Centre for the Developing Brain, King's College London, London, United Kingdom.
Centre for Medical Engineering, King's College London, London, United Kingdom.
Magn Reson Med. 2023 Mar;89(3):1151-1159. doi: 10.1002/mrm.29483. Epub 2022 Oct 18.
Preterm premature rupture of membranes complicates up to 40% of premature deliveries. Fetal infection may occur in the absence of maternal symptoms, delaying diagnosis and increasing morbidity and mortality. A noninvasive antenatal assessment of early signs of placental inflammation is therefore urgently required.
Sixteen women with preterm premature rupture of membranes < 34 weeks gestation and 60 women with uncomplicated pregnancies were prospectively recruited. A modified diffusion-weighted spin-echo single shot EPI sequence with a diffusion preparation acquiring 264 unique parameter combinations in < 9 min was obtained on a clinical 3 Tesla MRI scanner. The data was fitted to a 2-compartment -intravoxel incoherent motion model comprising fast and slowly circulating fluid pools to obtain quantitative information on perfusion, density, and tissue composition. Z values were calculated, and correlation with time from between the rupture of membranes and the scan, gestational age at delivery, and time between scan and delivery assessed.
Placental was significantly reduced in preterm premature rupture of membranes, and the 2-compartmental model demonstrated that this decline is mainly linked to the perfusion component observed in the placental parenchyma. Multi-modal MRI measurement of placental function is linked to gestational age at delivery and time from membrane rupture.
More complex models and data acquisition can potentially improve fitting of the underlying etiology of preterm birth compared with individual single-contrast models and contribute to additional insights in the future. This will need validation in larger cohorts. A multi-modal MRI acquisition between rupture of the membranes and delivery can be used to measure placental function and is linked to gestational age at delivery.
胎膜早破（PPROM）可导致多达 40%的早产，即使产妇无症状，胎儿仍可能发生感染，从而导致诊断延迟，发病率和死亡率增加。因此，迫切需要一种非侵入性的产前评估方法来早期发现胎盘炎症的迹象。
前瞻性纳入 16 例孕龄<34 周的胎膜早破孕妇和 60 例无并发症的孕妇。在临床 3T MRI 扫描仪上获得一种改良的扩散加权自旋回波单次激发 EPI 序列，该序列在不到 9 分钟的时间内获取 264 种独特的参数组合。将数据拟合到一个包含快速和缓慢循环液池的双室-体素内不相干运动模型，以获得关于灌注、密度和组织成分的定量信息。计算 Z 值，并评估与胎膜破裂和扫描之间的时间、分娩时的孕龄以及扫描和分娩之间的时间之间的相关性。
胎膜早破的胎盘 显著降低，双室模型表明这种下降主要与胎盘实质中观察到的灌注成分有关。胎盘功能的多模态 MRI 测量与分娩时的孕龄和从膜破裂到分娩的时间有关。
与单个单对比模型相比，更复杂的模型和数据采集有可能改善对早产潜在病因的拟合，并为未来提供更多的见解。这需要在更大的队列中进行验证。在胎膜破裂和分娩之间进行多模态 MRI 采集可用于测量胎盘功能，并与分娩时的孕龄有关。
