Perfusion fraction derived from diffusion-weighted MRI in the assessment of placental vascular malperfusion antenatally
Authors
Kragsterman, Ellen Maria Vilhelmina ; Malmberg, Molly Maine
Term
5. Term (Master thesis)
Education
Publication year
2021
Pages
14
Abstract
Placentaens blodforsyning er afgørende for fosterets vækst, men specifik vaskulær malperfusion diagnosticeres ofte først efter fødslen. Dette case-kontrol-studie vurderede, om perfusionsfraktionen (f) udledt af diffusionsvægtet MR (DWI) kan identificere bestemte typer af placental vaskulær malperfusion antenatalt. Vi analyserede 93 singleton-graviditeter med placental DWI i gestationsuge 23,9–41,3 og postpartum histopatologi som reference: 44 normale kontroller og 49 med vaskulær malperfusion (maternel n=30, føtal n=13, begge n=6). Regioner af interesse blev tegnet på tre placentale snit pr. case, og gennemsnitlig f blev estimeret med intravoxel incoherent motion (IVIM)-analyse. Hos normale placentae var f i gennemsnit 26,02% (SD 4,55) uden lineær korrelation til gestationsalder (p=0,72). Samlet set var f ikke signifikant forskellig mellem alle malperfusions-cases og kontroller (24,74% vs. kontroller, p=0,25). Ved føtal vaskulær malperfusion var f derimod lavere (22,73%, p=0,03), mens der ikke sås forskel ved maternel malperfusion (25,24%, p=0,55). Disse fund indikerer, at DWI-afledt f kan differentiere føtal vaskulær malperfusion fra normal placentahistologi in vivo og potentielt supplere den antenatale udredning, men yderligere forskning er nødvendig før klinisk implementering.
Placental blood flow is critical for fetal growth, yet specific vascular malperfusion is often diagnosed only after birth. This case-control study evaluated whether the placental perfusion fraction (f) derived from diffusion-weighted MRI (DWI) can identify specific types of placental vascular malperfusion antenatally. We analyzed 93 singleton pregnancies with placental DWI between 23.9 and 41.3 weeks’ gestation and postpartum histopathology as reference: 44 normal controls and 49 with vascular malperfusion (maternal n=30, fetal n=13, both n=6). Regions of interest were drawn on three placental slices per case, and mean f was estimated using intravoxel incoherent motion (IVIM) analysis. In normal placentas, mean f was 26.02% (SD 4.55) with no linear correlation to gestational age (p=0.72). Overall, f did not differ significantly between all malperfusion cases and controls (24.74% vs controls, p=0.25). However, placentas with fetal vascular malperfusion had a lower f (22.73%, p=0.03), while cases with maternal vascular malperfusion showed no significant difference (25.24%, p=0.55). These findings suggest that DWI-derived f can distinguish fetal vascular malperfusion from normal placental histology in vivo and could complement antenatal assessment, although further research is required before clinical implementation.
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