Dataset Information

Perfusion and apparent oxygenation in the human placenta (PERFOX).

ABSTRACT:

Purpose

To study placental function-both perfusion and an oxygenation surrogate ( T2* )-simultaneously and quantitatively in-vivo.

Methods

Fifteen pregnant women were scanned on a 3T MR scanner. For perfusion measurements, a velocity selective arterial spin labeling preparation module was placed before a multi-echo gradient echo EPI readout to integrate T2* and perfusion measurements in 1 joint perfusion-oxygenation (PERFOX) acquisition. Joint motion correction and quantification were performed to evaluate changes in T2* and perfusion over GA.

Results

The optimized integrated PERFOX protocol and post-processing allowed successful visualization and quantification of perfusion and T2* in all subjects. Areas of high T2* and high perfusion appear to correspond to placental sub-units and show a systematic offset in location along the maternal-fetal axis. The areas of highest perfusion are consistently closer to the maternal basal plate and the areas of highest T2* closer to the fetal chorionic plate. Quantitative results show a strong negative correlation of gestational age with T2* and weak negative correlation with perfusion.

Conclusions

A strength of the joint sequence is that it provides truly simultaneous and co-registered estimates of local T2* and perfusion, however, to achieve this, the time per slice is prolonged compared to a perfusion only scan which can potentially limit coverage. The achieved interlocking can be particularly useful when quantifying transient physiological effects such as uterine contractions. PERFOX opens a new avenue to elucidate the relationship between maternal supply and oxygen uptake, both of which are central to placental function and dysfunction.

SUBMITTER: Hutter J

PROVIDER: S-EPMC6825519 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

Perfusion and apparent oxygenation in the human placenta (PERFOX).

Hutter Jana J Harteveld Anita A AA Jackson Laurence H LH Franklin Suzanne S Bos Clemens C van Osch Matthias J P MJP O'Muircheartaigh Jonathan J Ho Alison A Chappell Lucy L Hajnal Joseph V JV Rutherford Mary M De Vita Enrico E

Magnetic resonance in medicine 20190821 2

<h4>Purpose</h4>To study placental function-both perfusion and an oxygenation surrogate ( T2* )-simultaneously and quantitatively in-vivo.<h4>Methods</h4>Fifteen pregnant women were scanned on a 3T MR scanner. For perfusion measurements, a velocity selective arterial spin labeling preparation module was placed before a multi-echo gradient echo EPI readout to integrate T2* and perfusion measurements in 1 joint perfusion-oxygenation (PERFOX) acquisition. Joint motion correction and quantification ...[more]

PMID: 31433077

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Project description:Although being the golden standard for intrapartum fetal surveillance, cardiotocography (CTG) has been shown to have poor specificity for detecting fetal acidosis. Non-invasive near-infrared-spectroscopy (NIRS) monitoring of placental oxygenation during labour has not been studied yet. The objective of the study was to determine whether changes in placental NIRS values during labour could identify intrapartum fetal hypoxia and resulting acidosis. We included 43 healthy women in active stage of labour at term. CTG and NIRS parameters in groups with vs. without neonatal umbilical artery pH ≤ 7.20 were compared using Mann-Whitney-U. Receiver-operating-characteristics (ROC) curves were used to estimate predictive value of CTG and NIRS parameters for neonatal pH ≤ 7.20. A computer-based statistical classification was also performed to further evaluate predictive values of CTG and NIRS for neonatal acidosis. Ten (23%) neonates were born with umbilical artery pH ≤ 7.20. Compared to group with pH > 7.20, fetal acidosis was associated with more episodes of placental NIRS deoxygenation (9 (range 2-37) vs. 2 (range 0-65); p<0.001), higher velocity of placental NIRS deoxygenation (2.31 (range 0-22) vs. 1 (range 0-49) %/s; p = 0.03), more decelerations on CTG (25 (range 3-91) vs. 10 (range 10-60); p = 0.02), and more prolonged decelerations on CTG (2 (range 0-4) vs. 1 (range 0-3); p = 0.04). Number of placental deoxygenations had the highest prognostic value for fetal/neonatal acidosis (area under the ROC curve 0.85 (95% confidence interval 0.70-0.99). Computer-based classification also identified number of placental deoxygenations as the most accurate classifier, with 25% false positive and 93% true positive rate in the training dataset, with 100% accuracy when applied to the testing dataset. Placental deoxygenations during labour measured by NIRS are associated with fetal/neonatal acidosis. Predictive value of placental NIRS for neonatal acidosis was superior to that of CTG.

Project description:BackgroundCerebral hypoperfusion and impaired oxygen delivery during pediatric critical illness may result in acute neurologic injury with subsequent long-term effects on neurodevelopmental outcome. Yet, the impact of norepinephrine on cerebral hemodynamics is unknown in children with shock. We aimed to describe the norepinephrine effects on cerebral perfusion and oxygenation during pediatric shock.Patients and methodsWe conducted an observational multicentre prospective study in 3 French pediatric intensive care units. Children <18 years of age excluding traumatic brain injury were included in the study if they need norepinephrine for shock. Systemic and cerebral hemodynamics were compared between the time of initiation of norepinephrine (T0), and the steady-state (Tss). Cardiac output (CO) was measured using ultrasound. Cerebral perfusion was assessed on middle cerebral arteries (MCA) using transcranial doppler ultrasound. Cerebral tissue oxygen saturation (rScO2) was recorded using near infrared spectroscopy, and we calculated cerebral fractional tissue oxygen extraction (cFTOE = SpO2-rScO2/SpO2).Main resultsFourteen children (median [IQR] age of 3.5[1; 13.5] years) were included. Norepinephrine at 0.2[0.1; 0.32] μg/kg/min significantly increased mean arterial blood pressure (61[56; 73] mmHg at Tss vs. 49[42;54] mmHg at T0, p=10-3) without change of CO. MCA velocities, pulsatility index, rScO2, and cFTOE did not significantly change between T0 and Tss. Some individuals observed variations in estimated CBF, which slightly improved in 7 patients, remained unchanged in 5, and was impaired in 2. No patient experienced significant variations of rScO2.ConclusionsLow-dosing norepinephrine, despite a homogeneous and significant increase in arterial blood pressure, had little effects on cerebral perfusion and oxygenation during pediatric shock. This reinforces the need for personalized tailored therapies in this population.Trial registrationClinicaltrials.gov, NCT03731104. Registered 6 November, 2018. https://clinicaltrials.gov/ct2/show/NCT03731104.

Dataset Information

Perfusion and apparent oxygenation in the human placenta (PERFOX).

Purpose

Methods

Results

Conclusions

Publications

Perfusion and apparent oxygenation in the human placenta (PERFOX).

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