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

Surgery for male obstructive infertility is not always successful. A number of clinical and operative findings, not previously reported, may influence the outcome. We have studied 182 patients with azoospermia who underwent vasoepididymostomy. The pre-operative and operative findings which adversely affected the function of the anastomosis were identified. The presence of spermatozoa in the semen sample was taken to mean a successful anastomosis. Abnormal testicular histology was an adverse pre-operative finding. Adverse operative findings included non-canalisation of the epididymal tubules and hypoplasia of the epididymis; both factors were associated with a high failure rate (almost 100%). The anastomosis was a failure in 78% of the patients when no fluid was seen on sectioning the epididymis. In the absence of adverse findings the success rate of vasoepididymostomy was 59%. Pre-operative testicular biopsy, together with careful observation and recording of findings before and during surgery, are recommended to avoid needless exploration and anastomosis.

What are the novel findings of this work?This study is the first to provide evidence that uterine artery magnetic resonance imaging (MRI) pulsatility index and MRI-flow measurements can distinguish between pregnancies which will have normal and those which will have adverse outcome. What are the clinical implications of this work?These preliminary findings support the potential of four-dimensional flow MRI as an effective clinical tool for risk stratification in early pregnancy.

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The differences in AUC did not reach statistical significance. CONCLUSION: Our fully automated segmentation method successfully yields PV measurements at 11-14 weeks that are significantly associated with SGA, but with no manual user input required. This paves the way for exploring such a tool in a clinical setting as part of a multivariable prediction model for risk stratification and patient counseling. Moreover, it can allow a more rigorous investigation of placental shape and morphometry as potentially relevant markers of placental development.