Placental MRI: Effect of maternal position and uterine contractions on placental BOLD MRI measurements

Esra Abaci Turk, S Mazdak Abulnaga, Jie Luo, Jeffrey N Stout, Henry A Feldman, Ata Turk, Borjan Gagoski, Lawrence L Wald, Elfar Adalsteinsson, Drucilla J Roberts, Carolina Bibbo, Julian N Robinson, Polina Golland, P Ellen Grant, William H Barth Jr, Esra Abaci Turk, S Mazdak Abulnaga, Jie Luo, Jeffrey N Stout, Henry A Feldman, Ata Turk, Borjan Gagoski, Lawrence L Wald, Elfar Adalsteinsson, Drucilla J Roberts, Carolina Bibbo, Julian N Robinson, Polina Golland, P Ellen Grant, William H Barth Jr

Abstract

Introduction: Before using blood-oxygen-level-dependent magnetic resonance imaging (BOLD MRI) during maternal hyperoxia as a method to detect individual placental dysfunction, it is necessary to understand spatiotemporal variations that represent normal placental function. We investigated the effect of maternal position and Braxton-Hicks contractions on estimates obtained from BOLD MRI of the placenta during maternal hyperoxia.

Methods: For 24 uncomplicated singleton pregnancies (gestational age 27-36 weeks), two separate BOLD MRI datasets were acquired, one in the supine and one in the left lateral maternal position. The maternal oxygenation was adjusted as 5 min of room air (21% O2), followed by 5 min of 100% FiO2. After datasets were corrected for signal non-uniformities and motion, global and regional BOLD signal changes in R2* and voxel-wise Time-To-Plateau (TTP) in the placenta were measured. The overall placental and uterine volume changes were determined across time to detect contractions.

Results: In mothers without contractions, increases in global placental R2* in the supine position were larger compared to the left lateral position with maternal hyperoxia. Maternal position did not alter global TTP but did result in regional changes in TTP. 57% of the subjects had Braxton-Hicks contractions and 58% of these had global placental R2* decreases during the contraction.

Conclusion: Both maternal position and Braxton-Hicks contractions significantly affect global and regional changes in placental R2* and regional TTP. This suggests that both factors must be taken into account in analyses when comparing placental BOLD signals over time within and between individuals.

Keywords: BOLD MRI; Braxton-Hicks contraction; Maternal hyperoxia; Maternal position; Placental MRI.

Conflict of interest statement

Declaration of competing interest The authors have no conflict of interests to declare.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Figures

Figure 1.
Figure 1.
Change of normalized R2* with time in the supine (black) and the left lateral (red) positions for each subject. The vertical dotted line represented the time 100% FiO2 was initiated. Left column: left lateral position first. Right column: supine position first. S = subject, GA = gestational age, w = weeks. Plots were ordered according to the gestational age increasing from top to bottom.
Figure 2.
Figure 2.
Coronal views selected as the center slice for placental normalized R2* image after placenta flattening for each subject and histograms in both maternal positions for whole placenta during normoxia and hyperoxia. Left column: left lateral position first. Right column: supine position first. Images were ordered according to the gestational age increasing from top to bottom.
Figure 3:
Figure 3:
Coronal views showing the center slice for TTP maps after placenta flattening for each subject and histograms of TTP values in both maternal positions for whole placenta. Left column: left lateral position first. Right column: supine position first. Images were ordered according to the gestational age increasing from top to bottom.
Figure 4:
Figure 4:
Effect of Braxton-Hicks Contractions on change of normalized R2*, placental and uterine volume with time in Supine and Left Lateral Positions. The vertical dotted line represented the time 100% FiO2 was initiated. Top row: left lateral position first. Other three rows: supine position first. S = subject, GA = gestational age, w = weeks. Images were ordered according to the gestational age increasing from left to right. The regions in which simultaneous drops in uterine volume and placenta volume were observed were indicated as a marker of uterine contractions with a blue box.
Figure 5:
Figure 5:
BOLD images acquired at t1 and t2 demonstrating the change in the signal during contraction and time activity curves generated for whole placenta (red) compared to the region with a dominant BOLD signal decrease during the contraction (blue).

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