80 - Can In-vivo Early Gestation Placental Magnetic Resonance Imaging Predict Ischemic Placental Disease?

Poster Number: 80
Publication Number: 80.324

Brian Lee, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Arya Aliabadi, UCLA David Geffen School of Medicine, Los Angeles, CA, United States; Kyung H. Sung, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Carla janzen, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Peggy S. Sullivan, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Sherin U. Devaskar, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States

Background: Ischemic placental disease (IPD) manifests clinically as preeclampsia, fetal growth restriction, or placental abruption, and is a risk factor for the development of long-term cardiovascular disorders in both the mother and the neonate. Similar uterine artery Doppler ultrasound findings and placental histology between these conditions suggest a common pathophysiological mechanism in early pregnancy. As the uterine artery pulsatility index (PI) has poor sensitivity and predictive value for IPD, our group developed a novel, multi-parametric (mp-) MRI using a multi-delay, pseudo-continuous arterial-spin-labeling sequence (pCASL) to simultaneously measure placental structure and function.

Objective: Our objective is to test the hypothesis that placental mp-MRI in early pregnancy can aid in the prediction of IPD, impacting maternal and neonatal cardiovascular disease.

Design/Methods: 200 women were recruited in the first trimester of pregnancy. We recorded the pregnancy course through four visits (at 11-14 weeks, 19-22 weeks, 36 weeks, and at delivery), focusing on the development of IPD. Uterine artery Doppler ultrasound was performed at 11-14 and 19-22 weeks of gestation. Placental pCASL mp-MRI was performed at 14-16 and 19-22 weeks of gestation. Imaging software was used to measure maternal to placental blood flow (PBF), regions of high placental blood flow (hPBF), and placental volume.

Results: 179 maternal-infant dyads were analyzed. 44 women developed IPD (24.5%), and 135 women did not develop IPD (75.5%).
At the first MRI timepoint (14-16 weeks), there were 117 controls and 44 IPD cases with MRI scans. There was no difference in placental volume or arterial transit time (ATT) between the groups (p = 0.71 and p = 0.26, respectively). In contrast, PBF was significantly lower in the IPD group than the control group (55.9 mL/min vs 64.2 mL/min respectively, p = 0.043; Figure 1). hPBF was also significantly lower in the IPD group than the control group (192.2 vs. 238.8 mL/min, p = 0.01; Figure 2).
At the second MRI timepoint (19-22 weeks), there were 111 controls and 42 IPD cases with MRI scans. There was no difference in placental volume or ATT between the groups (p = 0.85 and p = 0.39, respectively). In contrast to the first MRI timepoint, there was no significant difference in PBF or hPBF between the groups (p = 0.32 and p = 0.16, respectively).Conclusion(s): pCASL mp-MRI of early-gestation (14-16 weeks) placental blood flow may predict IPD. Our studies potentially have a major impact on maternal and neonatal development of long-term cardiovascular disease.
Supported by NIH U01-HD087221
Brian Lee _ Curriculum Vitae.pdf
Figure 2: high Placental blood flow at first MRI timepointHigh placental blood flow (hPBF) at first MRI timepoint (14 – 16 weeks GA). Average hPBF for the control group and IPD group is 238.8 mL/min vs 192.2 mL/min, respectively.