Fetal MRI-Based Body and Adiposity Quantification for Small for Gestational Age Perinatal Risk Stratification.
fat-water imaging
fetal growth restriction
fetus
small for gestation age
Journal
Journal of magnetic resonance imaging : JMRI
ISSN: 1522-2586
Titre abrégé: J Magn Reson Imaging
Pays: United States
ID NLM: 9105850
Informations de publication
Date de publication:
19 Nov 2023
19 Nov 2023
Historique:
revised:
06
11
2023
received:
13
08
2023
accepted:
06
11
2023
pubmed:
20
11
2023
medline:
20
11
2023
entrez:
20
11
2023
Statut:
aheadofprint
Résumé
Small for gestational age (SGA) fetuses are at risk for perinatal adverse outcomes. Fetal body composition reflects the fetal nutrition status and hold promise as potential prognostic indicator. MRI quantification of fetal anthropometrics may enhance SGA risk stratification. Smaller, leaner fetuses are malnourished and will experience unfavorable outcomes. Prospective. 40 SGA fetuses, 26 (61.9%) females: 10/40 (25%) had obstetric interventions due to non-reassuring fetal status (NRFS), and 17/40 (42.5%) experienced adverse neonatal events (CANO). Participants underwent MRI between gestational ages 30 + 2 and 37 + 2. 3-T, True Fast Imaging with Steady State Free Precession (TruFISP) and T Total body volume (TBV), fat signal fraction (FSF), and the fat-to-body volumes ratio (FBVR) were extracted from TruFISP and T Univariate and multivariate logistic regressions for the association between TBV, FBVR, and FSF and interventions for NRFS and CANO. Fisher's exact test was used to measure the association between sonographic FGR criteria and perinatal outcomes. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. A P-value <0.05 was considered statistically significant. FBVR (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.2-0.76) and FSF (OR 0.95, CI 0.91-0.99) were linked with NRFS interventions. Furthermore, TBV (OR 0.69, CI 0.56-0.86) and FSF (OR 0.96, CI 0.93-0.99) were linked to CANO. The FBVR sensitivity/specificity for obstetric interventions was 85.7%/87.5%, and the TBV sensitivity/specificity for CANO was 82.35%/86.4%. The sonographic criteria sensitivity/specificity for obstetric interventions was 100%/33.3% and insignificant for CANO (P = 0.145). Reduced TBV and FBVR may be associated with higher rates of obstetric interventions for NRFS and CANO. 2 TECHNICAL EFFICACY: Stage 5.
Sections du résumé
BACKGROUND
BACKGROUND
Small for gestational age (SGA) fetuses are at risk for perinatal adverse outcomes. Fetal body composition reflects the fetal nutrition status and hold promise as potential prognostic indicator. MRI quantification of fetal anthropometrics may enhance SGA risk stratification.
HYPOTHESIS
OBJECTIVE
Smaller, leaner fetuses are malnourished and will experience unfavorable outcomes.
STUDY TYPE
METHODS
Prospective.
POPULATION
METHODS
40 SGA fetuses, 26 (61.9%) females: 10/40 (25%) had obstetric interventions due to non-reassuring fetal status (NRFS), and 17/40 (42.5%) experienced adverse neonatal events (CANO). Participants underwent MRI between gestational ages 30 + 2 and 37 + 2.
FIELD STRENGTH/SEQUENCE
UNASSIGNED
3-T, True Fast Imaging with Steady State Free Precession (TruFISP) and T
ASSESSMENT
RESULTS
Total body volume (TBV), fat signal fraction (FSF), and the fat-to-body volumes ratio (FBVR) were extracted from TruFISP and T
STATISTICAL TESTS
METHODS
Univariate and multivariate logistic regressions for the association between TBV, FBVR, and FSF and interventions for NRFS and CANO. Fisher's exact test was used to measure the association between sonographic FGR criteria and perinatal outcomes. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. A P-value <0.05 was considered statistically significant.
RESULTS
RESULTS
FBVR (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.2-0.76) and FSF (OR 0.95, CI 0.91-0.99) were linked with NRFS interventions. Furthermore, TBV (OR 0.69, CI 0.56-0.86) and FSF (OR 0.96, CI 0.93-0.99) were linked to CANO. The FBVR sensitivity/specificity for obstetric interventions was 85.7%/87.5%, and the TBV sensitivity/specificity for CANO was 82.35%/86.4%. The sonographic criteria sensitivity/specificity for obstetric interventions was 100%/33.3% and insignificant for CANO (P = 0.145).
DATA CONCLUSION
CONCLUSIONS
Reduced TBV and FBVR may be associated with higher rates of obstetric interventions for NRFS and CANO.
