Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA.
Placenta. 2024 Sep 2;154:168-175. doi: 10.1016/j.placenta.2024.07.007. Epub 2024 Jul 14.
Our goal was to evaluate the potential utility of magnetic resonance imaging (MRI) placental volume as an assessment of placental insufficiency.
Secondary analysis of a prospective cohort undergoing serial placental MRIs at two academic tertiary care centers. The population included 316 participants undergoing MRI up to three times throughout gestation. MRI was used to calculate placental volume in milliliters (ml). Placental-mediated adverse pregnancy outcome (cAPO) included preeclampsia with severe features, abnormal antenatal surveillance, and perinatal mortality. Serial measurements were grouped as time point 1 (TP1) <22 weeks, TP2 22 0/7-29 6/7 weeks, and TP3 ≥30 weeks. Mixed effects models compared change in placental volume across gestation between cAPO groups. Association between cAPO and placental volume was determined using logistic regression at each TP with discrimination evaluated using area under receiver operator curve (AUC). Placental volume was then added to known clinical predictive variables and evaluated with test characteristics and calibration.
59 (18.7 %) of 316 participants developed cAPO. Placental volume growth across gestation was slower in the cAPO group (p < 0.001). Placental volume was lower in the cAPO group at all time points, and alone was moderately predictive of cAPO at TP3 (AUC 0.756). Adding placental volume to clinical variables had moderate discrimination at all time points, with strongest test characteristics at TP3 (AUC 0.792) with sensitivity of 77.5 % and specificity of 75.3 % at a predicted probability cutoff of 15 %.
MRI placental volume warrants further study for assessment of placental insufficiency, particularly later in gestation.
我们的目标是评估磁共振成像（MRI）胎盘体积作为评估胎盘功能不全的潜在效用。
对在两个学术三级保健中心进行连续胎盘 MRI 的前瞻性队列进行二次分析。该人群包括 316 名在整个妊娠期间进行 3 次 MRI 的参与者。MRI 用于计算胎盘体积（毫升，ml）。胎盘介导的不良妊娠结局（cAPO）包括伴有严重特征的子痫前期、产前监测异常和围产儿死亡。系列测量结果分为时间点 1（TP1）<22 周、TP2 22 0/7-29 6/7 周和 TP3≥30 周。混合效应模型比较了 cAPO 组之间整个妊娠期间胎盘体积的变化。使用逻辑回归在每个 TP 确定 cAPO 与胎盘体积之间的关联，使用接收器操作曲线下面积（AUC）评估鉴别力。然后将胎盘体积添加到已知的临床预测变量中，并使用测试特征和校准进行评估。
316 名参与者中有 59 名（18.7%）发生 cAPO。cAPO 组的胎盘体积在整个妊娠期间的增长较慢（p<0.001）。在所有时间点，cAPO 组的胎盘体积均较低，单独在 TP3 时对 cAPO 具有中等预测能力（AUC 0.756）。在所有时间点，将胎盘体积添加到临床变量中具有中等鉴别力，在 TP3 时具有最强的测试特征（AUC 0.792），预测概率截断值为 15%时的敏感性为 77.5%，特异性为 75.3%。
MRI 胎盘体积值得进一步研究，以评估胎盘功能不全，特别是在妊娠晚期。
