Diffusion-Derived Vessel Density Computed From a Simplified Intravoxel Incoherent Motion Imaging Protocol in Pregnancies Complicated by Early Preeclampsia: A Novel Biomarker of Placental Dysfunction

Abstract

BACKGROUND: Early preeclampsia is associated with significant placental hypoperfusion. We explore the diagnostic value of placental diffusion-derived vessel density, a biomarker derived from diffusion-weighted magnetic resonance imaging, which measures in vivo vessel microperfusion, in the differential diagnosis of normal and early preeclampsia pregnancies. METHODS: This was a prospective study involving 29 controls and 17 singleton pregnancies affected by early preeclampsia. Nineteen pregnancies from 28 to 34 weeks of gestational age were included from the normal group for a comparison with the early preeclampsia group. Using a 3.0 T magnetic resonance imaging scanner, diffusion-weighted images were obtained with the diffusion weighting b values of 0, 20, and 40 s/mm 2 . DDVD mean was the mean of DDVD b0b20 and DDVD b0b40 , while DDVD b0b20 and DDVD b0b40 refer to the diffusion-derived vessel density values computed from b =0 and 20 s/mm 2 images, and from b =0 and 40 s/mm 2 images, respectively. The correlation between DDVD mean and gestational age was examined using a linear regression model. The area under the curve of the DDVD mean for early preeclampsia pregnancies detection was calculated by the receiver operating characteristic analysis. RESULTS: As gestational age increased, DDVD mean linearly decreased. DDVD mean was significantly decreased in the early preeclampsia pregnancies compared with the normal pregnancies (52.72±46.73 versus 213.34±93.50 au/pixel; P <0.001). The area under the curve (DDVD mean ) for discriminating between normal and early preeclampsia pregnancies regardless of fetal growth restriction was 0.954, and the area under the curve was 1.000 when early preeclampsia pregnancies without fetal growth restriction were excluded. CONCLUSIONS: DDVD mean , an in vivo vessel microperfusion measure, allowed total separation of normal and early preeclampsia pregnancies.

Perfusion of hepatocellular carcinomas measured by diffusion‐derived vessel density biomarker: Higher hepatocellular carcinoma perfusion than earlier intravoxel incoherent motion reports

“…DDVD can be interpreted as a physiological surrogate of the area of microvessels per unit tissue area, which can be conceptually converted to a surrogate of the volume of microvessels per tissue unit volume if multiple slices are integrated. The clinical usefulness of DDVD as a straightforward diffusion imaging biomarker has been recently demonstrated 14–19 . DDVD is a useful parameter for the distinguishing of livers with and without fibrosis, and livers with more severe fibrosis tend to have even lower DDVD measurements than those with milder liver fibrosis 14–16 .…”

“…This agrees with the known physiological age‐dependent reduction in liver blood flow, which has been well documented using a variety of technical methods including histology, dye dilution, and indicator clearance. He et al 19 reported that DDVD analysis of the placenta allows excellent separation of normal and early preeclampsia pregnancies.…”

Use of Magnetic Resonance Imaging to Detect Placental Microvascular Rarefaction That Heralds Preeclampsia

“…Compared with standard MRI intravoxel incoherent motion (IVIM) protocols, DDVD is purportedly easier to execute with less erroneous calculation and shorter scan time, proposing DDVD as a practical and valuable index of placental microperfusion. Importantly, He et al 1 found that the DDVD mean measurement inversely associates with preeclampsia pregnancy progression, is reproducible, and distinguishes early preeclampsia from normal pregnancies.…”

“…6 DDVD-based acquisition and measurements can potentially help detect early preeclampsia and placental vessel malformations and may serve as a future diagnostic imaging modality. 1 The diagnosis of preeclampsia is a compelling hurdle for early recognition and treatment of at-risk women. Blood pressure monitoring and 24-hour-urine proteinuria are essential for establishing an early diagnosis, after which further clinical and imaging studies such as Doppler Ultrasound are warranted to detect and prevent unanticipated short-and long-term complications in both mother and fetus.…”

Higher perfusion of rectum carcinoma relative to tumor-free rectal wall: quantification by a new imaging biomarker diffusion-derived vessel density (DDVD)

“…On the other hand, earlier IVIM studies demonstrated slightly lower perfusion measures for MVI(+) HCCs or more malignment HCCs. He et al ( 17 ) reported that DDVD analysis of the placenta allowed excellent separation of normal and early preeclampsia pregnancies. More recently, Lu et al ( 18 ) reported that DDVD was significantly higher in pregnant women with placenta accreta spectrum disorders than women with normal placenta, and especially higher in patients with placenta increta and percreta.…”