POSTER PRESENTATION Open Access Fetal haemodynamic ... · clinical suspicion of IUGR at any stage...
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POSTER PRESENTATION Open Access Fetal haemodynamic assessment in a case of late-onset intrauterine growth restriction by phase contrast MRI and T2 mapping Meng Yuan Zhu 1* , Sujana Madathil 1 , Steven Miller 3,5 , Rory Windrim 8 , Christopher Macgowan 2,4 , John Kingdom 6 , Mike Seed 1,7 From 18th Annual SCMR Scientific Sessions Nice, France. 4-7 February 2015 Background Late-onset intrauterine growth restriction (IUGR) results from the failure of placenta to supply enough nutrients and oxygen to the rapidly growing late gestation fetus [1]. Inaccuracies in ultrasound based late gestational fetal weight estimation and the absence of typical Doppler changes make late-onset IUGR difficult to detect [2]. We were interested in whether new MRI technology incorpor- ating fetal vessel blood flow and oximetry measurement could improve the sensitivity of conventional fetal monitoring. Methods A normal pregnancy was studied at late gestation as part of an IRB approved study. The pulsatility index (PI) in the umbilical artery (UA) and middle cerebral artery (MCA) were measured using Doppler ultrasound. At 34, 36 and 39 week’s gestational age (GA), MRI scans were performed using a 1.5T Siemens Avanto. We measured fetal weight (3D SSFP), the flow and oxygen saturations in the major fetal vessels using phase contrast MRI and T2 mapping according to our previously published technique [3]. Fetal oxygen delivery (DO 2 ) and consumption (VO 2 ) were cal- culated using a haemoglobin concentration taken from population averages [4]. We also recorded clinical fetal monitoring and placental histopathology results. Results The UA PI (GA31: 0.9, GA34: 1.0, GA37: 1.1) and MCA PI (GA36: 1.95) were in normal range and there was no clinical suspicion of IUGR at any stage of the pregnancy. Estimated fetal weight increased from 2.25kg to 2.84kg from GA34 to 39; however, the weight percentile dropped from 38 th to 8 th (Fig. 1). The baby was born in good condition at GA39 weighting 2.74kg (5 th percen- tile). Blood flows in the major fetal vessels were within normal ranges according to our previously published data [5]. Umbilical vein flow decreased as GA increased but within normal range. The T2 values (Fig. 2a), calcu- lated VO2 and DO2 all decreased from GA34 to 39 (Fig. 2b). Placental pathology revealed low normal pla- cental weight (396g: 10 th to 25 th percentile for GA39) with mild over coiling of the umbilical cord (coiling index: 0.3-0.4) and mild dysmaturity of chorionic villi. Conclusions The fetal weight centile decline, placental histology and small for gestational age birth-weight in this case are in keeping with late-onset IUGR. We propose that the drop in fetal oxygen delivery is evidence of placental insufficiency while the dropped oxygen consumption is in keeping with fetal metabolic adaptation to reduced oxygen delivery, which resulted in slowing of fetal growth. With this novel approach to fetal hemody- namics, MRI could provide clinically significant addi- tional information to conventional fetal monitoring. Funding Canadian Institute of Health Research/Sickkids Founda- tion New Investigator Award. Authors’ details 1 Cardiology, The Hospital for Sick Children, Toronto, ON, Canada. 2 Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada. 3 Neurology, The Hospital for Sick Children, Toronto, ON, Canada. 1 Cardiology, The Hospital for Sick Children, Toronto, ON, Canada Full list of author information is available at the end of the article Zhu et al. Journal of Cardiovascular Magnetic Resonance 2015, 17(Suppl 1):P27 http://www.jcmr-online.com/content/17/S1/P27 © 2015 Zhu et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Transcript of POSTER PRESENTATION Open Access Fetal haemodynamic ... · clinical suspicion of IUGR at any stage...
POSTER PRESENTATION Open Access
Fetal haemodynamic assessment in a case oflate-onset intrauterine growth restriction byphase contrast MRI and T2 mappingMeng Yuan Zhu1*, Sujana Madathil1, Steven Miller3,5, Rory Windrim8, Christopher Macgowan2,4, John Kingdom6,Mike Seed1,7
From 18th Annual SCMR Scientific SessionsNice, France. 4-7 February 2015
BackgroundLate-onset intrauterine growth restriction (IUGR) resultsfrom the failure of placenta to supply enough nutrientsand oxygen to the rapidly growing late gestation fetus [1].Inaccuracies in ultrasound based late gestational fetalweight estimation and the absence of typical Dopplerchanges make late-onset IUGR difficult to detect [2]. Wewere interested in whether new MRI technology incorpor-ating fetal vessel blood flow and oximetry measurementcould improve the sensitivity of conventional fetalmonitoring.
