Pixelwise Quantification of Placental Perfusion Visualized by 3D Power Doppler Sonography

Abstract

Purpose: We present a new method for noninvasive automatic measurement of perfusion intensity (PixelFlux method) in standardized 3 D power Doppler sonography to quantify differences of perfusion intensities among different placental layers.

Materials and Methods: Power Doppler sonographic videos of anterior and central placentas were recorded at various gestational ages (13 to 38 weeks) under defined conditions in 22 women with uncomplicated pregnancies which ended in the delivery of an appropriately grown fetus. Tissue perfusion intensity in four placental layers was calculated as the product of the Doppler amplitude and the perfused area encoded by power Doppler signals related to the area of the respective layer. Measurements are given as the percentage of maximal possible perfusion.

Results: Significant differences in placental perfusion intensities in the uterine wall (6.6 %), the maternal flow within the intervillous space (2.4 %), the fetal flow within placental villi (1.6 %) and the chorionic plate (9.3 %) were demonstrated with a continuous increase in the uterine wall and the placental villi.

Conclusion: Placental perfusion intensity was quantified noninvasively from 3 D power Doppler signal data in an easily accomplishable manner with a new software-based measurement procedure. There are significant differences in perfusion intensities among placental layers. Placenta perfusion measurement with the PixelFlux method is feasible and can discern significant perfusion differences among different placenta layers.

Zusammenfassung

Ziel: Wir stellen eine neue, nicht invasive Methode vor, die eine pixelweise Bemessung der Perfusion verschiedener Plazentaschichten aus standardisierten dreidimensionalen Powerdoppler-Videos ermöglicht (PixelFlux-Methode).

Material und Methoden: Standardisierte Powerdoppler-Videos anterior und zentral lokalisierter Plazenten (13.–38. Schwangerschaftswoche) von 22 Schwangeren wurden unter definierten Bedingungen untersucht. Alle Schwangerschaften führten zur Geburt eines normalgewichtigen Kindes. Die Gewebsperfusionsintensität in 4 Plazentaschichten wurde mithilfe der PixelFlux-Software als Produkt der Amplitude der Powerdoppler-Signale und der perfundierten Fläche bezogen auf die Fläche der Untersuchungsregion automatisch berechnet. Die Perfusionsintensität wurde in Prozent der maximal möglichen Perfusion angegeben.

Ergebnisse: Zwischen der Uteruswand (6,6 %), der maternalen (2,4 %), der fetalen Schicht (1,6 %) und der Chorionplatte (9,3 %) konnten signifikante Perfusionsintensitätsunterschiede nachgewiesen werden. Im Verlauf der Schwangerschaft kam es zu einem kontinuierlichen Anstieg der Perfusionsintensität in der Uteruswand und den Plazentazotten.

Schlussfolgerung: Die PixelFlux-Methode erlaubt die Messung der Plazentaperfusion aus dreidimensionalen Powerdoppler-Ultraschallvideos und kann Unterschiede der Perfusion der Plazentaschichten darstellen.

