A placenta-based strategy for improved clinical prediction of fetal growth trajectory using automated image analysis of placental morphology and vascularity

基于胎盘的策略，使用胎盘形态和血管分布的自动图像分析来改进胎儿生长轨迹的临床预测

• 批准号: 10512601
• 负责人: Ipek Oguz
• 金额: $ 60.42万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-05 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10512601
• 关键词: 3D ultrasound; Acoustics; Algorithmic Software; Area; Assessment tool; Award; Biological Markers; Biological Models; Blood; Blood Vessels; Characteristics; Chorion; Clinical; Collaborations; Computers; Custom; Detection; Evaluation; Fetal Growth; Fetal Growth Retardation; Fetal Monitoring; Fetal Weight; Fetus; First Pregnancy Trimester; Gestational Age; Growth; Growth Disorders; Health; Histopathology; Hormonal; Human; Image; Image Analysis; Image Enhancement; Immune; Individual; Infant; Knowledge; Laws; Link; Manuals; Measurement; Measures; Medical Imaging; Metabolic; Methodology; Methods; Modeling; Modernization; Monitor; Morphology; National Institute of Child Health and Human Development; Nutritional; Outcome; PGF gene; Pathologic; Pathology; Pattern; Perinatal; Personal Satisfaction; Physicians; Physics; Placenta; Placental Extracts; Placentation; Play; Postpartum Period; Predictive Factor; Predictive Value; Pregnancy; Prenatal care; Provider; Research; Research Personnel; Risk; Risk Factors; Role; Scientist; Screening procedure; Second Pregnancy Trimester; Serum; Shapes; Site; Small for Gestational Age Infant; Structure; Surface; Techniques; Testing; Time; Ultrasonography; antenatal; antenatal care; automated image analysis; automated segmentation; base; clinical care; deep learning algorithm; density; dynamic system; fetal; healthy pregnancy; histopathological examination; image processing; improved; improved outcome; infant outcome; innovation; interdisciplinary approach; mathematical model; morphometry; novel; novel strategies; open innovation; personalized management; placental morphology; precision medicine; prenatal; prevent; recruit; screening; stillbirth; tool

PROJECT SUMMARY/ABSTRACT Fetal growth restriction is associated with a profound increase in perinatal and even long-term health risk. Antenatal care is key to optimizing outcomes and preventing stillbirth, yet up to half of growth-restricted infants are not identified during pregnancy. The placenta serves a central in maintaining a healthy pregnancy and supporting fetal growth; yet, direct assessment of placental development is glaringly absent from clinical care as there are no practical tools that enable providers to monitor placental development. In recent years, 3D ultrasound (3DUS) has allowed investigators to identify important associations between placental morphology and clinical outcomes using a variety of offline medical image analysis techniques. However, these techniques typically require extensive manual input. Moreover, we have recently developed an innovative tool based on a dynamic model of fetal-placental growth that considers placental growth in the evaluation of fetal growth and can help identify pregnancies at increased risk of growth restriction. However, this tool requires placental volume assessment, which, as mentioned above, remains impractical for clinical use. In this proposal, we will expand and enhance our automated segmentation tools to enable bedside volumetric assessment of the placenta throughout pregnancy. In addition, we will develop novel tools and parameters for assessing placental shape, gross morphology, and vascularity in an effort to identify additional features of placental development that can augment our understanding of placental development and create additional markers of placental health. Taken together, the current proposal leverages an ongoing collaboration between computer scientists and physician-scientists to utilize modern fully automated image analysis methodology to create clinically impactful placental assessment tools that can be integrated into the clinical workflow. The proposed research will allow bedside assessment of placental morphology and vascularity, which can be leveraged into precision medicine approaches and allow for more accurate and reliable surveillance of fetal growth and well-being. Specifically, we will build: 1) Refine and validate a fetal-placental growth model using automated early placental volume and placental histopathology, 2) Extend to include later gestational ages and expand the toolkit to include novel measures of placental shape and vascularity, and 3) create an augmented version of the dynamic model that incorporates the added functionality of our segmentation pipeline, as well as serum biomarkers, to result in a clinically useful tool for monitoring fetal growth. We anticipate that this proposal will significantly change clinical care and create a new, placenta-based paradigm for understanding and managing fetal growth disorders.

项目摘要/摘要 胎儿生长受限与围产期甚至长期健康风险的显著增加有关。 产前护理是优化结局和防止死产的关键，但多达一半的生长受限婴儿 在怀孕期间没有被确认。胎盘在维持健康妊娠中起着中心作用 支持胎儿生长；然而，临床护理中明显缺乏对胎盘发育的直接评估，因为 目前还没有实用的工具来使提供者能够监测胎盘发育。近年来，3D 超声(3DUS)使研究人员能够确定胎盘形态之间的重要联系 以及使用各种离线医学图像分析技术的临床结果。然而，这些技术 通常需要大量的手动输入。此外，我们最近开发了一种创新工具，基于 胎儿-胎盘生长的动态模型，在评估胎儿生长时考虑胎盘生长 帮助识别有更高生长受限风险的怀孕。然而，该工具需要胎盘体积 评估，如上所述，仍然不切实际的临床使用。 在这项提案中，我们将扩展和增强我们的自动分割工具，以实现床边体积测量 妊娠期间对胎盘的评估。此外，我们还将开发新的工具和参数 评估胎盘形状、大体形态和血管，以努力确定胎盘的其他特征 胎盘发育可以增加我们对胎盘发育的理解，并创造更多 胎盘健康的标志物。 综上所述，当前的提案利用了计算机科学家和 医生-科学家利用现代全自动图像分析方法创造临床效果 可集成到临床工作流程中的胎盘评估工具。拟议的研究将允许 床边对胎盘形态和血管的评估，可用于精确医学 这一方法有助于更准确、更可靠地监测胎儿的发育和健康状况。具体来说，我们 将建立：1)使用自动早期胎盘体积和 胎盘组织病理学，2)扩展到包括较晚的孕周，并扩展工具包到包括新的 胎盘形状和血管的测量，以及3)创建动态模型的增强版本 结合了我们的分段管道的附加功能，以及血清生物标志物，以导致 监测胎儿生长发育的临床有用工具。 我们预计，这项建议将显著改变临床护理，并创建一种新的、以胎盘为基础的范例 用于了解和管理胎儿生长障碍。