Association of placental perfusion, as assessed by magnetic resonance imaging and uterine artery Doppler ultrasound, and its relationship to pregnancy outcome
Association of placental perfusion, as assessed by magnetic resonance imaging and uterine artery Doppler ultrasound, and its relationship to pregnancy outcome
复制标题
DOI：
10.1016/j.placenta.2013.07.006
复制
发表时间：
2013-10-01
期刊：
影响因子：
3.8
通讯作者：
Nicolaides, K.
中科院分区：
文献类型：
--
作者：
Derwig, I.;Lythgoe, D. J.;Nicolaides, K.
目的：探讨(A)用两种无创性磁共振成像(MRI)技术测量妊娠中期胎盘血流是否与多普勒超声所评估的子宫动脉血流阻抗有关；方法：对37例妊娠24~29周的单胎孕妇，采用多普勒超声测量子宫动脉搏动指数(PI)，1.5T血流敏感交替反转恢复(FIRE)和体素内非相干运动(IVIM)回波平面成像测量胎盘血流灌注。结果：23例小于胎龄儿与14例足月胎龄儿相比，胎龄较小的胎儿的基础公平测量中位数显著降低(923.0对2359.0个任意单位；p=0.003)，静脉注射测量胎盘底部、中央和整个胎盘区的血流灌注分数(F)(37.8vs.40.7%；p=0.046；24.3vs.35.1%；P=0.014和27.9%vs.36.2%；p=0.001)。SGA组子宫正中动脉PI增加(1.96vs.1.03；p=0.001)。子宫动脉PI与胎盘血流灌注之间有显著的相关性。结论：妊娠合并胎盘发育迟缓的新生儿在妊娠中期经MRI检查发现胎盘血流灌注减少。这一测量结果被发现与子宫动脉的血流阻抗密切相关。我们建议FIRE或IVIM MRI检查可以用来直接和非侵入性地确定胎盘的血流灌注，并且测量值是未来妊娠结局的强有力的指标。(C)爱思唯尔有限公司出版的2013年。
Purpose: To investigate (a) if placental perfusion in the second trimester of pregnancy, measured by two non-invasive magnetic resonance imaging (MRI) techniques, is related to impedance to flow in the uterine arteries, as assessed by Doppler ultrasound; and (b) if these measures are associated with future gestational outcome.Methods: In 37 singleton pregnancies at 24-29 weeks' gestation, uterine artery pulsatility index (PI) was measured by Doppler ultrasound and placental perfusion was measured by Arterial Spin Labelling (flow-sensitive alternating inversion recovery (FAIR)) and intravoxel incoherent motion (IVIM) echo-planar imaging at 1.5 T in basal, central and placental regions of interest. The values were compared between those delivering small for gestational age (SGA) and appropriate for gestational age (AGA) neonates.Results: In 23 pregnancies that resulted in delivery of SGA neonates, compared to the 14 with AGA neonates, the median basal FAIR measure was significantly lower (923.0 vs. 2359.0 arbitrary units; p = 0.003) as were IVIM measures of perfusing fraction (f) in basal, central and whole-placental regions (37.8 vs. 40.7%; p = 0.046; 24.3 vs. 35.1%; p = 0.014 and 27.9% vs. 36.2%; p = 0.001, respectively). In the SGA group, the median uterine artery PI was increased (1.96 vs. 1.03; p = 0.001). There were significant associations between uterine artery PI and placental perfusion assessed by both FAIR and IVIM.Conclusion: Pregnancies that result in SGA neonates exhibited reduced placental perfusion as assessed by MRI during the second trimester. This measurement was found to be strongly associated with impedance to flow in the uterine arteries. We suggest that FAIR or IVIM MRI examinations may be used to directly and non-invasively determine placental perfusion, and that the measured values are strong indicators of future gestational outcome. (C) 2013 Published by Elsevier Ltd.