EVIDENCE LEVEL
METHODS
2 TECHNICAL EFFICACY: Stage 5.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Kamin Research Grant, Israel Innovation Authority
ID : 63418
Organisme : Kamin Research Grant, Israel Innovation Authority
ID : 72126
Organisme : Leo Mintz Grant
Organisme : Thrasher Research Fund
Informations de copyright
© 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.
Références
Nohuz E, Rivière O, Coste K, Vendittelli F. Prenatal identification of small-for-gestational age and risk of neonatal morbidity and stillbirth. Ultrasound Obstet Gynecol 2020;55:621-628.
Madden JV, Flatley CJ, Kumar S. Term small-for-gestational-age infants from low-risk women are at significantly greater risk of adverse neonatal outcomes. Am J Obstet Gynecol 2018;218:525.e1-525.e9.
Mendez-Figueroa H, Truong VTT, Pedroza C, Khan AM, Chauhan SP. Small-for-gestational-age infants among uncomplicated pregnancies at term: A secondary analysis of 9 Maternal-Fetal Medicine Units Network studies. Am J Obstet Gynecol 2016;215:628.e1-628.e7.
Chauhan SP, Rice MM, Grobman WA, et al. Neonatal morbidity of small- and large-for-gestational-age neonates born at term in uncomplicated pregnancies. Obstet Gynecol 2017;130:511-519.
Lees CC, Stampalija T, Baschat A, et al. ISUOG Practice Guidelines: Diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 2020;56:298-312.
Melamed N, Baschat A, Yinon Y, et al. FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: Best practice advice for screening, diagnosis, and management of fetal growth restriction. Int J Gynaecol Obstet 2021;152(Suppl 1):3-57.
Gordijn SJ, Beune IM, Thilaganathan B, et al. Consensus definition of fetal growth restriction: A Delphi procedure. Ultrasound Obstet Gynecol 2016;48:333-339.
Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction: (Replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol 2020;223:B2-B17.
Meler E, Martinez-Portilla RJ, Caradeux J, et al. Severe smallness as predictor of adverse neonatal outcome in suspected late SGA fetuses: Systematic review and meta-analysis. Ultrasound Obstet Gynecol 2022;60:328-337.
Martinez-Portilla RJ, Caradeux J, Meler E, Lip-Sosa DL, Sotiriadis A, Figueras F. Third-trimester uterine artery Doppler for prediction of adverse outcome in late small-for-gestational-age fetuses: Systematic review and meta-analysis. Ultrasound Obstet Gynecol 2020;55:575-585.
Schreiber V, Hurst C, da Silva CF, Stoke R, Turner J, Kumar S. Definitions matter: Detection rates and perinatal outcome for infants classified prenatally as having late fetal growth restriction using SMFM biometric vs ISUOG/Delphi consensus criteria. Ultrasound Obstet Gynecol 2023;61:377-385.
Salafia CM, Minior VK, Pezzullo JC, Popek EJ, Rosenkrantz TS, Vintzileos AM. Intrauterine growth restriction in infants of less than thirty-two weeks' gestation: Associated placental pathologic features. Am J Obstet Gynecol 1995;173:1049-1057.
Larciprete G, Valensise H, Di Pierro G, et al. Intrauterine growth restriction and fetal body composition. Ultrasound Obstet Gynecol 2005;26:258-262.
Abramowicz JS, Sherer DM, Bar-Tov E, Woods JRJ. The cheek-to-cheek diameter in the ultrasonographic assessment of fetal growth. Am J Obstet Gynecol 1991;165(4 Pt 1):846-852.
Padoan A, Rigano S, Ferrazzi E, Beaty BL, Battaglia FC, Galan HL. Differences in fat and lean mass proportions in normal and growth-restricted fetuses. Am J Obstet Gynecol 2004;191:1459-1464.
Manapurath R, Gadapani B, Pereira-da-Silva L. Body composition of infants born with intrauterine growth restriction: A systematic review and meta-analysis. Nutrients 2022;14:1085.
Stark DD, McCarthy SM, Filly RA, Callen PW, Hricak H, Parer JT. Intrauterine growth retardation: Evaluation by magnetic resonance. Radiology 1985;155:425-427.
Rabinowich A, Avisdris N, Zilberman A, et al. Reduced adipose tissue in growth-restricted fetuses using quantitative analysis of magnetic resonance images. Eur Radiol 2023. doi:10.1007/s00330-023-09855-y
Shaw M, Lutz T, Gordon A. Does low body fat percentage in neonates greater than the 5th percentile birthweight increase the risk of hypoglycaemia and neonatal morbidity? J Paediatr Child Health 2019;55:1424-1428.
