Female Pelvis & Fetal
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Thursday 10 May 2012
Room 219-220  10:30 - 12:30 Moderators: Evis Sala, Antonio C. A. Westphalen

10:30 0564.   Introduction
Nandita Desouza
10:42 0565.   Characterization of Malignancy of Adnexal Lesions using ADC Entropy: Comparison with Mean ADC and Qualitative DWI Assessment
A. S. Kierans1, G. L. Bennett1, T. C. Mussi1, J. S. Babb1, H. Rusinek1, J. Melamed2, and A. B. Rosenkrantz1
1Radiology, NYU Langone Medical Center, New York, NY, United States, 2Pathology, NYU Langone Medical Center, New York, NY, United States

37 patients with an adnexal mass underwent pelvic MRI including DWI before resection. We evaluated performance of mean ADC, ADC entropy, and subjective interpretation of two radiologists using DWI in discriminating benign and malignant adnexal lesions. Malignant lesions demonstrated significantly higher ADC entropy than benign lesions but no significant difference in mean ADC. Accuracy of ADC entropy was similar to that of the less experienced reader. However, the more experienced reader’s accuracy was greater than that of all other assessments. We conclude ADC entropy may serve as a useful quantitative metric for ovarian lesion evaluation, particularly for less experienced readers.

10:54 0566.   Diffusion properties of uterine fibroids pre- and post- uterine fibroid embolization
Jennifer W Chong1, Natalie Yang2, Sarah J Jenkins3, Errol Colak1, Shalini Anthwal1, Andrew A Common1, Vikram Prabhudesai1, and Anish Kirpalani1
1Department of Medical Imaging, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada, 2Department of Radiology, Austin Health, Heidelberg, Australia, 3Department of Diagnostic Imaging, Memorial University, St. John's, NL, Canada

A decrease in uterine fibroid enhancement on pelvic MRI is routinely used to monitor patients' response to uterine fibroid embolization (UFE). In this prospective cohort study of 50 patients (88 uterine fibroids), we examined whether the ADC from diffusion-weighted MRI also changed post-UFE. We found a statistically significant rise in the mean ADC of fibroids post-UFE. We also found that fibroids which have more residual contrast enhancement post-UFE had a higher pre-UFE ADC. ADC may therefore have a clinically important role in predicting treatment response.

11:06 0567.   Diffusion-weighted Imaging in Endometrial Carcinoma in Early Stage and Normal Endometrium of Childbearing Women in Different Menstrual Cycle -- Preliminary Study
Xiaoduo Yu1, Yan Chen1, Meng Lin1, Han Ouyang1, and Chunwu Zhou1
1Department of Diagnostic Radiology, Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, beijing, beijing, China

DWI could measure microscopic diffusion of water molecules and has the utility to evaluate the state of endometrium in physiology and pathology quantitatively. Difference among ADC value of endometrial carcinoma and normal endometrium of childbearing women in different menstrual cycle would be helpful in the diagnosis of endometrial carcinoma.

11:18 0568.   
Parallel MRI performance evaluation of a novel 32 channel fetal array at 1.5T
Ye Li1, Yong Pang1, Daniel Vigneron1,2, Orit Glenn1, Duan Xu1, and Xiaoliang Zhang1,2
1Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States, 2UCSF/UC Berkeley Joint Graduate Group in Bioengineering, San Francisco, CA, United States

In this work, we aim to evaluate parallel imaging performance of a 32 channel fetal array for fetal MRI at 1.5T. The gradient-echo image intensity of each coil element was calculated based on electromagnetic field distribution of each element. GRAPPA reconstructed images with different acceleration factors were carried out by using PULSAR toolbox. We studied the proposed flexible 32-channel array and compared with a commercial available 8-channel torso array that is routinely used in clinical fetal imaging. Our results show that the proposed fetal array improves parallel imaging performance for fetal MRI in terms of Artifact Power (AP) and image intensity.

11:30 0569.   
Oxygen-Enhanced MRI and BOLD in the human placenta
Isaac Huen1,2, David M. Morris1,2, Caroline Wright3, Colin P. Sibley3, Edward Johnstone3, and Josephine H. Naish1,2
1Imaging Sciences and Biomedical Engineering, University of Manchester, Manchester, United Kingdom, 2The University of Manchester Biomedical Imaging Institute, University of Manchester, Manchester, United Kingdom, 3Maternal & Fetal Health Research Centre, University of Manchester, Manchester, United Kingdom

Preeclampsia and Fetal Growth Restriction are common pregnancy complications thought to be caused by a compromised placental phenotype. This may affect placental oxygen delivery, for which there is little previously obtained data. Oxygen-Enhanced MRI (OE-MRI) measures ΔR1 (R1 = 1/T1) which increases when dissolved molecular oxygen concentration rises. Blood Oxygen Level Dependent (BOLD) MRI measures ΔR2* (R2*= 1/T2*) which decreases when deoxyhemoglobin concentration falls. OE-MRI and BOLD results are obtained in 10 pregnant subjects between breathing of medical air and 100% oxygen. Significant R1 increases and R2* decreases suggest oxygen delivery to the placenta has been observed in normal pregnancy.

