Cross‐modality and in‐vivo validation of 4D flow MRI evaluation of uterine artery blood flow in human pregnancy

• Published in: Ultrasound in obstetrics & gynecology 2021-11, Vol.58 (5), p.722-731
• Main Authors: Hwuang, E., Wu, P. H., Rodriguez‐Soto, A., Langham, M., Wehrli, F. W., Vidorreta, M., Moon, B., Kochar, K., Parameshwaran, S., Koelper, N., Tisdall, M. D., Detre, J. A., Witschey, W., Schwartz, N.
• Format: Article
• Language: English
• Subjects: 4D flow MRI; Adult; Area Under Curve; Blood flow; Blood Flow Velocity; Blood vessels; Body mass; Body mass index; Body size; Cross-Sectional Studies; Doppler effect; Doppler ultrasound; Eclampsia; Evaluation; Female; Fetal Growth Retardation - diagnostic imaging; Flow velocity; Gynecology; Hemodynamics; Humans; Infant, Newborn; Infant, Small for Gestational Age; intrauterine growth restriction; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Multimodal Imaging - methods; Obstetrics; Physiology; Placental Circulation; Pre-Eclampsia - diagnostic imaging; Predictive Value of Tests; Preeclampsia; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third - physiology; Prenatal Diagnosis - methods; pre‐eclampsia; Prospective Studies; Pulsatile Flow; Reproducibility of Results; Ultrasonic imaging; Ultrasound; uterine artery; Uterine Artery - diagnostic imaging; Uterine Artery - embryology; Uterus; Velocimetry
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.23112

ABSTRACT Objectives Clinical assessment of uterine artery (UtA) hemodynamics is currently limited to Doppler ultrasound (US) velocimetry. We have demonstrated previously the feasibility of applying four‐dimensional (4D) flow magnetic resonance imaging (MRI) to evaluate UtA hemodynamics during pregnancy, allowing flow quantification of the entire course of the vessel. In this study, we sought to further validate the physiological relevance of 4D flow MRI measurement of UtA blood flow by exploring its association with pregnancy outcome relative to US‐based metrics. Methods Recruited into this prospective, cross‐sectional study were 87 women with a singleton pregnancy who underwent 4D flow MRI between May 2016 and April 2019 to measure the UtA pulsatility index (MRI‐PI) and blood flow rate (MRI‐flow, in mL/min). UtA‐PI was also measured using US (US‐PI). The primary outcome was a composite (COMP) of pre‐eclampsia (PE) and/or small‐for‐gestational‐age (SGA) neonate, and secondary outcomes were PE and SGA neonate individually. We assessed the ability of MRI‐flow, MRI‐PI and US‐PI to distinguish between outcomes, and evaluated whether MRI‐flow changed as gestation progressed. Results Following 4D flow postprocessing and exclusions from the analysis, 74 women had 4D flow MRI data analyzed for both UtAs. Of these, 18 developed a COMP outcome: three developed PE only, 11 had a SGA neonate only and four had both. A comparison of the COMP group vs the no‐COMP group found no differences in maternal age, body mass index, nulliparity, gravidity or race. For 66 of the 74 subjects, US data were also available. In these subjects, both median MRI‐PI (0.95 vs 0.70; P