Discriminative imaging of maternal and fetal blood flow within the placenta using ultrafast ultrasound
Discriminative imaging of maternal and fetal blood flow within the placenta using ultrafast ultrasound
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DOI：
10.1038/srep13394
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发表时间：
2015-09-16
影响因子：
4.6
通讯作者：
Tanter, Mickael
中科院分区：
文献类型：
--
作者：
Osmanski, Bruno-Felix;Lecarpentier, Edouard;Tanter, Mickael
能够在临床上准确地绘制胎盘血流图可能对妊娠并发症（如宫内生长受限（IUGR））的诊断和随访具有重大意义。此外，这种成像方式对更好地诊断胎盘功能障碍的影响将需要解决尚未解决的问题，即区分强烈复杂的母体和胎儿血管网络。然而，目前还没有一种成像方式可以同时达到足够的灵敏度和选择性来区分这些纠缠流。虽然超声成像将是这种问题的临床选择，但传统的多普勒超声既缺乏检测和绘制胎盘微血管的敏感性，也缺乏区分两种纠缠流的概念。在这项工作中，我们建议使用超快多普勒成像方法，以增强的灵敏度绘制胎盘小血管（类似于100 μ m），并同时评估心脏周期内图像所有像素的多普勒频率变化。这种方法在怀孕兔的胎盘中进行了体内评估：通过逐像素研究局部血流脉动，可以从母体和胎儿的2D血液中分离出它们的脉动行为。意义声明：胎盘内母胎血流在体内的成像和鉴别能力是一个尚未解决的问题，它可以提高对宫内生长受限或先兆子痫等妊娠并发症的诊断。迄今为止，没有一种成像方式具有足够的灵敏度和选择性来区分这些紧密纠缠的流动。我们证明了帧速率比传统成像快100倍的超快多普勒超声方法解决了这一问题。它允许在2D中对胎盘的小血管（类似于100 μ m）进行映射，并具有增强的灵敏度。通过评估单个心脏周期内逐像素的脉搏，它实现了母体和胎儿血流的区分。
Being able to map accurately placental blood flow in clinics could have major implications in the diagnosis and follow-up of pregnancy complications such as intrauterine growth restriction (IUGR). Moreover, the impact of such an imaging modality for a better diagnosis of placental dysfunction would require to solve the unsolved problem of discriminating the strongly intricated maternal and fetal vascular networks. However, no current imaging modality allows both to achieve sufficient sensitivity and selectivity to tell these entangled flows apart. Although ultrasound imaging would be the clinical modality of choice for such a problem, conventional Doppler echography both lacks of sensibility to detect and map the placenta microvascularization and a concept to discriminate both entangled flows. In this work, we propose to use an ultrafast Doppler imaging approach both to map with an enhanced sensitivity the small vessels of the placenta (similar to 100 mu m) and to assess the variation of the Doppler frequency simultaneously in all pixels of the image within a cardiac cycle. This approach is evaluated in vivo in the placenta of pregnant rabbits: By studying the local flow pulsatility pixel per pixel, it becomes possible to separate maternal and fetal blood in 2D from their pulsatile behavior. Significance Statement: The in vivo ability to image and discriminate maternal and fetal blood flow within the placenta is an unsolved problem which could improve the diagnosis of pregnancy complications such as intrauterine growth restriction or preeclampsia. To date, no imaging modality has both sufficient sensitivity and selectivity to discriminate these intimately entangled flows. We demonstrate that Ultrafast Doppler ultrasound method with a frame rate 100x faster than conventional imaging solves this issue. It permits the mapping of small vessels of the placenta (similar to 100 mu m) in 2D with an enhanced sensitivity. By assessing pixel-per-pixel pulsatility within single cardiac cycles, it achieves maternal and fetal blood flow discrimination.