Dual-Imaging Modality Approach to Evaluate Cerebral Hemodynamics in Growth-Restricted Fetuses: Oxygenation and Perfusion

• DOI: 10.1159/000500954
• Publication Date: 2019-09-23T21:00:33Z
• Authors: Brijesh Kumar Yadav; Edgar Hernandez-A...; Uday Krishnamurthy; Sagar Buch; Pavan Jella; Anabela Trifan; Lami Yeo; Sonia S. Hassan; Ewart Mark Haacke; Roberto Romero; Jaladhar Neelavalli
• Keywords: Adult; Middle Cerebral Artery; Fetal Growth Retardation; Adolescent; Hemodynamics; Gestational Age; Ultrasonography, Doppler; Ultrasonography, Prenatal; United States; 3. Good health; Oxygen; 03 medical and health sciences; Cross-Sectional Studies; Diffusion Magnetic Resonance Imaging; 0302 clinical medicine; Predictive Value of Tests; Pregnancy; Case-Control Studies; Cerebrovascular Circulation; Humans; Female; Biomarkers; Blood Flow Velocity

<b><i>Objective:</i></b> To evaluate a dual-imaging modality approach to obtain a combined estimation of venous blood oxygenation (S<i>νO</i>₂) using susceptibility-weighted magnetic resonance imaging (SWI-MRI), and blood perfusion using power Dopp­ler ultrasound (PDU) and fractional moving blood volume (FMBV) in the brain of normal growth and growth-restricted fetuses. <b><i>Methods:</i></b> Normal growth (<i>n</i> = 33) and growth-restricted fetuses (<i>n</i> = 10) from singleton pregnancies between 20 and 40 weeks of gestation were evaluated. MRI was performed and S<i>νO</i>₂ was calculated using SWI-MRI data obtained in the straight section of the superior sagittal sinus. Blood perfusion was estimated using PDU and FMBV from the frontal lobe in a mid-sagittal plane of the fetal brain. The association between fetal brain S<i>νO</i>₂ and FMBV, and the distribution of S<i>νO</i>₂ and FMBV values across gestation were calculated for both groups. <b><i>Results:</i></b> In growth-restricted fetuses, the brain S<i>νO</i>₂ values were similar, and the FMBV values were higher across gestation as compared to normal growth fetuses. There was a significantly positive association between S<i>νO</i>₂ and FMBV values (slope = 0.38 ± 0.12; <i>r</i> = 0.7; <i>p</i> = 0.02) in growth-restricted fetuses. In normal growth fetuses, S<i>νO</i>₂ showed a mild decreasing trend (slope = –0.7 ± 0.4; <i>p</i> = 0.1), whereas FMBV showed a mild increasing trend (slope = 0.2 ± 0.2; <i>p</i> = 0.2) with advancing gestation, and a mild but significant negative association (slope = –0.78 ± 0.3; <i>r</i> = –0.4; <i>p</i> = 0.04) between these two estimates. <b><i>Conclusion:</i></b> Combined MRI (SWI) and ultrasound (FMBV) techniques showed a significant association between cerebral blood oxygenation and blood perfusion in normal growth and growth-restricted fetuses. This dual-imaging approach could contribute to the early detection of fetal “brain sparing” and brain oxygen saturation changes in high-risk pregnancies.