinical methods to directly quantify placental function thus our goal is to identify easily reproducible, non-invasive placental biomarkers to detect and predict placenta-related disease. Prospective, descriptive cohort study of patients at a tertiary medical center with uncomplicated pregnancies, chronic hypertension (cHTN), gestational hypertension (gHTN), or the ischemic placental diseases of preeclampsia or intrauterine growth restriction (IPD). Patients were enrolled antenatally for post-delivery placental collection. Shear wave speeds (SWS) of the ex vivo placenta were measured with placentae in a water bath at physiologic temperature via ultrasound elasticity techniques on a Siemens S3000 research platform. SWS were compiled to describe the range of measurements with the ability to discriminate between disease states quantified with ROC curves. Twenty-five term patients were enrolled with 12 regions per placenta analyzed in triplicate for a total of 900 SWS measurements. Mean SWS varied across disease states: 1.53±0.42 m/s in uncomplicated pregnancies versus pregnancies complicated by cHTN (1.43±0.40 m/s), gHTN (1.50±0.38 m/s), or IPD (1.28±0.33 m/s). While SWS slowed in all pathologic states, there was pronounced regional variation (Figure 1). Consequently, effective discrimination of disease state as demonstrated by area under a ROC curve relies on either knowledge of placental region quantified or utilizing a larger region of interest (Figure 2). Contrary to limited prior reports, SWS decreases in placental-mediated disease states. However, variation across planes is significant, thus random SWS assessments are less effective at discriminating tissue than location-informed assessment. Elasticity imaging has the potential for disease state discrimination if assessment is informed by the region undergoing analysis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)