Abstract
ObjectivesTo evaluate the feasibility of dynamic contrast enhanced magnetic resonance imaging (DCE MRI) and measure values of in vivo placental perfusion in women.MethodsThis study was part of the Placentimage trial (NCT01092949). Gadolinium-chelate (Gd) enhanced dynamic MRI was performed two days before termination of pregnancies at 16 to 34 weeks gestational age (GA). Quantitative analysis was performed using one-compartment intravascular modeling. DCE perfusion parameters were analyzed across GA and were compared in IUGR and AGA fetuses.Results134 patients were enrolled. After quality control check, 62 DCE MRI were analyzed including 48 and 14 pregnancies with normal and abnormal karyotypes, respectively. Mean placental blood flow was 129±61 mL/min/100ml in cases with normal karyotypes. Fetuses affected by IUGR (n = 13) showed significantly lower total placental blood flow values than AGA fetuses (n = 35) (F total = 122±88 mL/min versus 259±34 mL/min, p = 0.002). DCE perfusion parameters showed a linear correlation with GA.ConclusionsMeasuring placental perfusion in vivo is possible using DCE MRI. Although this study has many limitations it gives us the first DCE MRI values that provide a potential standard for future research into placental perfusion methods and suggests that placental functional parameters are altered in IUGR pregnancies.
Highlights
The placenta constitutes a circulatory interface between the mother and the fetus, supplying oxygen and nutrients to the fetus
Fetuses affected by intrauterine growth restriction (IUGR) (n = 13) showed significantly lower total placental blood flow values than AGA fetuses (n = 35) (F total = 122±88 mL/min versus 259±34 mL/min, p = 0.002)
dynamic contrast enhanced (DCE) perfusion parameters showed a linear correlation with gestational age (GA)
Summary
The placenta constitutes a circulatory interface between the mother and the fetus, supplying oxygen and nutrients to the fetus. Appropriate development of the placenta is required for the normal growth of the fetus. Placental insufficiency leads to several adverse outcomes in pregnancy, such as intrauterine growth restriction (IUGR) and pre-eclampsia. Ultrasonography is currently used to evaluate fetal growth and morphology during pregnancy. Doppler ultrasonography can evaluate fetal well-being through measurements of various circulatory parameters such as is done in spectral analysis of the flow in the umbilical artery, middle cerebral artery, and ductus venosus. Ultrasonography can describe the localization and morphology of the placenta, but cannot evaluate its flow and function, which should ideally be measured in ml/min/100mL of placenta. At most, increased resistance of the uterine artery, measured by Doppler ultrasonography, may indicate a higher risk of placental insufficiency as early as the end of the first trimester of pregnancy [4]
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