Key words

color Doppler - placenta - perfusion - measurement - software

• References

• 1 Benirschke K, Kaufmann P, Baergen R. Pathology of the human placenta. 5th edn. New York.: Springer; 2006
• 2 Kingdom JC, Kaufmann P. Oxygen and placental vascular development. Adv Exp Med Biol 1999; 474: 259-275
• 3 Spencer K et al. First-trimester maternal serum PP-13, PAPP-A and second-trimester uterine artery Doppler pulsatility index as markers of pre-eclampsia. Ultrasound Obstet Gynecol 2007; 29: 128-134
• 4 Papageorghiou AT et al. Multicenter screening for pre-eclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol 2001; 18: 441-449
• 5 Martin AM et al. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation. Ultrasound Obstet Gynecol 2001; 18: 583-586
• 6 Gomez O et al. Uterine artery Doppler at 11-14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Ultrasound Obstet Gynecol 2005; 26: 490-494
• 7 Konje JC et al. 3-dimensional colour power angiography for staging human placental development. Lancet 2003; 362: 1199-1201
• 8 Bower SJ et al. Prediction of pre-eclampsia by abnormal uterine Doppler ultrasound and modification by aspirin. Br J Obstet Gynaecol 1996; 103: 625-629
• 9 Hartung J, Kalache KD, Chaoui R. Three-dimensional power Doppler ultrasonography (3D-PDU) in fetal diagnosis. Ultraschall in Med 2004; 25: 200-205
• 10 Dubiel M et al. Fetal and placental power Doppler imaging in normal and high-risk pregnancy. Eur J Ultrasound 1999; 9: 223-230
• 11 Menigault E et al. Feto-maternal circulation: mathematical model and comparison with Doppler measurements. Eur J Ultrasound 1998; 7: 129-143
• 12 Scholbach TM, Stolle J, Scholbach J. Three-Dimensional Volumetric Spatially Angle-Corrected Pixelwise Fetal Flow Volume Measurement. Ultraschall in Med 2011; 32: E122-E128
• 13 Scholbach T. Dynamic Tissue Perfusion Measurement – Basics and Applications. Sonography (ed. by Kerry Thoirs at InTech – Open Access Publisher) 2012. ISBN 978-953-307-947-949, 293-324
• 14 Schulten-Wijman MJ et al. Evaluation of volume vascularization index and flow index: a phantom study. Ultrasound Obstet Gynecol 2008; 32: 560-564
• 15 Jones NW et al. In vitro dual perfusion of human placental lobules as a flow phantom to investigate the relationship between fetoplacental flow and quantitative 3D power doppler angiography. Placenta 2009; 30: 130-135
• 16 Merce LT, Barco MJ, Bau S. Reproducibility of the study of placental vascularization by three-dimensional power Doppler. J Perinat Med 2004; 32: 228-233
• 17 Rizzo G et al. Placental vascularization measured by three-dimensional power Doppler ultrasound at 11 to 13 + 6 weeks’ gestation in normal and aneuploid fetuses. Ultrasound Obstet Gynecol 2007; 30: 259-262
• 18 de Paula CF et al. Quantitative analysis of placental vasculature by three-dimensional power Doppler ultrasonography in normal pregnancies from 12 to 40 weeks of gestation. Placenta 2009; 30: 142-148
• 19 Noguchi J et al. Placental vascular sonobiopsy using three-dimensional power Doppler ultrasound in normal and growth restricted fetuses. Placenta 2009; 30: 391-397
• 20 Rizzo G et al. Effects of maternal cigarette smoking on placental volume and vascularization measured by 3-dimensional power Doppler ultrasonography at 11+0 to 13+6 weeks of gestation. Am J Obstet Gynecol 2009; 200: 415e1-415e5
• 21 Merce LT et al. Intervillous and uteroplacental circulation in normal early pregnancy and early pregnancy loss assessed by 3-dimensional power Doppler angiography. Am J Obstet Gynecol 2009; 200: 315e1-315e8
• 22 Zalud I, Shaha S. Evaluation of the utero-placental circulation by three-dimensional Doppler ultrasound in the second trimester of normal pregnancy. J Matern Fetal Neonatal Med 2007; 20: 299-305
• 23 Zalud I, Shaha S. Three-dimensional sonography of the placental and uterine spiral vasculature: influence of maternal age and parity. J Clin Ultrasound 2008; 36: 391-396
• 24 Lax A et al. The value of specific MRI features in the evaluation of suspected placental invasion. Magn Reson Imaging 2007; 25: 87-93
• 25 Duncan KR. Fetal and placental volumetric and functional analysis using echo-planar imaging. Top Magn Reson Imaging 2001; 12: 52-66
• 26 Francis ST et al. Non-invasive mapping of placental perfusion. Lancet 1998; 351: 1397-1399
• 27 Gowland PA et al. In vivo perfusion measurements in the human placenta using echo planar imaging at 0.5 T. Magn Reson Med 1998; 40: 467-473
• 28 Merce LT et al. Assessment of placental vascularization by three-dimensional power Doppler “vascular biopsy” in normal pregnancies. Croat Med J 2005; 46: 765-771
• 29 Scholbach T et al. New method of dynamic color doppler signal quantification in metastatic lymph nodes compared to direct polarographic measurements of tissue oxygenation. Int J Cancer 2005; 114: 957-962
• 30 Castellucci M et al. Villous sprouting: fundamental mechanisms of human placental development. Hum Reprod Update 2000; 6: 485-494
• 31 Kingdom J et al. Development of the placental villous tree and its consequences for fetal growth. Eur J Obstet Gynecol Reprod Biol 2000; 92: 35-43