Quantitative evaluation of placental microvascular blood flow and microstructure in fetal growth restriction with IVIM MRI

Abstract

Background: Intravoxel incoherent motion (IVIM) MRI uses diffusion-weighted (DW) MRI acquisitions to evaluate the microvascular and cellular environments of tissue. Due to these properties, IVIM has been increasingly utilized to evaluate abnormal placentation.

Objective: Our primary objective was to compare IVIM parameters in the placenta of patients with fetal growth restriction and appropriate for gestational age controls across gestational ages. Our secondary aim was to quantify IVIM parameters in fetal versus maternal placental aspects to evaluate microvascular and parenchymal differences.

Materials and methods: With IRB approval, pregnant individuals with a diagnosis of fetal growth restriction (n=24) and controls (n=22) were retrospectively analyzed. DW-MRI data were collected at 1.5 T with nine b-values (range, 0 s/mm² to 1,000 s/mm²). Data were processed by one non-blinded reader to obtain mean perfusion fraction (f), pseudo-diffusion coefficient (D*), their product fD*, and diffusion coefficient (D) in maternal and fetal aspects of the placenta, defined by bisecting the thickness of the placenta. Repeated measures of two-way ANOVAs were used to compare IVIM parameters in fetal and maternal placental aspects between participant groups. Correlations between IVIM parameters and gestational age were also evaluated in both groups.

Results: The average gestational age at MRI was 27±4 weeks for both groups. The percentile estimated fetal weight was 5.4±5.9% for the fetal growth restriction group and 42.8±28.5% for controls (P<0.001). The parameters D* and fD*, related to microvascular blood flow and tissue perfusion, were significantly lower in participants with fetal growth restriction compared to controls (D*, 40.5 vs. 52.4×10^-3 mm²/s, P=0.043; fD*, 14.7 vs. 21.0×10^-3 mm²/s, P=0.019). No other differences were observed, nor associations between gestational age and IVIM parameters in either group.

Conclusion: Our results suggest reduced microvascular flow in placentas of patients with fetal growth restriction compared to controls.

Keywords: Fetal MRI; Fetal growth restriction; Intravoxel incoherent motion (IVIM) MRI; Placental MRI; Quantitative MRI.