A retrospective segmentation analysis of placental volume by magnetic resonance imaging from first trimester to term gestation

Background Abnormalities of the placenta affect 5–7% of pregnancies. Because disturbances in fetal growth are often preceded by dysfunction of the placenta or attenuation of its normal expansion, placental health warrants careful surveillance. There are limited normative data available for placental volume by MRI. Objective To determine normative ranges of placental volume by MRI throughout gestation. Materials and methods In this cross-sectional retrospective analysis, we reviewed MRI examinations of pregnant females obtained between 2002 and 2017 at a single institution. We performed semi-automated segmentation of the placenta in images obtained in patients with no radiologic evidence of maternal or fetal pathology, using the Philips Intellispace Tumor Tracking Tool. Results Placental segmentation was performed in 112 women and had a high degree of interrater reliability (single-measure intraclass correlation coefficient =0.978 with 95% confidence interval [CI] 0.956, 0.989; P<0.001). Normative data on placental volume by MRI increased nonlinearly from 6 weeks to 39 weeks of gestation, with wider variability of placental volume at higher gestational age (GA). We fit placental volumetric data to a polynomial curve of third order described as placental volume = –0.02*GA3 + 1.6*GA2 – 13.3*GA + 8.3. Placental volume showed positive correlation with estimated fetal weight (P=0.03) and birth weight (P=0.05). Conclusion This study provides normative placental volume by MRI from early first trimester to term gestation. Deviations in placental volume from normal might prove to be an imaging biomarker of adverse fetal health and neonatal outcome, and further studies are needed to more fully understand this metric. Assessment of placental volume should be considered in all routine fetal MRI examinations

Application of Advanced MRI to Fetal Medicine and Surgery

Robust imaging is essential for comprehensive preoperative evaluation, prognostication, and surgical planning in the field of fetal medicine and surgery. This is a challenging task given the small fetal size and increased fetal and maternal motion which affect MRI spatial resolution. This thesis explores the clinical applicability of post-acquisition processing using MRI advances such as super-resolution reconstruction (SRR) to generate optimal 3D isotropic volumes of anatomical structures by mitigating unpredictable fetal and maternal motion artefact. It paves the way for automated robust and accurate rapid segmentation of the fetal brain. This enables a hierarchical analysis of volume, followed by a local surface-based shape analysis (joint spectral matching) using mathematical markers (curvedness, shape index) that infer gyrification. This allows for more precise, quantitative measurements, and calculation of longitudinal correspondences of cortical brain development. I explore the potential of these MRI advances in three clinical settings: fetal brain development in the context of fetal surgery for spina bifida, airway assessment in fetal tracheolaryngeal obstruction, and the placental-myometrial-bladder interface in placenta accreta spectrum (PAS). For the fetal brain, MRI advances demonstrated an understanding of the impact of intervention on cortical development which may improve fetal candidate selection, neurocognitive prognostication, and parental counselling. This is of critical importance given that spina bifida fetal surgery is now a clinical reality and is routinely being performed globally. For the fetal trachea, SRR can provide improved anatomical information to better select those pregnancies where an EXIT procedure is required to enable the fetal airway to be secured in a timely manner. This would improve maternal and fetal morbidity outcomes associated with haemorrhage and hypoxic brain injury. Similarly, in PAS, SRR may assist surgical planning by providing enhanced anatomical assessment and prediction for adverse peri-operative maternal outcome such as bladder injury, catastrophic obstetric haemorrhage and maternal death

Role of fetal MRI in the evaluation of isolated and non-isolated corpus callosum dysgenesis: results of a cross-sectional study

PURPOSE: The aims of this study were to characterize isolated and non-isolated forms of corpus callosum dysgenesis (CCD) at fetal magnetic resonance imaging (MRI) and to identify early predictors of associated anomalies. METHODS: We retrospectively analyzed 104 fetuses with CCD undergoing MRI between 2006 and 2016. Corpus callosum, cavum septi pellucidi, biometry, presence of ventriculomegaly, gyration anomalies, cranio-encephalic abnormalities and body malformations were evaluated. Results of genetic tests were also recorded. RESULTS: At MRI, isolated CCD was 26.9%, the rest being associated to other abnormalities. In the isolated group, median gestational age at MRI was lower in complete agenesis than in hypoplasia (22 vs 28 weeks). In the group with additional findings, cortical dysplasia was the most frequently associated feature (P = 0.008), with a more frequent occurrence in complete agenesis (70%) versus other forms; mesial frontal lobes were more often involved than other cortical regions (P = 0.006), with polymicrogyria as the most frequent cortical malformation (40%). Multivariate analysis confirmed the association between complete agenesis and cortical dysplasia (odds ratio = 7.29, 95% confidence interval 1.51-35.21). CONCLUSIONS: CCD is often complicated by other intra-cranial and extra-cranial findings (cortical dysplasias as the most prevalent) that significantly affect the postnatal prognosis. The present study showed CCD with associated anomalies as more frequent than isolated (73.1%). In isolated forms, severe ventriculomegaly was a reliable herald of future appearance of associated features

Neuroanatomy of the Subadult and Fetal Brain of the Atlantic White-Sided Dolphin (Lagenorhynchus acutus) from In Situ Magnetic Resonance Images

This article provides the first anatomically labeled, magnetic resonance imaging (MRI) -based atlas of the subadult and fetal Atlantic white-sided dolphin (Lagenorhynchus acutus) brain. It differs from previous MRI-based atlases of cetaceans in that it was created from images of fresh, postmortem brains in situ rather than extracted, formalin-fixed brains. The in situ images displayed the classic hallmarks of odontocete brains: fore-shortened orbital lobes and pronounced temporal width. Olfactory structures were absent and auditory regions (e.g., temporal lobes and inferior colliculi) were enlarged. In the subadult and fetal postmortem MRI scans, the hippocampus was identifiable, despite the relatively small size of this structure in cetaceans. The white matter tracts of the fetal hindbrain and cerebellum were pronounced, but in the telencephalon, the white matter tracts were much less distinct, consistent with less myelin. The white matter tracts of the auditory pathways in the fetal brains were myelinated, as shown by the T2 hypointensity signals for the inferior colliculus, cochlear nuclei, and trapezoid bodies. This finding is consistent with hearing and auditory processing regions maturing in utero in L. acutus, as has been observed for most mammals. In situ MRI scanning of fresh, postmortem specimens can be used not only to study the evolution and developmental patterns of cetacean brains but also to investigate the impacts of natural toxins (such as domoic acid), anthropogenic chemicals (such as polychlorinated biphenyls, polybrominated diphenyl ethers, and their hydroxylated metabolites), biological agents (parasites), and noise on the central nervous system of marine mammal species

Approaches for assessing the presence and impact of thyroid hormone disrupting chemicals in delphinid cetaceans

Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at the Massachusetts Institute of Technology and the Woods Hole Oceanographic Institution September 2006Cetacean blubber is a primary site for lipid storage, which the animal utilizes during periods of energetic stress. It is important to understand how the blubber responds to factors such as ontogeny, water temperature, reproductive status, and nutritional state because blubber is also the primary bioaccumulation site for persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs). During periods of lipid mobilization such as lactation, PCBs from the blubber are mobilized into the circulatory system and may cause toxic effects. One particular toxic mechanism may include the induction of cytochrome P450 enzymes in the integument and liver, which could enhance the biotransformation of PCBs to hydroxylated metabolites (OH-PCBs). OH-PCBs may then interfere with thyroid hormone dependent neurodevelopment. The goals of these studies were to investigate the relationships between lipid dynamics and PCB effects and to devise a quantitative approach to assess neurodevelopment in delphinid cetaceans. Blubber morphology, cytochrome P450 1A1 (CYP1A1) expression in the skin-blubber biopsy, blubber and plasma PCBs, and plasma OH-PCBs were assessed in bottlenose dolphins (Tursiops truncatus). In addition, magnetic resonance (MR) images of the postmortem brain in situ were obtained from Atlantic white-sided dolphin (Lagenorhynchus acutus) specimens.These results showed that: 1) Factors such as ontogeny, water temperature, and reproductive status affected blubber morphology in bottlenose dolphins. In response to warmer water, the lipid content of the blubber decreased and this appeared to involve loss of lipids from adipocytes in the middle blubber layer. Similar to the effects of starvation on blubber morphology, lactation decreased adipocyte size predominantly in the deeper blubber, 2) CYP1A1 levels in the deep blubber were significantly related to the total plasma TEQ98 concentrations, adipocyte shrinkage, and plasma OH-PCB levels, 3) Through in situ MR imaging of stranded, Atlantic white-sided dolphin specimens, the size of brain structures that depend on thyroid hormones for maturation could be measured accurately. Future studies can use this technique, coupled with chemical analysis of brain regions, to determine if thyroid hormone disrupting chemicals in delphinid cetaceans are associated with changes in the size of brain structures.Funding for this research was provided by an Environmental Protection Agency STAR fellowship (U-91616101-2) awarded to Eric Montie, NOAA contract #WC1330- 02SE0257, NOAA contract #JHT04P1226, NOAA Fisheries Marine Mammal Health and Stranding Response Program, the Florida Protect Wild Dolphins License Plate Fund, the National Woman’s Farm and Garden Association Scholarship awarded to Eric Montie, Shields MRI and CT of Cape Cod, the Quebec Labrador Fund/Atlantic Center for the Environment, Woods Hole Oceanographic Institution Academic Programs Office, Office of Naval Research, and NOAA Fisheries Marine Mammal Health and Stranding Response Program

Magnetic Resonance Imaging of the Brain in Moving Subjects. Application of Fetal, Neonatal and Adult Brain Studies

Imaging in the presence of subject motion has been an ongoing challenge for magnetic resonance imaging (MRI). Motion makes MRI data inconsistent, causing artifacts in conventional anatomical imaging as well as invalidating diffusion tensor imaging (DTI) reconstruction. In this thesis some of the important issues regarding the acquisition and reconstruction of anatomical and DTI imaging of moving subjects are addressed; methods to achieve high resolution and high signalto- noise ratio (SNR) volume data are proposed. An approach has been developed that uses multiple overlapped dynamic single shot slice by slice imaging combined with retrospective alignment and data fusion to produce self consistent 3D volume images under subject motion. We term this method as snapshot MRI with volume reconstruction or SVR. The SVR method has been performed successfully for brain studies on subjects that cannot stay still, and in some cases were moving substantially during scanning. For example, awake neonates, deliberately moved adults and, especially, on fetuses, for which no conventional high resolution 3D method is currently available. Fine structure of the in-utero fetal brain is clearly revealed for the first time with substantially improved SNR. The SVR method has been extended to correct motion artifacts from conventional multi-slice sequences when the subject drifts in position during data acquisition. Besides anatomical imaging, the SVR method has also been further extended to DTI reconstruction when there is subject motion. This has been validated successfully from an adult who was deliberately moving and then applied to inutero fetal brain imaging, which no conventional high resolution 3D method is currently available. Excellent fetal brain 3D apparent diffusion coefficient (ADC) maps in high resolution have been achieved for the first time as well as promising fractional Anisotropy (FA) maps. Pilot clinical studies using SVR reconstructed data to study fetal brain development in-utero have been performed. Growth curves for the normally developing fetal brain have been devised by the quantification of cerebral and cerebellar volumes as well as some one dimensional measurements. A Verhulst model is proposed to describe these growth curves, and this approach has achieved a correlation over 0.99 between the fitted model and actual data

Construction of realistic hybrid computational fetal phantoms from radiological images in three gestational ages for radiation dosimetry applications

Radiation exposure and associated radiation risks are major concerns for fetal development for pregnant patients who undergo radiation therapy or diagnostic imaging procedures. In order to accurately estimate the radiation dose to the fetus and assess the uncertainty of fetal position and rotation, three hybrid computational fetus phantoms were constructed using magnetic resonance imaging (MRI) for each fetus model as a starting point to construct a complete anatomically accurate fetus, gravid uterus, and placenta. A total of 27 fetal organs were outlined from radiological images via the Velocity Treatment Planning System. The DICOM-Structure set was imported to Rhinoceros software for further reconstruction of 3D fetus phantom model sets. All fetal organ masses were compared with ICRP-89 reference data. Our fetal model series corresponds to 20, 31, and 35 weeks of pregnancy, thus covering the second and third trimester. Fetal positions and locations were carefully adapted to represent the real fetus locations inside the uterus for each trimester of pregnancy. The new series of hybrid computational fetus models together with pregnant female models can be used in evaluating fetal radiation doses in diagnostic imaging and radiotherapy procedures

A Fetal Brain magnetic resonance Acquisition Numerical phantom (FaBiAN)

Accurate characterization of in utero human brain maturation is critical as it involves complex and interconnected structural and functional processes that may influence health later in life. Magnetic resonance imaging is a powerful tool to investigate equivocal neurological patterns during fetal development. However, the number of acquisitions of satisfactory quality available in this cohort of sensitive subjects remains scarce, thus hindering the validation of advanced image processing techniques. Numerical phantoms can mitigate these limitations by providing a controlled environment with a known ground truth. In this work, we present FaBiAN, an open-source Fetal Brain magnetic resonance Acquisition Numerical phantom that simulates clinical T2-weighted fast spin echo sequences of the fetal brain. This unique tool is based on a general, flexible and realistic setup that includes stochastic fetal movements, thus providing images of the fetal brain throughout maturation comparable to clinical acquisitions. We demonstrate its value to evaluate the robustness and optimize the accuracy of an algorithm for super-resolution fetal brain magnetic resonance imaging from simulated motion-corrupted 2D low-resolution series compared to a synthetic high-resolution reference volume. We also show that the images generated can complement clinical datasets to support data-intensive deep learning methods for fetal brain tissue segmentation