title: 3-D volumetric MRI evaluation of the placenta in fetuses with complex congenital heart disease.
abstract: BACKGROUND
  Placental insufficiency remains a common cause of perinatal mortality and neurodevelopmental morbidity. Congenital heart disease (CHD) in the fetus and its relationship to placental function is unknown. This study explores placental health and its relationship to neonatal outcomes by comparing placental volumes in healthy pregnancies and pregnancies complicated by CHD using in vivo three-dimensional MRI studies.
  
  
  METHODS
  In a prospective observational study, pregnant women greater than 18 weeks gestation with normal pregnancies or pregnancies complicated by CHD were recruited and underwent fetal MR imaging. The placenta was manually outlined and the volume was calculated in cm(3). Brain volume was also calculated and clinical data were also collected. Relationships, including interactive effects, between placental and fetal growth, including brain growth, were evaluated using longitudinal multiple linear regression analysis.
  
  
  RESULTS
  135 women underwent fetal MRI between 18 and 39 weeks gestation (mean 31.6 ± 4.4). Placental volume increased exponentially with gestational age (p = 0.041). Placental volume was positively associated with birth weight (p < 0.001) and increased more steeply with birth weight in CHD-affected fetuses (p = 0.046). Total brain and cerebral volumes were smaller in the CHD group (p < 0.001), but brainstem volume (p < 0.001) was larger. Placental volumes were not associated with brain volumes.
  
  
  CONCLUSIONS
  Impaired placental growth in CHD is associated with gestational age and birth weight at delivery. Abnormalities in placental development may contribute to the significant morbidity in this high-risk population. Assessment of placental volume by MRI allows for in vivo assessments of placental development.
authors.affiliation: Division of Neonatology, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037, United States.
authors.forename: Nickie
authors.initials: N
authors.lastname: Andescavage
authors.affiliation: Division of Diagnostic Imaging & Radiology, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States.
authors.forename: Alexa
authors.initials: A
authors.lastname: Yarish
authors.affiliation: Division of Cardiology, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States.
authors.forename: Mary
authors.initials: M
authors.lastname: Donofrio
authors.affiliation: Division of Diagnostic Imaging & Radiology, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Bulas
authors.affiliation: Division of Diagnostic Imaging & Radiology, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States; Division of Fetal & Transitional Medicine, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States; Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037, United States.
authors.forename: Iordanis
authors.initials: I
authors.lastname: Evangelou
authors.affiliation: Division of Diagnostic Imaging & Radiology, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States; Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037, United States.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Vezina
authors.affiliation: Division of Biostatistics & Informatics, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.affiliation: Division of Fetal & Transitional Medicine, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037, United States.
authors.forename: Adre
authors.initials: A
authors.lastname: duPlessis
authors.affiliation: Division of Diagnostic Imaging & Radiology, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States; Division of Fetal & Transitional Medicine, Children's National Health Systems, 111 Michigan Ave. NW, Washington, DC 20010, United States; Department of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037, United States. Electronic address: climpero@childrensnational.org.
authors.forename: Catherine
authors.initials: C
authors.lastname: Limperopoulos
mesh_terms: D000328:Adult; D001921:Brain / Q000196:embryology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D047109:Fetal Development; D006330:Heart Defects, Congenital / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D010920:Placenta / Q000473:pathology* / Q000503:physiopathology; D011247:Pregnancy; D055815:Young Adult
keywords: Congenital heart disease; Fetal MRI; Placenta; Volumetric assessment