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Ultrasound/Imaging

Poster Session 4

(1033) Regional Diffusion of the Chronic Hypertensive Placenta

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: In placental disease, spiral artery remodeling is thought to be more aberrant at the periphery but remains normal in the central area near the cord. Considering this pathology, we aimed to investigate the impact of chronic hypertension (cHTN) during pregnancy on placental diffusion in vivo. Water diffusion is relatively stable against aging changes represented by connective tissue or calcifications, making diffusion mapping a tool to evaluate placenta pathology.

Study Design:

In this prospective study, pregnant individuals with and without chronic hypertension were imaged at 16-20 (visit 1) and 24-28 (visit 2) weeks gestation on a Phillips 3T Ingenia MRI. Sagittal diffusion weighted-imaging (DWI) was obtained during free breathing with 7 b-values - 0, 50, 100, 150, 400, 700, 1000 sec/mm2. Apparent diffusion coefficient (ADC) map was generated using mono-exponential fit.

Placental volumes and cord location region of interests (ROIs) were drawn on the ADC maps. The Euclidian distance between center of mass of the cord insertion and placental image voxels was calculated. Association between the distance and ADC value for each patient was evaluated using linear regression. The slope coefficient (change in ADC value per mm away from cord insertion) was estimated and compared between those with and without cHTN for each visit using Wilcoxon rank sum test.

Results: Analysis included 33 pregnant individuals. At time point 1, 17 had cHTN, and 15 did not; at time point 2, 18 had cHTN, and 14 did not. Subjects with cHTN had significantly lower slope values at visit 2 compared to those without cHTN, with matched gestational age (P = 0.049). At visit 2, we observed a decrease in ADC value in tissue farther from the cord insertion, indicating an increase in tissue diffusivity (reduced tissue compactness) in placental periphery.

Conclusion:

Regional diffusion may correlate with placental health changes in pregnancies with chronic hypertension. Regional differences may implicate pathology for fetal/neonatal findings. Further study is needed to determine if ADC mapping may be useful indicator of placental pathology.