Risk Stratification for Pregnancies Diagnosed With Fetal Growth Restriction Based on Placental <scp>MRI</scp>
Risk Stratification for Pregnancies Diagnosed With Fetal Growth Restriction Based on Placental <scp>MRI</scp>
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基于胎盘 <scp>MRI</scp> 诊断胎儿生长受限的妊娠风险分层
DOI：
10.1002/jmri.28298
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发表时间：
2022
影响因子：
4.4
通讯作者：
Nakamoto Yuji
中科院分区：
文献类型：
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作者：
Himoto Yuki;Fujimoto Koji;Kido Aki;Otani Satoshi;Matsumoto Yuka Kuriyama;Mogami Haruta;Nakao Kyoko Kameyama;Kurata Yasuhisa;Moribata Yusaku;Chigusa Yoshitsugu;Minamiguchi Sachiko;Mandai Masaki;Nakamoto Yuji
背景胎儿生长受限（fetal growth restriction，FGR）的诊断需要区分因病理条件如胎盘功能不全而不能实现其生长潜力的胎儿和体质性小的胎儿。胎盘MRI对诊断为FGR的妊娠进行危险分层的可行性仍未得到证实。PurposeTo探讨定量MRI特征对识别妊娠不良结局有用，并评估MRI视觉分析的诊断性能，以检测妊娠不良结局，在诊断为FGR的妊娠中。研究类型回顾性。人群13例结局不良的妊娠（早产紧急剖宫产或宫内胎儿死亡）和11例妊娠结局良好的孕妇在妊娠21- 36周进行MRI检查。场强/序列A 5-T，半傅立叶采集单次激发快速自旋回波（HASTE），自旋回波回波平面成像（SE‐EPI）和来自SE‐EPI的T2图。评估提取HASTE序列上的胎盘大小和基于T2图的直方图特征。三位放射科医生使用3分Likert量表定性评价了HASTE和SE‐EPI序列上的母体子叶可见性，回波时间（TE）= 60、90和120 msec：0，不存在; 1，不确定; 2，存在。统计学检验Welch t检验或Mann-Whitney U检验用于有利和不利结局组之间的定量特征。三位读片员视觉分析的受试者工作曲线下面积（AUC），以检测妊娠不良结局。结果两组胎盘大小（长轴和短轴、胎盘床估计面积和胎盘体积）和基于T2映射的直方图特征（平均值、偏度和峰度）在统计学上有显著差异。TE = 60 msec时HASTE和SE-EPI的视觉分析显示AUC为0.80-0.86，可检测出不良结局的妊娠。Data Conclusion胎盘大小、直方图特征和胎盘MRI的视觉分析可用于诊断为FGR的妊娠结局的风险分层。
BackgroundDiagnosis of fetal growth restriction (FGR) entails difficulties with differentiating fetuses not fulfilling their growth potential because of pathologic conditions, such as placental insufficiency, from constitutionally small fetuses. The feasibility of placental MRI for risk stratification among pregnancies diagnosed with FGR remains unexplored.PurposeTo explore quantitative MRI features useful to identify pregnancies with unfavorable outcomes and to assess the diagnostic performance of visual analysis of MRI to detect pregnancies with unfavorable outcomes, among pregnancies diagnosed with FGR.Study TypeRetrospective.PopulationThirteen pregnancies with unfavorable outcomes (preterm emergency cesarean section or intrauterine fetal death) and 11 pregnancies with favorable outcomes performed MRI at gestational weeks 21–36.Field Strength/SequenceA 5‐T, half‐Fourier‐acquired single‐shot turbo spin echo (HASTE), spin‐echo echo‐planar imaging (SE‐EPI) and T2 map derived from SE‐EPI.AssessmentPlacental size on HASTE sequences and T2 mapping‐based histogram features were extracted. Three radiologists qualitatively evaluated the visibility of maternal cotyledon on HASTE and SE‐EPI sequences with echo times (TEs) = 60, 90, and 120 msec using 3‐point Likert scales: 0, absent; 1, equivocal; and 2, present.Statistical TestsWelch's t‐test or Mann–Whitney U test for quantitative features between the favorable and unfavorable outcome groups. Areas under the receiver operating curves (AUCs) of the three readers' visual analyses to detect pregnancies with unfavorable outcomes. APvalue of <0.05 was inferred as statistically significant.ResultsPlacental size (major and minor axis, estimated area of placental bed, and volume of placenta) and T2 mapping‐based histogram features (mean, skewness, and kurtosis) were statistically significantly different between the two groups. Visual analysis of HASTE and SE‐EPI with TE = 60 msec showed AUCs of 0.80–0.86 to detect pregnancies with unfavorable outcomes.Data ConclusionPlacental size, histogram features, and visual analysis of placental MRI may allow for risk stratification regarding outcomes among pregnancies diagnosed with FGR.Evidence Level3Technical EfficacyStage 5