Quantification of blood velocity and flow rates in the uterine vessels using echo planar imaging at 0.5 Tesla.

PURPOSE: To measure uterine artery and vein blood velocity and flow rate profiles using MRI during normal pregnancy. MATERIALS AND METHODS: A two-shot velocity magnitude-encoded echo planar imaging (EPI) sequence is used at a magnetic field 0.5T. Data analysis procedures, necessary to overcome problems associated with low signal to noise ratio (SNR), and a spatial resolution comparable to the vessel size were used. RESULTS: The measured blood flow values averaged over nine volunteers for the mean velocity are 5.33 and 3.97 cm/s and for the unilateral flow rate are 203 and 274 mL/min (for the arteries and veins respectively). Values for the flow rate are consistent with ultrasound Doppler studies. Arterial velocity measurements are more pulsatile than venous ones and validation calculations performed on average velocity values would suggest that the nature of blood flow in the uterine vessels is laminar. CONCLUSION: This study presents the first report of noninvasive quantitative measurements of uterine artery and vein blood velocity and flow rate profiles using MRI during normal pregnancy. Consistent and reproducible measurements have been obtained by subject specific sequence optimization and data analysis procedures.

Spiral artery blood volume in normal pregnancies and those compromised by pre-eclampsia.

The aim of this work was to use intravoxel incoherent motion (IVIM) to provide a non-invasive in vivo assessment of the function of the maternal spiral arteries that feed the placenta in normal pregnancy and in pre-eclampsia. Eleven normal pregnant women were scanned at 16, 22, 29 and 35 weeks gestation in a longitudinal study. Nine normal pregnant women and six women with pre-eclampsia were scanned in a cross-sectional study, within 10 days of delivery. The MRI IVIM technique was used to measure the moving blood fraction (f%) at the basal plate. There was no evidence that f% changed with gestational age (P = 0.84), but considering the cross-sectional groups, f% in women with pre-eclampsia was reduced compared with normal pregnancy (mean +/- SD: 36 +/- 5% and 27 +/- 5%; P < 0.005). In conclusion, pregnancies complicated by pre-eclampsia exhibit a reduced fraction of moving blood within the region of the spiral arteries. IVIM performed in the mid-trimester may provide an early means of predicting those pregnancies with an increased likelihood of being complicated by pre-eclampsia.

Rapid and accurate measurement of transverse relaxation times using a single shot multi-echo echo-planar imaging sequence.

Methods for making rapid and accurate measurements and maps of the transverse relaxation time from a single free induction decay (FID) are proposed. The methods use a multi-echo sequence in combination with B1 insensitive (hyperbolic secant or BIREF2b) refocusing pulses and rapid echo-planar imaging techniques. The results were calibrated against a single spin echo echo-planar imaging sequence using a phantom containing a range of CuSO4 concentrations. The mean percentage absolute difference between the multi-echo and single-echo results was 3% for the multi-echo sequence using the hyperbolic secant refocusing pulse, and 7% for the multi-echo sequence using the BIREF2b refocusing pulse, compared to 13% for a multi-echo sequence using a nonselective sinc refocusing pulse. The use of the sequences in vivo has been demonstrated in studies of gastric function, i.e., the measurement of gastric dilution and monitoring of formation of a raft of alginate polysaccharide within the stomach.

Fetal brain activity and hemodynamic response to a vibroacoustic stimulus.

Previous studies have demonstrated the practicality of using functional magnetic resonance imaging (fMRI) techniques to assess fetal brain activity. The purpose of this study was to compare the fetal hemodynamic response to that of the adult. Seventeen pregnant subjects, all of whom were at more than 36 weeks gestation were scanned while the fetus was exposed to a vibroacoustic stimulus. Thirteen adult subjects were scanned with an equivalent acoustic stimulus. Of the fetal subjects, two could not be analyzed due to technical problems, eight did not show significant activation, and seven showed significant activation. In all cases, activation was localized within the temporal region. Measures of fetal hemodynamic responses revealed an average time to peak (ttp) of 7.36 +/- 0.94 sec and an average percentage change of 2.67 +/- 0.93%. In contrast, activation was detected in 5 of 13 adults with an average ttp of 6.54 +/- 0.54 sec and an average percentage change of 1.02 +/- 0.40%. The measurement of changes in the fetal hemodynamic response may be important in assessing compromised pregnancies.

Fetal brain activity in response to a visual stimulus.

Previous studies have demonstrated the use of functional magnetic resonance imaging (fMRI) to assess fetal brain activity. To extend these studies, a fetal fMRI experiment using a visual stimulus has been performed at 0.5 T. This used a block fMRI paradigm with a bright, constant-intensity light source being shone at the maternal abdomen for 8 sec followed by 16 sec of darkness. This was repeated typically 40 times on nine subjects all of whom were greater than 36 weeks gestational age. Of these, one could not be analysed due to motion, three did not show significant activation, and five showed significant activation (P < 0.0085). In all cases, activation was localised within the frontal cortex. Exact localisation was difficult but this may correspond to the frontal eye fields and dorsolateral prefontal cortex. In no cases was significant activation present within the occipital region as would have been expected and was observed in 2/8 adult subjects. Hum. Brain Mapping 20:239-245, 2003.

Myometrial and placental artery reactivity alone cannot explain reduced placental perfusion in pre-eclampsia and intrauterine growth restriction.

OBJECTIVES: (1) To investigate a possible association between myometrial and placental artery vasoreactivity and perfusion at the basal and chorionic plates, respectively. (2) To confirm that myometrial arteries from women with pre-eclampsia and intrauterine growth restriction exhibit an attenuated endothelium-dependent vasodilatory response. METHODS: Women with normal pregnancy, pre-eclampsia and intrauterine growth restriction had a magnetic resonance scan to assess placental perfusion using a technique called intravoxel incoherent motion. At delivery, myometrial and chorionic plate placental arteries were assessed on a wire myograph. Vessels were pre-constricted with the thromboxane mimetic U46619 and dilated with incremental doses of bradykinin. RESULTS: Pre-constricted myometrial arteries from women with pre-eclampsia or intrauterine growth restriction exhibited an attenuated vasodilatory response to bradykinin, compared with normal pregnancy (P < 0.0001). Pre-constricted placental arteries exhibited a minimal vasodilatory response in all three groups of women (P = 0.10). Maximal constrictor and vasodilatory responses of myometrial arteries were not associated with the perfusing fraction at the basal plate. Maximal constrictor and vasodilatory responses of chorionic plate placental arteries were not associated with the perfusing fraction at the chorionic plate. CONCLUSION: We confirm that myometrial arteries from women with pre-eclampsia or intrauterine growth restriction exhibit an attenuated endothelium-dependent vasodilatory response. Apart from vasoreactivity of small arteries, other factors may be involved in the control of placental perfusion.