Functional and Radiomic Magnetic Resonance Profiling in Normal and Hypertensive Placentas

项目摘要 三分之一患有慢性高血压（CHTN）的孕妇因以下并发症而早产： 叠加先兆子痫或胎儿生长受限（FGR）。具体目标是：1）前瞻性评价 通过功能性磁共振成像（MRI）对健康孕妇的胎盘进行纵向扫描， 患有CHTN的孕妇; 2）提取正常和高血压胎盘中的放射组学纹理特征，以及3） 对感兴趣区域的自动分割进行技术改进，以描绘 胎盘异常我们将对20名正常孕妇和40名CHTN孕妇进行研究， 怀孕将在孕早期和孕中期晚期进行MRI，以通过动脉自旋评估灌注 标记（ASL）、通过体素内非相干运动（IVIM）的扩散、扩散加权成像（DWI）和DWI- 推导表观扩散系数（ADC）映射，并通过血氧水平的T2* 进行氧合 依赖性（粗体）MRI。放射组学纹理特征也可以从MR成像中提取并自动化 分割应用于更主观的胎盘评估。这个职业发展奖将建立 博士Herrera作为一名临床研究者，专注于胎盘发育的非侵入性成像评估 和功能障碍。该奖项将为她提供在3个领域发展专业知识所需的支持：1）临床 研究2）先进成像模式的应用和解释，以及3）术后的技术技能， 处理和深度学习。为了实现这些目标，Herrera博士组建了一个跨学科的团队， 具有临床研究、胎盘成像、后处理和自动分割方面的专业知识 技术.她的主要导师，凯瑟琳·斯庞博士，有着长期成功的临床记录， 翻译和基础科学研究，包括270多篇同行评审出版物和指导教师， 成为独立调查员。这项提案的重点是人类胎盘。尽管150多年来， 胎盘研究，胎盘在妊娠相关疾病的病理作用仍然很差 明白了解正常的胎盘发育和胎盘疾病中存在的变化， 为促进妊娠期病理状况的临床预测提供基础， 测试干预措施的机会。在本研究中，我们将解决未满足的临床需求，以表征 正常胎盘发育和体内胎盘功能障碍。我们选择比较正常妊娠 患有慢性高血压的孕妇，因为这些妇女的胎盘- 介导的疾病。本项目的成功完成将使我们更好地了解胎盘， 正常妊娠和受慢性高血压影响的妊娠。我们还将把我们的结果与 先兆子痫和FGR的临床结局。考虑到先兆子痫和胎儿生长迟缓的风险增加 在患有慢性高血压的孕妇中，我们从这些结果中期待更多的见解和新的发现。 关于预测先兆子痫和FGR的潜在放射性生物标志物的假设。

PROJECT SUMMARY One in 3 pregnant women with chronic hypertension (CHTN) deliver preterm from complications of superimposed preeclampsia or fetal growth restriction (FGR). The specific aims are: 1) prospectively evaluate the placental longitudinally via functional magnetic resonance imaging (MRI) in healthy pregnant women and pregnant women with CHTN; 2) extract radiomics texture features in normal and hypertensive placentas and 3) execute technical refinement toward automated segmentation for regions of interest to delineate patterns in placental abnormalities. We will study 20 normal pregnant women and 40 pregnant women with CHTN across gestation. MRI will be performed in the early and late second trimester to assess perfusion via arterial spin labeling (ASL), diffusion via intra-voxel incoherent motion (IVIM) diffusion weighted imaging (DWI) and DWI- derived apparent diffusion coefficient (ADC) mapping, and oxygenation via T2* from blood-oxygen level dependent (BOLD) MRI. Radiomics texture features also be extracted from MR imaging and automated segmentation applied for more subjective placental assessment. This career development award will establish Dr. Herrera as a clinical investigator focused on non-invasive imaging assessment of placental development and dysfunction. The award will provide her with the support needed to develop expertise in 3 areas: 1) clinical research 2) application and interpretation of advanced imaging modalities, and 3) technical skills of post- processing and deep learning. To achieve these goals, Dr. Herrera has assembled an interdisciplinary team with expertise in clinical investigation, placental imaging, and post-processing and automated segmentation techniques. Her primary mentor, Dr. Catherine Spong, has a long track record of successful clinical, translational, and basic science research including over 270 peer review publications and mentoring faculty to become independent investigators. The focus of this proposal is on the human placenta. Despite 150+ years of placental research, the role of the placenta in the pathology of pregnancy-related disease remains poorly understood. Understanding normal placental development and changes present in placental disease will provide a foundation to facilitate clinical prediction of pathologic conditions during pregnancy and provide an opportunity to test interventions. In this study, we will address the unmet clinical need to characterize both normal placental development and placental dysfunction in vivo. We have chosen to compare normal pregnant women with pregnant women with chronic hypertension as these women are increased risk for placental- mediated disease. Successful completion of this project will allow for better understanding of the placenta in normal pregnancy and pregnancy affected by chronic hypertension. We will also correlate our results with clinical outcomes of preeclampsia and FGR. Given the increased risk of superimposed preeclampsia and FGR in pregnant women with chronic hypertension, we anticipate from these results additional insights and novel hypotheses regarding potential radiomic biomarkers for the prediction of preeclampsia and FGR.