BOLD MRI in the brain of fetal sheep at 3T during experimental hypoxia.

PURPOSE: To calculate regional fetal brain oxygen saturation (sO2) during hypoxia in sheep. MATERIALS AND METHODS: Eight pregnant ewes were examined at a 3T MR-scanner using blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) to measure signal intensity changes of the fetal brain during a control period and a period of induced hypoxia. Regions of interest were placed in the fetal cerebrum to assess ΔR2* from GRE signal intensity plateaus (S(control), S(hypoxia)) and the relation between ΔR2* and ΔpO2 was analyzed. A probe was placed surgically in the fetal brain to directly measure local pO2 as a reference standard. Baseline and hypoxic pO2 values were recorded and compared (ΔpO2). RESULTS: Mean fetal brain pO2 decreased from 14.3 mmHg (95% confidence interval [CI]: 10-19) to 3.4 mmHg (95% CI: 2-5) during hypoxia (mean ΔpO2 = 10.9 mmHg and ΔR2* = -5s(-1)). A significant correlation between ΔR2* and ΔpO2 was noted (r = 0.93, P < 0.001), and conversion of pO2 into sO2 resulted in a linear regression coefficient of (-0.14 ± 0.01)s(-1)/% (r(2) = 0.91). CONCLUSION: Measured fetal brain BOLD-MRI was compared and converted to pO2, followed by calculation of cerebral sO2.

Quantification of prenatal liver and spleen iron in a sheep model and assessment of iron stores in a human neonate with neonatal hemochromatosis using R2* mapping.

PURPOSE: We evaluated the feasibility of prenatal quantification of liver and spleen iron by magnetic resonance imaging (MRI) gradient recalled echo (GRE) measurements of transverse relaxation time (R2*) (MRI-GRE-R2*) in a fetal sheep model and applied the method to a human neonate with suspected neonatal hemochromatosis. METHODS: We subjected 13 fetal sheep to MRI at 1.5 Tesla using a breath-triggered (ewe) multi-echo sequence to determine the transverse relaxation rate (R2*) of the liver and spleen. In the human neonate, we measured the R2* of the liver, spleen, and pancreas on the 30th postgestational day. RESULTS: The median R2* of the fetal sheep liver was 25.6 s(-1) (range 20 to 114 s(-1)) and of the spleen, 40.2 s(-1) (range 20 to 70 s(-1)), and the corresponding median iron concentration in the liver was 0.85 mg/g dry weight (d.w.) and in the spleen, 1.22 mg/gd.w.. R2* rates in the human neonate liver were elevated between 67 s(-1) (average), which corresponded with an iron concentration of 1.9 mg Fe/gd.w., and 126 s(-1) (regional maximum), which corresponded with 3.4 mg Fe/gd.w.. The average pancreatic R2* (72.4 s(-1)) was significantly above normal values, which indicated iron overload. CONCLUSION: We demonstrated the feasibility of prenatal quantification of tissue iron by fetal MRI in this sheep model and successfully quantified iron, including that in the pancreas, in a human neonate to confirm the diagnosis of neonatal hemochromatosis. Transferring the successful approach of quantifying iron in intrauterine tissue in fetal sheep to human pregnancies with suspected fetal siderosis could aid early diagnosis.

Fetal blood flow velocimetry by phase-contrast MRI using a new triggering method and comparison with Doppler ultrasound in a sheep model: a pilot study.

OBJECT: We present the first study demonstrating the feasibility of antenatal blood flow velocimetry performing ECG triggered phase-contrast (PC)-MRI in the fetal aorta by using a newly developed Doppler ultrasound trigger. MATERIALS AND METHODS: Five pregnant sheep carrying singleton fetuses (gestational age 121 days) were anesthetized to undergo fetal 2D PC-MRI in the fetal descending aorta (1.5 T) using a newly developed MR-compatible Doppler ultrasound trigger for fetal cardiac triggering. Inter-operator variability was assessed for PC-MR measurements and reproducibility was tested by repeated scans in one fetus. Inter-modality comparison was performed by Doppler ultrasound velocimetry. RESULTS: Fetal cardiac triggering was possible in all examinations. PC-MR velocimetry revealed a mean inter-operator variability of 3 ± 5%. Average peak systolic flow velocities of 62.5 ± 4.4 cm/s were in good agreement with Doppler ultrasound measurements of 62.0 ± 9.2 cm/s (p (Lord's U test) ≫ 0.05). CONCLUSION: Fetal PC-MR velocimetry was successfully performed using the newly developed MR-compatible Doppler ultrasound trigger for intrauterine fetal cardiac triggering, demonstrating high inter-operator and inter-modality agreement. This new method has the high potential for alternative assessment of hemodynamic decompensation of the fetal circulation.

Diffusion-weighted MR imaging of fetal lung maturation in sheep: effect of prenatal cortisone administration on ADC values.

