T2*‐weighted placental MRI: basic research tool or emerging clinical test for placental dysfunction?

Sørensen, Anne; Hutter, Jana; Seed, Mike; Grant, P. Ellen; Gowland, Penny

doi:10.1002/uog.20855

Cited by 59 publications

(70 citation statements)

References 42 publications

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“…Ultrasound is a very powerful technique for guiding care in clinical obstetrics; uterine artery Doppler can measure flow in larger vessels and can assess spiral artery resistance indirectly [8], but provides limited information on movement of blood within or across the IVS [9]. Magnetic Resonance Imaging (MRI -glossary in Table S1) is increasingly used to study fetal growth and development, and diffusion weighted imaging (DWI) of the AF F utero-placental unit is established as a clinical marker of placental adhesion [10] and DWI and T2 * -weighted imaging are increasingly being used to assess placental development [11][12][13][14][15][16][17][18][19][20].…”

Section: Mainmentioning

confidence: 99%

The haemodynamics of the human placenta in utero

Dellschaft

Hutchinson

Shah

et al. 2020

Preprint

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We have used MRI to provide important new insights into the function of the human placenta in utero. We have measured slow net flow and high net oxygenation in the placenta in vivo, which is consistent with efficient delivery of oxygen from mother to fetus. Our experimental evidence substantiates previous hypotheses on the effects of spiral artery remodelling in utero and we have observed rapid venous drainage from the placenta, which is important since the outflow has been largely neglected in the past. Beyond Braxton Hicks contractions which involve the entire uterus, we have identified a new physiological phenomenon, the 'utero-placental pump', by which the placenta and underlying uterine wall contracts independently of the rest of the uterus, expelling maternal blood from the intervillous space.

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Section: Mainmentioning

confidence: 99%

The haemodynamics of the human placenta in utero

Dellschaft

Hutchinson

Shah

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Ultrasound is a very powerful technique for guiding care in clinical obstetrics; uterine artery Doppler can measure flow in larger vessels and can assess spiral artery resistance indirectly [8] but provides limited information on movement of blood within or across the IVS [9]. Magnetic resonance imaging (MRI-glossary in S1 Table) is increasingly used to study fetal growth and development, diffusion-weighted imaging (DWI) of the utero-placental unit is established as a clinical marker of abnormally invasive placentation [10], and DWI and T 2 � -weighted imaging are increasingly being used to assess placental development [11][12][13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

The haemodynamics of the human placenta in utero

et al. 2020

View full text Add to dashboard Cite

We have used magnetic resonance imaging (MRI) to provide important new insights into the function of the human placenta in utero. We have measured slow net flow and high net oxygenation in the placenta in vivo, which are consistent with efficient delivery of oxygen from mother to fetus. Our experimental evidence substantiates previous hypotheses on the effects of spiral artery remodelling in utero and also indicates rapid venous drainage from the placenta, which is important because this outflow has been largely neglected in the past. Furthermore, beyond Braxton Hicks contractions, which involve the entire uterus, we have identified a new physiological phenomenon, the 'utero-placental pump', by which the placenta and underlying uterine wall contract independently of the rest of the uterus, expelling maternal blood from the intervillous space.

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“…Automatic segmentation of the placenta has attracted reasonable interest mainly on anatomical data with the aim to perform volumetrics (13)(14)(15). Previous functional T2*-based studies have used manual segmentations of either individual slices (4,6,9) or the entire organ (8,12). The presented study allows automatic segmentation of the entire placenta, but does not provide exact volumetrics due the distortions and inter-slice motion present in the Multi-Echo Gradient Echo data.…”

Section: Discussionmentioning

confidence: 99%

“…has been recently studied with T2* relaxometry (4)(5)(6)(7)(8)(9)(10)(11). The T2* values can be linked to the concentration of deoxygenated haemoglobin via the BOLD effect and thus provide both an ability to visually inspect and quantify function in spatial maps cross-sectionally and over gestation.…”

Section: B State Of the Art Placental Development Over Gestationmentioning

confidence: 99%

APPLAUSE: Automatic Prediction of PLAcental health via U-net Segmentation and statistical Evaluation

Pietsch

Bardanzellu

et al. 2020

Preprint

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Purpose: Artificial-intelligence population-based automated quantification of placental maturation and health from a rapid functional Magnetic Resonance scan. The placenta plays a crucial role for any successful human pregnancy. Deviations from the normal dynamic maturation throughout gestation are closely linked to major pregnancy complications. Antenatal assessment in-vivo using T2* relaxometry has shown great promise to inform management and possible interventions but clinical translation is hampered by time consuming manual segmentation and analysis techniques based on comparison against normative curves over gestation. Methods: This study proposes a fully automatic pipeline to predict the biological age and health of the placenta based on a rapid (sub-30 second) T2* scan in two steps: Automatic segmentation using a U-Net and a Gaussian Process regression model to characterize placental maturation and health. These are trained and evaluated on 110 3T MRI placental data sets including 20 high-risk pregnancies diagnosed with pre-eclampsia and/or fetal growth restriction. Results: Automatic segmentation achieves comparable performance to human experts (mean DICE coefficients automatic-manual 0.76, Pearson Correlation Coefficient 0.986 for mean T2* within the masks). The placental health prediction achieves an excellent ability to differentiate early cases of placental insufficiency before 32 weeks. High abnormality scores correlate with low birth weight, premature birth and histopathological findings. Retrospective application on a different cohort imaged at 1.5T illustrates the ability for direct clinical translation. Conclusion: The presented automatic pipeline facilitates a fast, robust and reliable prediction of placental maturation. It yields human-interpretable and verifiable intermediate results and quantifies uncertainties on the cohort-level and for individual predictions. The proposed machine-learning pipeline runs in close to real-time and, deployed in clinical settings, has the potential to become a cornerstone of diagnosis and intervention of placental insufficiency.

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T2*‐weighted placental MRI: basic research tool or emerging clinical test for placental dysfunction?

Cited by 59 publications

References 42 publications

The haemodynamics of the human placenta in utero

The haemodynamics of the human placenta in utero

The haemodynamics of the human placenta in utero

APPLAUSE: Automatic Prediction of PLAcental health via U-net Segmentation and statistical Evaluation

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