Carberry AE, Raynes-Greenow CH, Turner RM, Askie LM, Jeffery HE. Is body fat percentage a better measure of undernutrition in newborns than birth weight percentiles? Pediatr Res 2013;74:730-736.
Banting SA, Dane KM, Charlton JK, et al. Estimation of neonatal body fat percentage predicts neonatal hypothermia better than birthweight centile. J Matern Neonatal Med 2022;35:1-8.
Huvanandana J, Carberry AE, Turner RM, et al. An anthropometric approach to characterising neonatal morbidity and body composition, using air displacement plethysmography as a criterion method. PloS One 2018;13:e0195193.
Giza SA, Koreman TL, Sethi S, et al. Water-fat magnetic resonance imaging of adipose tissue compartments in the normal third trimester fetus. Pediatr Radiol 2021;51:1214-1222.
Blondiaux E, Chougar L, Gelot A, et al. Developmental patterns of fetal fat and corresponding signal on T1-weighted magnetic resonance imaging. Pediatr Radiol 2018;48:317-324.
Bhide A, Acharya G, Baschat A, et al. ISUOG practice guidelines (updated): Use of Doppler velocimetry in obstetrics. Ultrasound Obstet Gynecol 2021;58:331-339.
Dudovitch G, Link-Sourani D, Ben Sira L, Miller E, Ben Bashat D, Joskowicz L. Deep learning automatic fetal structures segmentation in MRI scans with few annotated datasets. In: Martel AL, Abolmaesumi P, Stoyanov D, et al., editors. Med Image Comput Comput Assist Interv-MICCAI 2020. Cham: Springer International Publishing; 2020. p 365-374.
Specktor-Fadida B, Link-Sourani D, Rabinowich A, et al. Deep learning-based segmentation of whole-body fetal MRI and fetal weight estimation: Assessing performance, repeatability, and reproducibility. Eur Radiol 2023. doi:10.1007/s00330-023-10038-y
Avisdris N, Rabinowich A, Fridkin D, et al. Automatic fetal fat quantification from MRI. Int work preterm, perinat paediatr image anal. Cham: Springer; 2022. p 25-37.
Yushkevich PA, Piven J, Hazlett HC, et al. User-guided 3D active contour segmentation of anatomical structures: Significantly improved efficiency and reliability. Neuroimage 2006;31:1116-1128.
Desoye G, Herrera E. Adipose tissue development and lipid metabolism in the human fetus: The 2020 perspective focusing on maternal diabetes and obesity. Prog Lipid Res 2021;81:101082.
Himoto Y, Fujimoto K, Kido A, et al. Risk stratification for pregnancies diagnosed with fetal growth restriction based on placental MRI. J Magn Reson Imaging 2022;56:1650-1658.
Dahdouh S, Andescavage N, Yewale S, et al. In vivo placental MRI shape and textural features predict fetal growth restriction and postnatal outcome. J Magn Reson Imaging 2018;47:449-458.
Sørensen A, Hutter J, Seed M, Grant PE, Gowland P. T2*-weighted placental MRI: Basic research tool or emerging clinical test for placental dysfunction? Ultrasound Obstet Gynecol 2020;55:293-302.
Link-Sourani D, Avisdris N, Harel S, et al. Ex-vivo MRI of the normal human placenta: Structural-functional interplay and the association with birth weight. J Magn Reson Imaging 2022;56:134-144.
Li K, Yan G, Zheng W, Sun J, Zou Y. Measurement of the brain volume/liver volume ratio by three-dimensional MRI in appropriate-for-gestational age fetuses and those with fetal growth restriction. J Magn Reson Imaging 2021;54:1796-1801.
Dall'Asta A, Stampalija T, Mecacci F, et al. Ultrasound prediction of adverse perinatal outcome at diagnosis of late-onset fetal growth restriction. Ultrasound Obstet Gynecol 2022;59:342-349.
Rizzo G, Mappa I, Bitsadze V, et al. Role of Doppler ultrasound at time of diagnosis of late-onset fetal growth restriction in predicting adverse perinatal outcome: Prospective cohort study. Ultrasound Obstet Gynecol 2020;55:793-798.
Kühn J-P, Jahn C, Hernando D, et al. T1 bias in chemical shift-encoded liver fat-fraction: Role of the flip angle. J Magn Reson Imaging 2014;40:875-883.
Yu H, Shimakawa A, McKenzie CA, Brodsky E, Brittain JH, Reeder SB. Multiecho water-fat separation and simultaneous R2* estimation with multifrequency fat spectrum modeling. Magn Reson Med 2008;60:1122-1134.
Unterscheider J, Daly S, Geary MP, et al. Optimizing the definition of intrauterine growth restriction: The multicenter prospective PORTO study. Am J Obstet Gynecol 2013;208(290):e1-e6.