MethodsA normal pregnancy was studied at late gestation as partof an IRB approved study. The pulsatility index (PI) in theumbilical artery (UA) and middle cerebral artery (MCA)were measured using Doppler ultrasound. At 34, 36 and39 week’s gestational age (GA), MRI scans were performedusing a 1.5T Siemens Avanto. We measured fetal weight(3D SSFP), the flow and oxygen saturations in the majorfetal vessels using phase contrast MRI and T2 mappingaccording to our previously published technique [3]. Fetaloxygen delivery (DO2) and consumption (VO2) were cal-culated using a haemoglobin concentration taken frompopulation averages [4]. We also recorded clinical fetalmonitoring and placental histopathology results.
ResultsThe UA PI (GA31: 0.9, GA34: 1.0, GA37: 1.1) and MCAPI (GA36: 1.95) were in normal range and there was noclinical suspicion of IUGR at any stage of the pregnancy.
Estimated fetal weight increased from 2.25kg to 2.84kgfrom GA34 to 39; however, the weight percentiledropped from 38th to 8th (Fig. 1). The baby was born ingood condition at GA39 weighting 2.74kg (5th percen-tile). Blood flows in the major fetal vessels were withinnormal ranges according to our previously publisheddata [5]. Umbilical vein flow decreased as GA increasedbut within normal range. The T2 values (Fig. 2a), calcu-lated VO2 and DO2 all decreased from GA34 to 39(Fig. 2b). Placental pathology revealed low normal pla-cental weight (396g: 10th to 25th percentile for GA39)with mild over coiling of the umbilical cord (coilingindex: 0.3-0.4) and mild dysmaturity of chorionic villi.
ConclusionsThe fetal weight centile decline, placental histology andsmall for gestational age birth-weight in this case are inkeeping with late-onset IUGR. We propose that thedrop in fetal oxygen delivery is evidence of placentalinsufficiency while the dropped oxygen consumption isin keeping with fetal metabolic adaptation to reducedoxygen delivery, which resulted in slowing of fetalgrowth. With this novel approach to fetal hemody-namics, MRI could provide clinically significant addi-tional information to conventional fetal monitoring.
FundingCanadian Institute of Health Research/Sickkids Founda-tion New Investigator Award.
Authors’ details1Cardiology, The Hospital for Sick Children, Toronto, ON, Canada. 2Physiologyand Experimental Medicine, The Hospital for Sick Children, Toronto, ON,Canada. 3Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
1Cardiology, The Hospital for Sick Children, Toronto, ON, CanadaFull list of author information is available at the end of the article
Zhu et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):P27http://www.jcmr-online.com/content/17/S1/P27
© 2015 Zhu et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Figure 1 Percentile of estimated fetal weight (GA34: 2.25kg, 38th percentile; GA36: 2.43kg, 17th percentile; GA39: 2.84 8th percentile) and actualbirth weight (2.74kg, 5th percentile) when compared with normal fetal population at the same gestation age.
Figure 2 a) Plots of T2 measurements in the umbilical vein at GA34, 36 and 39 comparing with the normal range (Mean T2 ± 2SD). b)Calculated O2 consumption (VO2) and O2 delivery (DO2) at GA34, 36 and 39 based on umbilical vein flows, T2 values of umbilical vein anddescending aorta and GA appropriate estimations of hemoglobin concentration.
Zhu et al. Journal of Cardiovascular MagneticResonance 2015, 17(Suppl 1):P27http://www.jcmr-online.com/content/17/S1/P27
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4Department of Medical Biophysics and Medical Imaging, University ofToronto, Toronto, ON, Canada. 5Paediatrics, University of Toronto, Toronto,ON, Canada. 6Department of Obstetrics & Gynaecology, Mount SinaiHospital, Toronto, ON, Canada. 7Department of Paediatrics and DiagnosticImaging, University of Toronto, Toronto, ON, Canada. 8Maternal-FetalMedicine, Mount Sinai Hospital, Toronto, ON, Canada.
Published: 3 February 2015
References1. Lausman A, et al: J Obstet Gynaecol Can 2013, 35:741-757.2. Oros D, et al: Ultrasound Obstet Gynecol 2011, 37:191-195.3. Seed M, Macgowan CK: Magnetom Flash 2014, 57:66-72.4. Nicolaides K: Lancet 1988, 331:1073-1075.5. Prsa M, et al: Circ: Cardiovasc Imag 2014, 7:663-70.
doi:10.1186/1532-429X-17-S1-P27Cite this article as: Zhu et al.: Fetal haemodynamic assessment in acase of late-onset intrauterine growth restriction by phase contrast MRIand T2 mapping. Journal of Cardiovascular Magnetic Resonance 2015 17(Suppl 1):P27.
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