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: 10407576
• 负责人: Zungho Zun
• 金额: $ 66.69万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10407576
• 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; Spiral Artery of the Endometrium; Techniques; Testing; Time; Tissues; Uteroplacental Circulation; Uterus; Validation; arterial spin labeling; base; brain magnetic resonance imaging; 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.

妊娠早期，滋养层细胞迁移至螺旋动脉管腔，导致终末期5-10倍 扩张动脉，从而增加流经胎盘的血流量。胎盘功能不全有关系 螺旋动脉转换失败，导致最常见的妊娠并发症 例如胎儿生长受限（FGR）和先兆子痫（PE）。在管理和治疗方面 妊娠因胎盘功能不全而并发时，早期可靠的检测至关重要，因为到时候 胎盘功能障碍明显，对胎儿或母体的病理改变是不可逆的。 已经提出了多种方法来识别子宫内胎盘功能不全。特别是，有 已经提出了各种基于 MRI 的方法来测量胎盘功能。然而，之前所有的研究都部署了 标准脑 MRI 成像方案，未对胎盘进行显着优化，或使用以下方法 对胎盘异常不太敏感。在过去的几年里，我们拥有先进的专用 MRI 使用速度选择性动脉自旋标记进行胎盘特异性灌注和氧合测量的技术 （VSASL）和定量磁化率绘图（QSM），并在我们的研究中展示了有希望的结果 初步数据。在本研究中，我们将首先在 3 T 下优化胎盘 VSASL，以提高信噪比和 图像质量（目标 1）。然后，我们将在确诊的妊娠中应用我们的胎盘 VSASL 和 QSM 方法 使用 FGR 或 PE 和健康妊娠来确定胎盘灌注和氧合的差异 FGR/PE 和控制（目标 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 针对胎盘病理学和临床结果的措施（目标 3）。该项目的顺利完成将 确定胎盘功能不全与体内胎盘灌注/氧合改变之间的关联 测量。最终，这将开发出胎盘健康和疾病的早期且可靠的生物标志物，并将 协助开发和评估旨在改善妊娠结局的新干预方法。