Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA.
Parkland Health and Hospital System, Dallas, TX, USA.
Eur Radiol. 2023 Dec;33(12):9223-9232. doi: 10.1007/s00330-023-09945-x. Epub 2023 Jul 19.
To evaluate longitudinal placental perfusion using pseudo-continuous arterial spin-labeled (pCASL) MRI in normal pregnancies and in pregnancies affected by chronic hypertension (cHTN), who are at the greatest risk for placental-mediated disease conditions.
Eighteen normal and 23 pregnant subjects with cHTN requiring antihypertensive therapy were scanned at 3 T using free-breathing pCASL-MRI at 16-20 and 24-28 weeks of gestational age.
Mean placental perfusion was 103.1 ± 48.0 and 71.4 ± 18.3 mL/100 g/min at 16-20 and 24-28 weeks respectively in normal pregnancies and 79.4 ± 27.4 and 74.9 ± 26.6 mL/100 g/min in cHTN pregnancies. There was a significant decrease in perfusion between the first and second scans in normal pregnancies (p = 0.004), which was not observed in cHTN pregnancies (p = 0.36). The mean perfusion was not statistically different between normal and cHTN pregnancies at both scans, but the absolute change in perfusion per week was statistically different between these groups (p = 0.044). Furthermore, placental perfusion was significantly lower at both time points (p = 0.027 and 0.044 respectively) in the four pregnant subjects with cHTN who went on to have infants that were small for gestational age (52.7 ± 20.4 and 50.4 ± 20.9 mL/100 g/min) versus those who did not (85 ± 25.6 and 80.0 ± 25.1 mL/100 g/min).
pCASL-MRI enables longitudinal assessment of placental perfusion in pregnant subjects. Placental perfusion in the second trimester declined in normal pregnancies whereas it remained unchanged in cHTN pregnancies, consistent with alterations due to vascular disease pathology. Perfusion was significantly lower in those with small for gestational age infants, indicating that pCASL-MRI-measured perfusion may be an effective imaging biomarker for placental insufficiency.
pCASL-MRI enables longitudinal assessment of placental perfusion without administering exogenous contrast agent and can identify placental insufficiency in pregnant subjects with chronic hypertension that can lead to earlier interventions.
• Arterial spin-labeled (ASL) magnetic resonance imaging (MRI) enables longitudinal assessment of placental perfusion without administering exogenous contrast agent. • ASL-MRI-measured placental perfusion decreased significantly between 16-20 week and 24-28 week gestational age in normal pregnancies, while it remained relatively constant in hypertensive pregnancies, attributed to vascular disease pathology. • ASL-MRI-measured placental perfusion was significantly lower in subjects with hypertension who had a small for gestational age infant at 16-20-week gestation, indicating perfusion as an effective biomarker of placental insufficiency.
利用伪连续动脉自旋标记（pCASL）MRI 评估正常妊娠和患有慢性高血压（cHTN）的妊娠中的胎盘灌注，因为后者有发生胎盘介导疾病的最大风险。
18 名正常妊娠和 23 名患有 cHTN 并需要降压治疗的孕妇分别在 3T 下进行自由呼吸 pCASL-MRI 扫描，扫描时间分别为 16-20 周和 24-28 周。
正常妊娠中，16-20 周和 24-28 周时胎盘灌注分别为 103.1 ± 48.0 和 71.4 ± 18.3 mL/100g/min，cHTN 妊娠中胎盘灌注分别为 79.4 ± 27.4 和 74.9 ± 26.6 mL/100g/min。在正常妊娠中，第一次和第二次扫描之间的灌注显著下降（p=0.004），而在 cHTN 妊娠中则没有观察到这种下降（p=0.36）。两次扫描时，正常妊娠和 cHTN 妊娠的平均灌注无统计学差异，但两组间每周灌注的绝对变化有统计学差异（p=0.044）。此外，与未发生的孕妇相比，在 cHTN 中 4 名最终分娩的胎儿为小于胎龄儿的孕妇（52.7 ± 20.4 和 50.4 ± 20.9 mL/100g/min）的胎盘灌注在两个时间点（p=0.027 和 0.044）均显著降低，而未发生的孕妇（85 ± 25.6 和 80.0 ± 25.1 mL/100g/min）的胎盘灌注无统计学差异。
pCASL-MRI 可实现对妊娠孕妇胎盘灌注的纵向评估。正常妊娠中，胎盘灌注在中期妊娠时下降，而在 cHTN 妊娠中则保持不变，这与血管疾病病理引起的变化一致。在胎儿小于胎龄的孕妇中，灌注明显降低，提示 pCASL-MRI 测量的灌注可能是胎盘功能不全的有效影像学生物标志物。
pCASL-MRI 可在不使用外源性对比剂的情况下对胎盘灌注进行纵向评估，并能识别出有慢性高血压的妊娠孕妇中的胎盘功能不全，从而进行更早的干预。
动脉自旋标记（ASL）磁共振成像（MRI）可在不使用外源性对比剂的情况下对胎盘灌注进行纵向评估。
ASL-MRI 测量的胎盘灌注在正常妊娠中 16-20 周和 24-28 周之间显著下降，而在高血压妊娠中则相对稳定，这归因于血管疾病病理。
在 16-20 周妊娠时患有高血压且胎儿小于胎龄的孕妇中，ASL-MRI 测量的胎盘灌注明显降低，提示灌注作为胎盘功能不全的有效生物标志物。
