Interpretation of Wave Reflections in the Umbilical Arterial Segment of the Feto-Placental Circulation: Computational Modeling of the Feto-Placental Arterial Tree.
Interpretation of Wave Reflections in the Umbilical Arterial Segment of the Feto-Placental Circulation: Computational Modeling of the Feto-Placental Arterial Tree.
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DOI：
10.1109/tbme.2021.3082064
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发表时间：
2021-12
期刊：
影响因子：
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通讯作者：
Sled J
中科院分区：
文献类型：
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作者：
Saghian R;Cahill L;Rahman A;Steinman J;Stortz G;Kingdom J;Macgowan C;Sled J
胎盘血管异常与许多妊娠并发症相关，包括胎盘介导的胎儿生长受限（FGR）。脐动脉 (UA) 多普勒超声速度波形广泛用于诊断疑似 FGR 妊娠的潜在胎盘血管异常，这有助于通过持续的胎儿监测和及时分娩来预防死产。然而，UA 多普勒诊断的敏感性在妊娠后期降低。我们的目标是提出一种广义的波分解方法来计算 UA 波形的前向和反射分量。还开发了一个详细的基于解剖学的模型来解释观察到的 UA 血流波形并探索血管特性如何影响血流波分量的形状。利用之前使用高频超声显微镜对怀孕小鼠进行的研究数据，我们检查了 15 名胎儿 UA 的子宫内多普勒和 M 型超声测量结果。超声检查后，收集胎盘并灌注造影剂，以获得胎儿胎盘动脉的高分辨率 3D 图像。这些样本的模型表明终端负载阻抗（毛细管和/或静脉）在产生正反射流波形或负反射流波形中的重要作用。当终端阻抗升高时，会得到负流反射波形。这与所提出的导致早发性 FGR 中发现的高度异常 UA 波形的细长且不分支的终末绒毛一致。这些发现对于 UA 多普勒在人类妊娠中的诊断效用的意义在于，波反射的识别和测量可能有助于区分疑似迟发性 FGR 妊娠的健康和异常胎盘脉管系统。
Placental vascular abnormalities are associated with a host of pregnancy complications including placenta mediated fetal growth restriction (FGR). Umbilical arterial (UA) Doppler ultrasound velocity waveforms are widely used in the diagnosis of underlying placental vascular abnormalities in pregnancies with suspected FGR, which greatly helps to prevent stillbirth via ongoing fetal monitoring and timely delivery. However, the sensitivity of UA Doppler diagnosis diminishes late in gestation. Our goal was to present a generalized wave decomposition method to compute forward and reflected components from UA waveforms. A detailed anatomical based model was also developed to explain observed UA flow waveform and to explore how vascular properties affect the shape of flow wave components. Using data from a previous study of pregnant mice using high frequency ultrasound microscopy, we examined in utero Doppler and M-mode ultrasound measurements in 15 fetuses’ UA. Following ultrasound, the placentas had been collected and perfused with contrast agent to obtain high-resolution 3D images of the feto-placental arteries. Model of these specimens indicates the significant role of terminal load impedance (capillary and/or veins) in creating positive or negative reflected flow waveforms. A negative flow reflected waveform is obtained when terminal impedance is elevated. This is consistent with the elongated and non-branching terminal villi that are proposed cause the highly abnormal UA waveforms found in early-onset FGR. The significance of these findings for the diagnostic utility of UA Doppler in human pregnancy is that the identification and measurement of wave reflections may aid in discriminating between healthy and abnormal placental vasculature in pregnancies with suspected late-onset FGR.
DOI：
10.1038/jcbfm.2014.229
发表时间：
2015-03
期刊：
Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
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