title: Discriminative imaging of maternal and fetal blood flow within the placenta using ultrafast ultrasound.
abstract: Being able to map accurately placental blood flow in clinics could have major implications in the diagnosis and follow-up of pregnancy complications such as intrauterine growth restriction (IUGR). Moreover, the impact of such an imaging modality for a better diagnosis of placental dysfunction would require to solve the unsolved problem of discriminating the strongly intricated maternal and fetal vascular networks. However, no current imaging modality allows both to achieve sufficient sensitivity and selectivity to tell these entangled flows apart. Although ultrasound imaging would be the clinical modality of choice for such a problem, conventional Doppler echography both lacks of sensibility to detect and map the placenta microvascularization and a concept to discriminate both entangled flows. In this work, we propose to use an ultrafast Doppler imaging approach both to map with an enhanced sensitivity the small vessels of the placenta (~100 μm) and to assess the variation of the Doppler frequency simultaneously in all pixels of the image within a cardiac cycle. This approach is evaluated in vivo in the placenta of pregnant rabbits: By studying the local flow pulsatility pixel per pixel, it becomes possible to separate maternal and fetal blood in 2D from their pulsatile behavior. Significance Statement: The in vivo ability to image and discriminate maternal and fetal blood flow within the placenta is an unsolved problem which could improve the diagnosis of pregnancy complications such as intrauterine growth restriction or preeclampsia. To date, no imaging modality has both sufficient sensitivity and selectivity to discriminate these intimately entangled flows. We demonstrate that Ultrafast Doppler ultrasound method with a frame rate 100x faster than conventional imaging solves this issue. It permits the mapping of small vessels of the placenta (~100 μm) in 2D with an enhanced sensitivity. By assessing pixel-per-pixel pulsatility within single cardiac cycles, it achieves maternal and fetal blood flow discrimination.
authors.affiliation: Institut Langevin, ESPCI ParisTech, PSL University, CNRS UMR7587, INSERM U979, Université Paris VII, France.
authors.forename: Bruno-Felix
authors.initials: BF
authors.lastname: Osmanski
authors.affiliation: UMR-S 1139 INSERM, Paris Descartes University, Sorbonne Paris Cité, France.|Obstetrics and Gynecology Unit, Maternité Port-Royal, APHP, Paris Descartes University, Paris, France.|PremUP foundation, Paris, France.|DHU Risk and Pregnancy Paris Descartes University, Sorbonne Paris Cité, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Lecarpentier
authors.affiliation: Institut Langevin, ESPCI ParisTech, PSL University, CNRS UMR7587, INSERM U979, Université Paris VII, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Montaldo
authors.affiliation: Obstetrics and Gynecology Unit, Maternité Port-Royal, APHP, Paris Descartes University, Paris, France.|PremUP foundation, Paris, France.|DHU Risk and Pregnancy Paris Descartes University, Sorbonne Paris Cité, France.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Tsatsaris
authors.affiliation: PremUP foundation, Paris, France.|INRA, UMR 1198 Biologie du Développement et Reproduction, F-78350 Jouy en Josas, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Chavatte-Palmer
authors.affiliation: Institut Langevin, ESPCI ParisTech, PSL University, CNRS UMR7587, INSERM U979, Université Paris VII, France.
authors.forename: Mickael
authors.initials: M
authors.lastname: Tanter
mesh_terms: D000465:Algorithms; D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000209:etiology; D005333:Fetus / Q000098:blood supply*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional; D010920:Placenta / Q000098:blood supply* / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011817:Rabbits; D012039:Regional Blood Flow; D018608:Ultrasonography, Doppler / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods