MRI of foetal development

Foetal MRI represents a non-invasive imaging technique that allows detailed visualisation of foetus in utero and the maternal structure. This thesis outlines the quantitative imaging techniques used to investigate the effect of maternal diabetes and maternal smoking on foetal development at 1.5 Tesla. The effect of maternal diabetes on placental blood flow and foetal growth was studied. The placental images were acquired using Echo Planar Imaging and blood flow was measured using Intra Voxel Incoherent Motion. The results indicate that peak blood flow in the basal plate and chorionic plate increases across gestation in both normal and diabetic pregnancies. Conversely, diffusion in the whole placenta decreases across gestation, with a more pronounced decrease in diabetic placentae. Following this, a method was developed to use a Tl weighted fat suppressed MRI scan to quantify foetal fat images in-utero. In addition, HAlf Fourier Single-shot Turbo spin Echo (HASTE) and balanced Fast Field Echo (bFFE) were used to acquire images encompassing the whole foetus in three orthogonal planes. These scans were used to measure foetal volume, foetal length and shoulder width. The data shows that foetal fat volume and intra-abdominal fat were increased in foetuses of diabetic mothers at third trimester. The HASTE and bFFE sequences were also used to study the effect of maternal smoking on foetal development. Here, foetal organ volumes, foetal and placental volume, shoulder width and foetal length were measured using a semiautomatic approach based on the concept of edge detection and a stereological method, the Cavalieri technique. The data shows that maternal smoking has significant negative effect on foetal organ growth and foetal growth, predominantly foetal kidney and foetal volume. The work described here certainly has a great potential in non-invasive assessment of abnormal placental function and can be used to study foetal development

Metric to quantify white matter damage on brain magnetic resonance images

PURPOSE: Quantitative assessment of white matter hyperintensities (WMH) on structural Magnetic Resonance Imaging (MRI) is challenging. It is important to harmonise results from different software tools considering not only the volume but also the signal intensity. Here we propose and evaluate a metric of white matter (WM) damage that addresses this need. METHODS: We obtained WMH and normal-appearing white matter (NAWM) volumes from brain structural MRI from community dwelling older individuals and stroke patients enrolled in three different studies, using two automatic methods followed by manual editing by two to four observers blind to each other. We calculated the average intensity values on brain structural fluid-attenuation inversion recovery (FLAIR) MRI for the NAWM and WMH. The white matter damage metric is calculated as the proportion of WMH in brain tissue weighted by the relative image contrast of the WMH-to-NAWM. The new metric was evaluated using tissue microstructure parameters and visual ratings of small vessel disease burden and WMH: Fazekas score for WMH burden and Prins scale for WMH change. RESULTS: The correlation between the WM damage metric and the visual rating scores (Spearman ρ > =0.74, p  =0.72, p < 0.0001). The repeatability of the WM damage metric was better than WM volume (average median difference between measurements 3.26% (IQR 2.76%) and 5.88% (IQR 5.32%) respectively). The follow-up WM damage was highly related to total Prins score even when adjusted for baseline WM damage (ANCOVA, p < 0.0001), which was not always the case for WMH volume, as total Prins was highly associated with the change in the intense WMH volume (p = 0.0079, increase of 4.42 ml per unit change in total Prins, 95%CI [1.17 7.67]), but not with the change in less-intense, subtle WMH, which determined the volumetric change. CONCLUSION: The new metric is practical and simple to calculate. It is robust to variations in image processing methods and scanning protocols, and sensitive to subtle and severe white matter damage

Association between preterm brain injury and exposure to chorioamnionitis during fetal life

Preterm infants are susceptible to inflammation-induced white matter injury but the exposures that lead to this are uncertain. Histologic chorioamnionitis (HCA) reflects intrauterine inflammation, can trigger a fetal inflammatory response, and is closely associated with premature birth. In a cohort of 90 preterm infants with detailed placental histology and neonatal brain magnetic resonance imaging (MRI) data at term equivalent age, we used Tract-based Spatial Statistics (TBSS) to perform voxel-wise statistical comparison of fractional anisotropy (FA) data and computational morphometry analysis to compute the volumes of whole brain, tissue compartments and cerebrospinal fluid, to test the hypothesis that HCA is an independent antenatal risk factor for preterm brain injury. Twenty-six (29%) infants had HCA and this was associated with decreased FA in the genu, cingulum cingulate gyri, centrum semiovale, inferior longitudinal fasciculi, limbs of the internal capsule, external capsule and cerebellum (p < 0.05, corrected), independent of degree of prematurity, bronchopulmonary dysplasia and postnatal sepsis. This suggests that diffuse white matter injury begins in utero for a significant proportion of preterm infants, which focuses attention on the development of methods for detecting fetuses and placentas at risk as a means of reducing preterm brain injury