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Journal article
Cross-modality and in-vivo validation of 4D flow MRI evaluation of uterine artery blood flow in human pregnancy
ULTRASOUND IN OBSTETRICS & GYNECOLOGY, v 58(5), pp 722-731
Nov 2021
PMID: 32898295
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objectives Clinical assessment of uterine artery (UtA) hemodynamics is currently limited to Doppler ultrasound (US) velocimetry. We have demonstrated previously the feasibility of applying four-dimensional (4D) flow magnetic resonance imaging (MRI) to evaluate UtA hemodynamics during pregnancy, allowing flow quantification of the entire course of the vessel. In this study, we sought to further validate the physiological relevance of 4D flow MRI measurement of UtA blood flow by exploring its association with pregnancy outcome relative to US-based metrics. Methods Recruited into this prospective, cross-sectional study were 87 women with a singleton pregnancy who underwent 4D flow MRI between May 2016 and April 2019 to measure the UtA pulsatility index (MRI-PI) and blood flow rate (MRI-flow, in mL/min). UtA-PI was also measured using US (US-PI). The primary outcome was a composite (COMP) of pre-eclampsia (PE) and/or small-for-gestational-age (SGA) neonate, and secondary outcomes were PE and SGA neonate individually. We assessed the ability of MRI-flow, MRI-PI and US-PI to distinguish between outcomes, and evaluated whether MRI-flow changed as gestation progressed. Results Following 4D flow postprocessing and exclusions from the analysis, 74 women had 4D flow MRI data analyzed for both UtAs. Of these, 18 developed a COMP outcome: three developed PE only, 11 had a SGA neonate only and four had both. A comparison of the COMP group vs the no-COMP group found no differences in maternal age, body mass index, nulliparity, gravidity or race. For 66 of the 74 subjects, US data were also available. In these subjects, both median MRI-PI (0.95 vs 0.70; P<0.01) and median US-PI (0.95 vs 0.73; P<0.01)were significantly increased in subjects in the COMP group compared with those in the no-COMP group. The UtA blood-flow rate, as measured by MRI, did not increase significantly from the second to the third trimester (median flow (interquartile range (IQR)), 543 (419-698) vs 575 (440-746) mL/min; P=0.77), but it was significantly lower overall in the COMP compared with the no-COMP group (median flow (IQR), 486 (366-598) vs 624 (457-749) mL/min; P=0.04). The areas under the receiver-operating-characteristics curves for MRI-flow, MRI-PI and US-PI in predicting COMP were not significantly different (0.694, 0.737 and 0.731, respectively; P=0.87). Conclusions 4D flow MRI can yield physiological measures of UtA blood-flow rate and PI that are associated with adverse pregnancy outcome. This may open up new avenues in the future to expand the potential of this technique as a robust tool with which to evaluate UtA hemodynamics in pregnancy. (C) 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Details
- Title
- Cross-modality and in-vivo validation of 4D flow MRI evaluation of uterine artery blood flow in human pregnancy
- Publication Details
- ULTRASOUND IN OBSTETRICS & GYNECOLOGY, v 58(5), pp 722-731
- Publisher
- WILEY; HOBOKEN
- Number of pages
- 9
- Grant note
- We gratefully acknowledge support from grants U01-HD087180, DGE-1321851, T32-EB009384, P41-EB015893, R00-HL108157, R01-HL137984 and R00-HD074649. We also thank the MRI technologists, Maternal Fetal Medicine research coordinators, and pregnant volunteers who participated in this study at the Hospital of the University of Pennsylvania.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:000704412100001
- Scopus ID
- 2-s2.0-85116449529
- Other Identifier
- 991021860671204721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Acoustics
- Obstetrics & Gynecology
- Radiology, Nuclear Medicine & Medical Imaging