Elizabeth Garret Anderson Institute for Women's Health, University College London, UK; School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK.
School of Biomedical Engineering and Imaging Sciences (BMEIS), King's College London, UK.
Placenta. 2023 Oct;142:36-45. doi: 10.1016/j.placenta.2023.08.066. Epub 2023 Aug 19.
Comprehensive imaging using ultrasound and MRI of placenta accreta spectrum (PAS) aims to prevent catastrophic haemorrhage and maternal death. Standard MRI of the placenta is limited by between-slice motion which can be mitigated by super-resolution reconstruction (SRR) MRI. We applied SRR in suspected PAS cases to determine its ability to enhance anatomical placental assessment and predict adverse maternal outcome.
Suspected PAS patients (n = 22) underwent MRI at a gestational age (weeks + days) of (32±3, range (27-38)). SRR of the placental-myometrial-bladder interface involving rigid motion correction of acquired MRI slices combined with robust outlier detection to reconstruct an isotropic high-resolution volume, was achieved in twelve. 2D MRI or SRR images alone, and paired data were assessed by four radiologists in three review rounds. All radiologists were blinded to results of the ultrasound, original MR image reports, case outcomes, and PAS diagnosis. A Random Forest Classification model was used to highlight the most predictive pathological MRI markers for major obstetric haemorrhage (MOH), bladder adherence (BA), and placental attachment depth (PAD).
At delivery, four patients had placenta praevia with no abnormal attachment, two were clinically diagnosed with PAS, and six had histopathological PAS confirmation. Pathological MRI markers (T2-dark intraplacental bands, and loss of retroplacental T2-hypointense line) predicting MOH were more visible using SRR imaging (accuracy 0.73), in comparison to 2D MRI or paired imaging. Bladder wall interruption, predicting BA, was only easily detected by paired imaging (accuracy 0.72). Better detection of certain pathological markers predicting PAD was found using 2D MRI (placental bulge and myometrial thinning (accuracy 0.81)), and SRR (loss of retroplacental T2-hypointense line (accuracy 0.82)).
The addition of SRR to 2D MRI potentially improved anatomical assessment of certain pathological MRI markers of abnormal placentation that predict maternal morbidity which may benefit surgical planning.
使用超声和磁共振成像（MRI）对胎盘植入谱系（PAS）进行全面成像，旨在预防灾难性出血和产妇死亡。胎盘的标准 MRI 受到层间运动的限制，而超分辨率重建（SRR）MRI 可以减轻这种限制。我们在疑似 PAS 病例中应用了 SRR，以确定其增强解剖胎盘评估和预测不良母婴结局的能力。
对 22 例疑似 PAS 患者（孕周+天为（32±3，范围为（27-38）））进行 MRI 检查。对胎盘-子宫肌层-膀胱界面进行 SRR，涉及对采集的 MRI 切片进行刚性运动校正，并结合稳健的异常值检测，以重建各向同性高分辨率体积，在 12 例中实现。对 2D MRI 或 SRR 图像单独进行评估，并在三轮评估中由四名放射科医生对配对数据进行评估。所有放射科医生均对超声、原始 MRI 图像报告、病例结局和 PAS 诊断结果不知情。使用随机森林分类模型突出显示预测主要产科出血（MOH）、膀胱粘连（BA）和胎盘附着深度（PAD）的最具预测性的病理 MRI 标志物。
分娩时，4 例患者胎盘前置且附着正常，2 例临床诊断为 PAS，6 例组织病理学 PAS 确诊。与 2D MRI 或配对成像相比，SRR 成像更能显示预测 MOH 的病理 MRI 标志物（T2 暗胎盘内带和胎盘后 T2 低信号线缺失）（准确性为 0.73）。预测 BA 的膀胱壁中断仅通过配对成像容易检测到（准确性为 0.72）。使用 2D MRI（胎盘膨出和子宫肌层变薄（准确性为 0.81））和 SRR（胎盘后 T2 低信号线缺失（准确性为 0.82））更好地检测到预测 PAD 的某些病理标志物。
在 2D MRI 中添加 SRR 可能会改善异常胎盘病理 MRI 标志物的解剖评估，这些标志物预测产妇发病率，这可能有利于手术计划。
