Department of Obstetrics and Gynecology, University of Rome Sapienza, Viale del Policlinico 155, Rome, Italy.
Placenta. 2010 Dec;31(12):1051-6. doi: 10.1016/j.placenta.2010.09.004. Epub 2010 Oct 23.
Magnetic resonance imaging requested for a potentially serious indication, provided a unique opportunity to explore the intervillous circulation of placentas from pregnancies complicated by Intra Uterine Growth Restriction (IUGR) and to compare them to normal cases. This allowed an innovative characterization of in vivo utero-placental blood flow, correlating a compromised intervillous circulation in IUGR to the deterioration of fetal condition. MR imaging was requested to rule out suspected posterior placental adhesive disorders in 26 patients. Twelve patients had fetuses appropriate for gestational age, while in 14 patients fetuses were affected by severe IUGR. Multiphasic dynamic contrast-enhanced sagittal sequences were acquired and a quantitative analysis of signal intensity and enhancement kinetics was performed for both the entire placenta and for selected regions. Images disclosed a homogeneous perfusion overall the placenta in normal cases, while IUGR placentas displayed a slow intervillous blood flow, along with many patchy unperfused areas. Intermittent stops worsen the perfusion dynamics of the intervillous mostly in IUGR cases with an elevated ductus venosus pulsatility index. In conclusion, we proved that in IUGR placenta maternal placental blood flow is extremely compromised and that superimposed dynamic phenomena concur to worsen the intervillous circulation leading to an end-stage fetal decompensation.
磁共振成像（MRI）用于潜在严重的指征，为探索因宫内生长受限（IUGR）而复杂化的胎盘绒毛间隙循环提供了独特的机会，并将其与正常情况进行比较。这使得对宫内胎盘血流进行创新的特征描述成为可能，将绒毛间隙循环受损与胎儿状况恶化相关联。MRI 用于排除 26 例疑似胎盘后粘连障碍。12 例患者胎儿符合孕龄，而 14 例患者胎儿受到严重 IUGR 的影响。获得多相动态对比增强矢状序列，并对整个胎盘和选定区域的信号强度和增强动力学进行定量分析。图像显示在正常情况下胎盘整体灌注均匀，而 IUGR 胎盘显示出缓慢的绒毛间隙血流，伴有许多片状未灌注区域。间歇性停止会恶化绒毛间隙的灌注动力学，尤其是在静脉导管搏动指数升高的 IUGR 病例中。总之，我们证明了在 IUGR 胎盘中，母体胎盘血流严重受损，叠加的动态现象共同导致绒毛间隙循环恶化，导致胎儿终末失代偿。
