Novel use of proton magnetic resonance spectroscopy (1HMRS) to non-invasively assess placental metabolism.
Novel use of proton magnetic resonance spectroscopy (1HMRS) to non-invasively assess placental metabolism.
复制标题
质子磁共振光谱（1HMR）的新型使用用于非侵入性评估胎盘代谢。
DOI：
10.1371/journal.pone.0042926
复制
发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Norman JE
中科院分区：
文献类型：
--
作者：
Denison FC;Semple SI;Stock SJ;Walker J;Marshall I;Norman JE
胎盘功能不全是产前死胎和胎儿生长受限（FGR）的主要原因。在受影响的妊娠中，当继续妊娠的风险超过早产的风险时，分娩会加快。目前的测试无法评估胎盘功能，并确定最佳分娩时间。一个准确的，非侵入性的测试，明确界定失败的胎盘将解决一个主要的未满足的临床需求。质子磁共振光谱（1H MRS）可用于评估体内组织的代谢特征。在FGR妊娠中，N-乙酰天冬氨酸（NAA）/胆碱比值的降低和乳酸甲酯的检测分别成为神经元代谢受损和胎儿缺氧的生物标志物。然而，胎儿脑缺氧是一个晚期，有时是致命的事件，胎盘妥协，限制了临床效用的大脑1H MRS，以防止死产。我们假设异常的胎盘1H MRS可能是宫内缺氧的早期生物标志物，为优化高危胎儿的分娩时间提供了机会。我们招募了三名患有严重胎盘功能不全/FGR的妇女和三名匹配的对照。使用3 T MR系统和相控阵线圈组合，沿着胎盘“长轴”选择20×20×40 mm 1H MRS体素，在体素周围放置饱和带以防止污染信号。在所有健康胎盘中检测到显著的胆碱峰（胆碱/脂质比1.35-1.79）。相反，在妊娠合并FGR的患者中，所有胎盘的胆碱/脂质比均≤0.02，尽管脂质峰得以保留（p<0.001）。这项新的概念验证研究表明，在重度胎盘功能不全/FGR中，通过1H MRS观察到的胆碱/脂质比降低60倍可能代表严重胎盘功能不全的早期生物标志物。进一步的研究将确定该测试的性能和1H-MRS在胎盘功能体内评估中的潜在作用，以告知分娩时间。
Placental insufficiency is a major cause of antepartum stillbirth and fetal growth restriction (FGR). In affected pregnancies, delivery is expedited when the risks of ongoing pregnancy outweigh those of prematurity. Current tests are unable to assess placental function and determine optimal timing for delivery. An accurate, non-invasive test that clearly defines the failing placenta would address a major unmet clinical need. Proton magnetic resonance spectroscopy (1H MRS) can be used to assess the metabolic profile of tissue in-vivo. In FGR pregnancies, a reduction in N-acetylaspartate (NAA)/choline ratio and detection of lactate methyl are emerging as biomarkers of impaired neuronal metabolism and fetal hypoxia, respectively. However, fetal brain hypoxia is a late and sometimes fatal event in placental compromise, limiting clinical utility of brain 1H MRS to prevent stillbirth. We hypothesised that abnormal placental 1H MRS may be an earlier biomarker of intrauterine hypoxia, affording the opportunity to optimise timing of delivery in at-risk fetuses. We recruited three women with severe placental insufficiency/FGR and three matched controls. Using a 3T MR system and a combination of phased-array coils, a 20×20×40 mm1H MRS voxel was selected along the ‘long-axis’ of the placenta with saturation bands placed around the voxel to prevent contaminant signals. A significant choline peak (choline/lipid ratio 1.35–1.79) was detected in all healthy placentae. In contrast, in pregnancies complicated by FGR, the choline/lipid ratio was ≤0.02 in all placentae, despite preservation of the lipid peak (p<0.001). This novel proof-of-concept study suggests that in severe placental insufficiency/FGR, the observed 60-fold reduction in the choline/lipid ratio by 1H MRS may represent an early biomarker of critical placental insufficiency. Further studies will determine performance of this test and the potential role of 1H-MRS in the in-vivo assessment of placental function to inform timing of delivery.
登录
查看更多内容
影响因子：
7.2
作者：
Heazell, Alexander E. P.;Sharp, Andrew N.;Crocker, Ian P.
通讯作者：
Crocker, Ian P.
DOI：
10.1111/j.1471-0528.2006.00882.x
发表时间：
2006-05-01
影响因子：
5.8
作者：
Egbor, M;Ansari, T;Sibbons, PD
通讯作者：
Sibbons, PD
影响因子：
3.8
作者：
Dunn, W. B.;Brown, M.;Heazell, A. E. P.
通讯作者：
Heazell, A. E. P.
影响因子：
3.1
作者：
Bonellie S;Chalmers J;Gray R;Greer I;Jarvis S;Williams C
通讯作者：
Williams C
影响因子：
2
作者：
Kakogawa, Jun;Sumimoto, Kazuhiro;Kanayama, Naohiro
通讯作者：
Kanayama, Naohiro