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

项目总结/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预防死产的关键，但多达一半的生长受限婴儿 在怀孕期间无法识别。胎盘是维持健康妊娠的中心， 支持胎儿生长;然而，胎盘发育的直接评估在临床护理中缺乏， 没有实用的工具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学之间的重要联系， 和临床结果。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，并可 帮助识别生长受限风险增加的妊娠。然而，该工具需要胎盘体积 评估，如上所述，这对于临床使用仍然是不切实际的。 在本提案中，我们将扩展和增强我们的自动分割工具， 评估整个妊娠期间的胎盘。此外，我们将开发新的工具和参数， 评估胎盘形状、大体形态和血管分布，以确定 胎盘发育，可以增加我们对胎盘发育的理解， 胎盘健康的标志 总的来说，目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， 胎盘评估工具，可以集成到临床工作流程。这项研究将使 胎盘形态和血管分布的床旁评估，可用于精准医疗 这是一种新的方法，可以更准确和可靠地监测胎儿的生长和健康。我们特别 将建立：1）使用自动化早期胎盘体积优化和验证胎儿-胎盘生长模型， 胎盘组织病理学，2）扩展至包括晚孕龄，并扩展工具包以包括新的 胎盘形状和血管分布的测量，以及3）创建动态模型的增强版本， 结合了我们的分割管道的附加功能以及血清生物标志物， 临床上有用的工具，用于监测胎儿生长。 我们预计，这一建议将大大改变临床护理，并创造一个新的，胎盘为基础的范例 了解和管理胎儿生长障碍。

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.