OBJECTIVE: To assess changes in diffusion properties in the fetal lung after cortisone administration with diffusion-weighted imaging (DWI) in fetal sheep. METHODS: DWI was performed on 11 pregnant sheep with singleton pregnancies on a 1.5-T MRI scanner. Four animals received cortisone injections before baseline imaging. Seven animals served as controls. Apparent diffusion coefficient (ADC) was measured on DWI in the fetal lungs by two independent readers. The Pearson test was used to correlate ADC and gestational age. A t-test was performed to compare differences in ADC values at the baseline and follow-up images within and between groups. Inter-rater reliability was calculated. RESULTS: In the cortisone group, ADC values increased about 10 % between the baseline and follow-up images (P = 0.039). Comparing the cortisone and control groups, ADC values of the baseline images did not differ; whereas in the follow-up imaging, ADC values were significantly higher in the cortisone group (P = 0.024). Lung ADC values did not correlate with gestational age (P = 0.970). Inter-rater reliability was high (0.970, P = 0.000). CONCLUSION: In this experimental model, MR-DWI can detect cortisone-induced changes in diffusion properties of the fetal lung. KEY POINTS: • Corticosteroids are frequently administered antenatally to prevent fetal lung immaturity at birth • DWI can detect changes in the fetal lung after corticosteroid administration • Changes can be detected as early as 5 days after treatment • Fetal MRI may offer a non-invasive method of monitoring lung maturation.

Magnetic resonance imaging of prostate cancer: diffusion-weighted imaging in comparison with sextant biopsy.

PURPOSE: To retrospectively evaluate the impact of diffusion-weighted imaging (DWI) on the detection of prostate cancer in comparison with sextant biopsy. MATERIALS AND METHODS: Fifty patients with clinical suspicion of prostate cancer underwent a combined endorectal-body-phased array magnetic resonance imaging examination at a 1.5 T magnetic resonance imaging (Siemens, Erlangen, Germany). The DWI was performed using b values of 50, 400, 800 s/mm. The prostate was divided into sextants, including the apex, the middle aspect, and the base for the left and right sides, separately. Regions of interest were placed in the peripheral zone of each sextant to evaluate the apparent diffusion coefficient (ADC) values. The results of the DWI were compared side by side with the findings of the histological examination of endorectal sonographically guided sextant biopsy. The sensitivity and specificity of ADC for the identification of the tumor tissue were computed for variable discrimination thresholds to evaluate its receiver operating characteristic. An association between ADC and Gleason score was tested for both the whole study group and on an individual basis using the nonparametric Spearman ρ test and the Pearson correlation, respectively. RESULTS: Histopathology identified tumor tissue in 21 (42%) of the 50 patients. The ADC value was 1.65 ± 0.32 mm/s 10 in normal tissue and 0.96 ± 0.24 mm/s 10 in tumor tissue (mean ± 1 SD). The area under the receiver operating characteristic curve was 0.966. Using the discrimination threshold 1.21 mm/s 10, for example, the ADC value provided a sensitivity of 0.92 and a specificity of 0.93. There was a highly significant negative correlation between the ADC value and the Gleason score in the tumor-positive tissue probes (n = 62, ρ = -0.405, P = 0.001) in the whole study group. On the individual patient basis, the Pearson correlation revealed a mean coefficient of r = -0.89 (SD ± 0.12) with a P < 0.001. CONCLUSIONS: Diffusion-weighted imaging of the prostate can be used to differentiate benign from malignant tissue in the peripheral zone. In the present study, ADC values were significantly lower in prostate cancer than in benign tissue.

Fetal sheep with tracheal occlusion: monitoring lung development with MR imaging and B-mode US.

PURPOSE: To assess the accuracy of magnetic resonance (MR) imaging in determining fetal lung volume (FLV) and to observe fetal lung development with B-mode ultrasonography (US) and MR imaging. MATERIALS AND METHODS: Seven sheep fetuses between 92 and 141 gestational days (term, 145 days) with and without tracheal occlusion (controls) underwent serial MR imaging and US. FLV at MR imaging was measured with true fast imaging with steady-state precession in coronal and transverse planes. The combined cross-sectional left- and right-lung area was measured with US at three transverse levels. FLV was measured at autopsy. Statistical evaluations included linear regression analysis and calculation of the mean and 95% CI. RESULTS: No differences in FLV were observed on coronal or transverse MR images (r2 = 0.98; slope = 0.91; 95% CI: 0.82, 1.01). FLV at MR imaging at termination of the experiment was significantly related to FLV at autopsy (r2 = 0.96; slope = 1.27; 95% CI: 0.97, 1.57; n = 6). FLV at MR imaging increased more rapidly with gestational age in fetuses with tracheal occlusion (21.0 mL/d; 95% CI: 10.7, 31.3) than in controls (4.7 mL/d; 95% CI: 1.7, 7.7). Increase in left- and right-lung area at US was accelerated in fetuses with tracheal occlusion (1.60 cm2/d; 95% CI: 1.3, 1.9) compared with controls (0.38 cm2/d; 95% CI: 0.23, 0.53). Left- and right-lung area at US and FLV at MR imaging were significantly correlated (r2 = 0.82). CONCLUSION: FLV can be measured with moderate accuracy at MR imaging on both coronal and transverse images. MR imaging and B-mode US are useful tools for monitoring and quantifying tracheal occlusion-stimulated fetal lung growth in sheep fetuses.