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19.07.2023 | Magnetic Resonance

Longitudinal assessment of placental perfusion in normal and hypertensive pregnancies using pseudo-continuous arterial spin–labeled MRI: preliminary experience

verfasst von: Christina L. Herrera, Yiming Wang, Durga Udayakumar, Yin Xi, Quyen N. Do, Matthew A. Lewis, David M. Owen, Baowei Fei, Catherine Y. Spong, Diane M. Twickler, Ananth J. Madhuranthakam

Erschienen in: European Radiology | Ausgabe 12/2023

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Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusion

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.

Clinical relevance statement

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.

Key Points

• 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.

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Titel: Longitudinal assessment of placental perfusion in normal and hypertensive pregnancies using pseudo-continuous arterial spin–labeled MRI: preliminary experience
verfasst von: Christina L. Herrera
Yiming Wang
Durga Udayakumar
Yin Xi
Quyen N. Do
Matthew A. Lewis
David M. Owen
Baowei Fei
Catherine Y. Spong
Diane M. Twickler
Ananth J. Madhuranthakam
Publikationsdatum: 19.07.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 12/2023
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-09945-x

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Longitudinal assessment of placental perfusion in normal and hypertensive pregnancies using pseudo-continuous arterial spin–labeled MRI: preliminary experience