利用血氧水平依赖 MRI 研究先天性心脏病胎儿母体高氧血症时胎盘和脑的血液动力学反应。
Hemodynamic Responses of the Placenta and Brain to Maternal Hyperoxia in Fetuses with Congenital Heart Disease by Using Blood Oxygen-Level Dependent MRI.
机构信息
From the Divisions of Diagnostic Imaging & Radiology (W.Y., K.K., C.L.), Neonatology (N.N.A.), Cardiology (M.T.D.), Fetal & Transitional Medicine (M.T.D., C.L.), and Epidemiology and Biostatistics (M.J.), Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010; and Department of Pediatrics, George Washington University School of Medicine, Washington, DC (N.N.A., M.T.D., C.L.).
出版信息
Radiology. 2020 Jan;294(1):141-148. doi: 10.1148/radiol.2019190751. Epub 2019 Nov 5.
Background Impaired brain development in fetuses with congenital heart disease (CHD) may result from inadequate cerebral oxygen supply in utero. Purpose To test whether fetal cerebral oxygenation can be increased by maternal oxygen administration, effects of maternal hyperoxia on blood oxygenation of the placenta and fetal brain were examined by using blood oxygenation level-dependent (BOLD) functional MRI. Materials and Methods In this prospective study, BOLD MRI was performed in 86 fetuses (56 healthy fetuses and 30 fetuses diagnosed with CHD) between 22 and 39 weeks gestational age (GA) from May 2015 to December 2017, with the following study design: phase I, 2-minute resting state at baseline (room air); phase II, 6-minute maternal hyperoxia with 100% oxygen; and phase III, 5.6-minute return to resting state. After motion correction, the signals were averaged over the placenta and fetal brain and converted to the change in R2* (ΔR2*). Fetuses with CHD were categorized into those with a single ventricle (SV) or two ventricles (TVs) and those with aortic obstruction (AO) or non-AO. Data were analyzed by using generalized linear mixed models controlling for GA and sex. Results Placental ΔR2* increased during maternal hyperoxia in healthy fetuses and fetuses with CHD, but it was higher in SV CHD (mean ΔR2*, 1.3 sec ± 0.1 [standard error; < .01], 1.9 sec ± 0.2 [ < .01], and 1.0 sec ± 0.3 [ < .01], respectively, for control fetuses, fetuses with SV CHD, and fetuses with TV CHD). Placental ΔR2* during maternal hyperoxia changed with GA in healthy control fetuses and fetuses with SV or AO CHD (ΔR2* per week, 0.1 sec ± 0 [ < .01], 0.2 sec ± 0 [ = .01], and 0.2 sec ± 0 [ = .01], respectively), but not in fetuses with CHD and TV or non-AO. Fetal brain ΔR2* was constant across all phases in healthy control fetuses and fetuses with TV CHD but increased during maternal hyperoxia in fetuses with SV or AO CHD (mean ΔR2*, 0.7 sec ± 0.2 [ = .01] and 0.5 sec ± 0.2 [ = .02], respectively). Conclusion Six minutes of maternal hyperoxia increased placental oxygenation in healthy fetuses and fetuses with congenital heart disease, and it selectively increased cerebral blood oxygenation in fetuses with single ventricle or aortic obstruction. © RSNA, 2019
背景 先天性心脏病（CHD）胎儿的脑发育受损可能是由于宫内脑供氧不足所致。
目的 本研究旨在通过血氧水平依赖功能磁共振成像（BOLD fMRI）检测母体高氧对胎盘和胎儿脑血氧的影响，探讨是否可以通过母体给氧增加胎儿脑氧合。
材料与方法 本前瞻性研究于 2015 年 5 月至 2017 年 12 月期间纳入了 86 例胎龄为 22 周至 39 周的胎儿（56 例健康胎儿和 30 例 CHD 胎儿），研究设计如下：Ⅰ期，在基线时（室内空气）静息状态 2 分钟；Ⅱ期，母体高氧 6 分钟，吸入 100%氧气；Ⅲ期，恢复静息状态 5.6 分钟。经运动校正后，将信号平均到胎盘和胎儿脑，并转换为 R2变化（ΔR2）。将 CHD 胎儿分为单心室（SV）或双心室（TV）以及主动脉梗阻（AO）或非 AO 组。通过控制胎龄和性别，采用广义线性混合模型进行数据分析。
结果 在健康胎儿和 CHD 胎儿中，母体高氧期间胎盘 ΔR2增加，但在 SV-CHD 胎儿中更高（平均 ΔR2，对照组胎儿为 1.3 秒±0.1[标准误差；<.01]，SV-CHD 胎儿为 1.9 秒±0.2[<.01]，TV-CHD 胎儿为 1.0 秒±0.3[<.01]）。健康对照组胎儿、SV 或 AO-CHD 胎儿的胎盘 ΔR2在母体高氧期间随胎龄变化（每增加一周，ΔR2分别为 0.1 秒±0[<.01]、0.2 秒±0[=.01]和 0.2 秒±0[=.01]），但在 CHD 胎儿和 TV 或非-AO 胎儿中无变化。在健康对照组胎儿和 TV-CHD 胎儿中，胎儿脑 ΔR2在所有阶段均保持不变，但在 SV 或 AO-CHD 胎儿中，母体高氧期间增加（平均 ΔR2，0.7 秒±0.2[=.01]和 0.5 秒±0.2[=.02]）。
结论 6 分钟母体高氧增加了健康胎儿和 CHD 胎儿的胎盘氧合，并且选择性地增加了 SV 或 AO 胎儿的脑血氧。
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