11:42 0570.   Arterial Spin Labelling in the Human Placenta – Mapping Perfusion
David M Morris1,2, Caroline Wright3, Mark S Dobbs1,2, Philip N Baker4, Ian P Crocker3, Penny A Gowland5, Sue T Francis5, Colin P Sibley3, and Geoff JM Parker1,2
1Imaging Sciences, University of Manchester, Manchester, United Kingdom, 2Biomedical Imaging Institute, University of Manchester, Manchester, United Kingdom, 3Maternal and Fetal Health Research Group, University of Manchester, Manchester, United Kingdom, 4Department of Physiology, University of Alberta, Edmonton, Alberta, Canada, 5Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, Nottingham, United Kingdom

Disruptions in placental morphology lead to impaired function that increases the risk of perinatal mortality and morbidity. Flow-sensitive Alternating Inversion Recovery Arterial Spin Labelling has been applied to investigate the flow characteristic of the placenta. Analysis was carried out to determine the robustness of results generated and clinical applicability. Nine human placentas in normal pregnancies were scanned in the third trimester. These results show the applicability of the technique, its potential to categorize the inhomogeneity of flow in the placenta on a voxel by voxel level, and good agreement with perfusion values using other methodologies.

11:54 0571.   
The Effect of Maternal Smoking on Fetal Organ Growth
Devasuda Anblagan1, Nia W Jones2, Alexander J Parker3, George Bugg2, Carolyn Costigan1, Ruta Deshpande2, Lucy Coyne4, Rosanne Aleong5, Neil Roberts6, Zdenka Pausova7,8, Nick Raine Fenning9, Tomas Paus5,10, and Penny A Gowland1
1Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom, 2Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, United Kingdom, 3University of Aberdeen, Aberdeen, United Kingdom, 4Liverpool Women's Hospital, Liverpool, United Kingdom, 5Rotman Research Institute, University of Toronto, Toronto, Ontario, Canada, 6Clinical Research and Imaging Centre, Queens Medical Research Institute, Edinburgh, United Kingdom, 7Research Institute of the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada, 8Universite de Montreal, Montreal, Quebec, Canada, 9School of Clinical Sciences, University of Nottingham, United Kingdom, 10School of Psychology, University of Nottingham, United Kingdom

Cigarette smoke contains two main compounds: carbon monoxide and nicotine; both cross the placenta into the fetus where they reach levels exceeding those found in the maternal circulation. This has been associated with miscarriage, placenta abruption, placenta praevia, low birth weight and perinatal mortality. In the long-term, maternal smoking during pregnancy appears to increase the probability of respiratory disorders, obesity and behavioral problems. This work studies the effect of maternal smoking on the growth of fetal organs and shows that fetal lungs, kidneys and brain volumes are reduced by maternal smoking during pregnancy.

12:06 0572.   Unique in utero identification of fetuses in multi-fetal mouse pregnancies by placental bi-directional arterial spin labeling (BD-ASL) MRI
Reut Avni1, Tal Raz1, Joel Garbow2, and Michal Neeman1
1Biological Regulation, Weizmann Institute of Sceince, Rehovot, Israel, 2Biomedical MR Laboratory, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, United States

The study presented here examines whether natural occurring deaths, as well as genetic manipulation to create targeted defects in placental function (PKBá/ Akt1-/- fetuses), affect placental perfusion and maternal blood volume in adjacent (normal) fetuses at late-gestation, as measured by in vivo Bi-Directional Arterial Spin Labeling (BD-ASL) MRI and ex vivo fluorescence microscopy, respectively. The ability to noninvasively determine fetal location along the uterine horn using BD-ASL method opens possibilities for determining and pursuing phenotypic alterations in genetic, as well as developmental, longitudinal studies. These data suggest in systems of multiple fetuses within one uterus there may exist communication mechanisms (e.g. hydrodynamic)

12:18 0573.   MRI of the active second stage of vaginal delivery in real-time
Felix Victor Guettler1, Andreas Heinrich1, Christian Bamberg2, Jens Rump1, Bernhard Schnackenburg3, Maximilian de Bucourt1, Andreas Thomas1, Bernd Hamm1, and Ulf Teichgraeber1
1Department of Radiology, Charité - University Hospital Berlin, Berlin, Berlin, Germany, 2Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Berlin, Germany, 3Philips Medical Systems, Hamburg, Germany

The aim of this study was the visualization of the active second stage of vaginal delivery in real-time through an open magnetic resonance imager complying with modern safety standards in obstetrics. For this purpose an MR-compatible cardiotocograph (CTG) was developed. With some pregnant probands, a suitable birth position and a dynamic MR-sequence was designed. The demonstration of the fetal and maternal organs occurred with an interactive single-shot TSE sequence, which was also able to compensate eventual image artifacts of mother and child. The real-time representation of the human expulsive phase via open MRI allows further research of birth complication and birth defects, but is also suitable for birth simulations.