Assessment of placental perfusion and oxygenation using novel MRI approaches.

使用新型 MRI 方法评估胎盘灌注和氧合。

• 批准号: 10164841
• 负责人: Zungho Zun
• 金额: $ 2.51万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-07 至 2021-06-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10164841
• 关键词: Abnormal placentation; Address; Arteries; Biological Markers; Blood; Blood flow; Brain; Cells; Clinic; Clinical; Data; Detection; Diagnosis; Disease; Early Intervention; Failure; Fetal Growth; Fetal Growth Retardation; Fetal Heart; Fetal health; Fetus; Functional disorder; Gestational Age; Growth and Development function; Health; Heart Diseases; Image; Injury; Intervention; Invaded; Label; Magnetic Resonance Imaging; Measurement; Measures; Methods; Mothers; Motion; Neonatal; Noise; Outcome; Pathologic; Pathology; Perfusion; Phase; Physiologic pulse; Placenta; Placental Insufficiency; Pre-Eclampsia; Predisposition; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Regional Blood Flow; Relaxation; Risk; Sample Size; Scanning; Scheme; Signal Transduction; Site; Spin Labels; Spiral Artery of the Endometrium; Techniques; Testing; Time; Tissues; Uteroplacental Circulation; Uterus; Validation; base; healthy pregnancy; imaging modality; implantation; improved; in utero; in vivo; migration; novel; perfusion imaging; trophoblast; water diffusion

Early in pregnancy migration of trophoblast cells to the lumen of the spiral arteries leads to 5-10 fold terminal dilation of the arteries, thereby increasing blood flow through the placenta. Placental insufficiency is associated with failure of this conversion of the spiral arteries, and results in the most common complications of pregnancy such as fetal growth restriction (FGR) and preeclampsia (PE). In the management and treatment of pregnancies complicated by placental insufficiency, early and reliable detection is critical, because by the time placental dysfunction becomes evident, the pathological changes to the fetus or mother are irreversible. Numerous approaches have been suggested for identifying placental insufficiency in utero. Particularly, there have been various MRI-based methods proposed to measure placental function. However, all of prior studies deployed standard imaging schemes of brain MRI without significant optimization for the placenta or used the methods that are not very sensitive to placental abnormalities. Over the past several years, we have advanced dedicated MRI techniques for placental-specific perfusion and oxygenation measures using velocity-selective arterial spin labeling (VSASL) and quantitative susceptibility mapping (QSM), and have demonstrated promising results in our preliminary data. In this study, we will first optimize placental VSASL at 3 T for improved signal-to-noise ratio and image quality (aim 1). We will then apply our approaches of placental VSASL and QSM in pregnancies diagnosed with FGR or PE and healthy pregnancies to determine differences in placental perfusion and oxygenation between FGR/PE and controls (aim 2). Lastly, we will validate our MR imaging methods by comparing in-vivo placental measures against placental pathology and clinical outcomes (aim 3). Successful completion of this project will determine the association between placental insufficiency and altered in-vivo placental perfusion/oxygenation measurements. Ultimately, this will develop early and reliable biomarkers of placental health and disease, and will assist in developing and assessing new interventional approaches aimed to improve pregnancy outcomes.

怀孕的早期，滋养细胞细胞向螺旋动脉腔的迁移导致5-10倍末端 动脉扩张，从而增加了血液流过胎盘的流动。胎盘不足与 随着这种螺旋动脉转化的失败，并导致怀孕最常见的并发症 例如胎儿生长限制（FGR）和先兆子痫（PE）。在管理和处理 胎盘功能不全，早期和可靠检测复杂的妊娠至关重要，因为到了 胎盘功能障碍变得明显，胎儿或母亲的病理变化是不可逆的。 已经提出了许多方法来确定子宫内胎盘不足。特别是 提出了各种基于MRI的方法来测量胎盘功能。但是，所有先前的研究都部署了 脑MRI的标准成像方案，没有对胎盘的显着优化或使用的方法 对胎盘异常不太敏感。在过去的几年中，我们提高了专用MRI 使用速度选择性动脉自旋标记的胎盘特异性灌注和氧合测量的技术 （VSASL）和定量敏感性映射（QSM），并在我们的 初步数据。在这项研究中，我们将首先优化3 t的胎盘VSASL，以提高信噪比和 图像质量（目标1）。然后，我们将在诊断的怀孕中应用胎盘VSASL和QSM的方法 FGR或PE和健康怀孕，以确定胎盘灌注和氧合的差异 FGR/PE和控件（AIM 2）。最后，我们将通过比较体内胎盘来验证我们的MR成像方法 针对胎盘病理和临床结果的措施（AIM 3）。成功完成该项目将 确定胎盘功能不全和体内胎盘灌注/氧合之间的关联 测量。最终，这将发展胎盘健康和疾病的早期可靠的生物标志物，并将 协助开发和评估旨在改善妊娠结局的新介入方法。