Exploring the role of a time-efficient MRI assessment of the placenta and fetal brain in uncomplicated pregnancies and these complicated by placental insufficiency

Jana Hutter; Ayman Al-Wakeel; Vanessa Kyriakopoulou; Jacqueline Matthew; Lisa Story; Mary Rutherford

doi:10.1016/j.placenta.2023.05.014

Exploring the role of a time-efficient MRI assessment of the placenta and fetal brain in uncomplicated pregnancies and these complicated by placental insufficiency

Placenta. 2023 Aug:139:25-33. doi: 10.1016/j.placenta.2023.05.014. Epub 2023 Jun 3.

Authors

Jana Hutter¹, Ayman Al-Wakeel², Vanessa Kyriakopoulou³, Jacqueline Matthew³, Lisa Story⁴, Mary Rutherford³

Affiliations

¹ Centre for the Developing Brain, King's College London, UK; Centre for Medical Engineering, King's College London, UK. Electronic address: jana.hutter@kcl.ac.uk.
² GKT School of Medical Education, King's College London, London, UK.
³ Centre for the Developing Brain, King's College London, UK; Centre for Medical Engineering, King's College London, UK.
⁴ Centre for the Developing Brain, King's College London, UK; Institute for Women's and Children's Health, King's College London, UK; Fetal Medicine Unit, St Thomas' Hospital, London, UK.

PMID: 37295055
DOI: 10.1016/j.placenta.2023.05.014

Abstract

Introduction: The development of placenta and fetal brain are intricately linked. Placental insufficiency is related to poor neonatal outcomes with impacts on neurodevelopment. This study sought to investigate whether simultaneous fast assessment of placental and fetal brain oxygenation using MRI T2* relaxometry can play a complementary role to US and Doppler US.

Methods: This study is a retrospective case-control study with uncomplicated pregnancies (n = 99) and cases with placental insufficiency (PI) (n = 49). Participants underwent placental and fetal brain MRI and contemporaneous ultrasound imaging, resulting in quantitative assessment including a combined MRI score called Cerebro-placental-T2*-Ratio (CPTR). This was assessed in comparison with US-derived Cerebro-Placental-Ratio (CPR), placental histopathology, assessed using the Amsterdam criteria [1], and delivery details.

Results: Pplacental and fetal brain T2* decreased with increasing gestational age in both low and high risk pregnancies and were corrected for gestational-age alsosignificantly decreased in PI. Both CPR and CPTR score were significantly correlated with gestational age at delivery for the entire cohort. CPTR was, however, also correlated independently with gestational age at delivery in the PI cohort. It furthermore showed a correlation to birth-weight-centile in healthy controls.

Discussion: This study indicates that MR analysis of the placenta and brain may play a complementary role in the investigation of fetal development. The additional correlation to birth-weight-centile in controls may suggest a role in the determination of placental health even in healthy controls. To our knowledge, this is the first study assessing quantitatively both placental and fetal brain development over gestation in a large cohort of low and high risk pregnancies. Future larger prospective studies will include additional cohorts.

Keywords: Brain development; Brain sparing; Longitudinal; MRI; Oxygen transfer; Relaxometry; T2*.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain / diagnostic imaging
Case-Control Studies
Female
Fetal Growth Retardation / pathology
Gestational Age
Humans
Infant, Newborn
Magnetic Resonance Imaging
Placenta* / diagnostic imaging
Placenta* / pathology
Placental Insufficiency* / diagnostic imaging
Placental Insufficiency* / pathology
Pregnancy
Pregnancy, High-Risk
Prospective Studies
Retrospective Studies
Ultrasonography, Prenatal

Abstract

Publication types

MeSH terms

Grants and funding