Kyoko Kameyama1, Aki Kido1, Yuki Himoto1, Ko Suginami2, Sachiko Minamiguchi3, Ikuo Konishi2, and Kaori Togashi1
1Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 2Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 3Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Synopsis
Half-Fourier
acquisition single-shot turbo spin-echo (HASTE) imaging is now widely used for
placental and fetal imaging due to its rapidity and its low sensitivity to
fetal movement. We aimed to investigate the index of placental dysfunction
using HASTE imaging by comparing T2-relaxation time, which is known to be one of the noninvasive biomarkers for IUGR. The placental SIR to the maternal
psoas muscle (SIRpl/psoas muscle) showed significant correlation
with placental T2 relaxation time. There was possibility that SIRpl/psoas muscle
may have relation with fetal well-beings.Background
The
placenta plays an important role in the growth rate of the fetus and its
well-being and its dysfunction is associated with neonatal morbidity, such as
intrauterine growth restriction (IUGR), the delivery of small-for-gestational
age (SGA) neonates. Recently, quantitative values obtained from MRI has been
reported in many articles for identifying indexes of placental dysfunction or
fetal well-being [1-3]. Half-Fourier acquisition single-shot turbo spin-echo (HASTE) imaging
is now widely used for placental and fetal imaging due to its rapidity and its
low sensitivity to fetal movement[4].
Purpose
The placental T2 relaxation
time is known to be one of the noninvasive biomarkers for IUGR in both human
and animal models[2,5-8]. T2 relaxation time has been reported to
be associated with placental dysfunction, birth of small neonate, complicated
pregnancies such as pre-eclampsia and so on[5,7]. However, the measurements of T2
relaxation time on MRI is time-consuming and not easy for clinical usage. If
placental dysfunction is predicted quantitative value obtained from HASTE image,
it will be a great advantage to evaluating placental well-being. This study
aimed to investigate the index of placental dysfunction by using HASTE imaging.
Methods
This prospective study
included 41 singleton pregnancies who underwent MRI examinations within period
from February 2014 to June 2015, carried out in the Department of Gynecology
and Obsterics. All examinations were performed using a 1.5-Tesla MR units
(Avanto; Siemens Healthcare), with our routine placental MRI protocol,
including three direction of HASTE images, and additionally measurements of T2
relaxation times. As quantitative evaluation, the six signal intensity
ratio(SIR)s measured using HASTE images were included to comparing the
correlation with T2-values of placenta. The six SIRs were as follows: the
placental SIR to the amniotic fluid (SIR
pl/amn. flu. = placental mean SI
HASTE /
mean SI amniotic fluid), to the fetal ocular globes (SIR
pl/ocular globe),
to the gastric fluid (SIR
pl/gastric flu.), to the bladder (SIR
pl/bladder),
to the maternal psoas major muscles (SIR
pl/psoas muscle) and to the
maternal abdominal subcutaneous adipose tissue (SIR
pl/adipose tissue).
The measurements were performed by one reader. In cases with delivered placenta,
we compared T2 relaxation time and SIR
pl/psoas muscle between
histopathologically abnormal and normal placentas in 3rd trimester.
Results
Thirty-nine placentas were calculated T2
relaxation time and signal intensity ratio(SIR)s and the following cases were
excluded due to oligohydramnios (n=1), chronic abruption-oligohydramnios
sequence(CAOS)(n=1). Among these 39 cases, histopathological examinations were
performed on 21cases (normal 12 cases, abnormal 9cases). Since other 15 were
regarded as “normal placenta” clinically, pathological diagnoses were not
performed. The remaining two cases could not followed and one placenta was
remained within the uterus due to placenta accreta.
The
most significant correlation with placental T2 relaxation time were observed
with SIR
pl/psoas muscle (r= -0.4145, p= 0.0087; Fig.1), and there
is a weak association between placental T2 relaxation and SIR
pl/ocular
globe (r= -0.3414, P=0.033). In the comparison between histopathologically
abnormal (n=11) and normal (n=20) placentas in 3rd trimester, the
value for normal placenta was higher in both T2 relaxation times and SIR
pl/psoas
muscle, though there was no significance (p=0.016, p=0.098, respectively).
Discussion and conclusion
This study revealed that
placental signal intensity ratio(SIR) in HASTE imaging was well associated
with placental T2 relaxation time, which has been known to show close correlation
with placental dysfunction. Especially, the placental signal intensity ratio to
the maternal psoas major muscles (SIR
pl/psoas muscle) showed the
best correlation to T2 relaxation times of placenta. The signal intensity of maternal
psoas major muscles can be obtained without effect of motion artifact of the
fetus such as amniotic fluid and bladder. In addition, there was possibility
that SIR
pl/psoas muscle may have relation with fetal outcomes. Since
HASTE image is now essential sequence for fetal imaging, radiologists may
indicate the placenta and fetal functional condition using SIR
pl/psoas
muscle in addition to the morphological information.
Acknowledgements
No acknowledgement found.References
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