Placental MRI and its application to fetal intervention

Objective

Magnetic resonance imaging (MRI) of placental invasion has been part of clinical practice for many years. The possibility of being better able to assess placental vascularization and function using MRI has multiple potential applications. This review summarises up-to-date research on placental function using different MRI modalities.

Method

We discuss how combinations of these MRI techniques have much to contribute to fetal conditions amenable for therapy such as singletons at high risk for fetal growth restriction (FGR) and monochorionic twin pregnancies for planning surgery and counselling for selective growth restriction and transfusion conditions.

Results

The whole placenta can easily be visualized on MRI, with a clear boundary against the amniotic fluid, and a less clear placental-uterine boundary. Contrasts such as diffusion weighted imaging, relaxometry, blood oxygenation level dependent MRI and flow and metabolite measurement by dynamic contrast enhanced MRI, arterial spin labeling, or spectroscopic techniques are contributing to our wider understanding of placental function.

Conclusion

The future of placental MRI is exciting, with the increasing availability of multiple contrasts and new models that will boost the capability of MRI to measure oxygen saturation and placental exchange, enabling examination of placental function in complicated pregnancies.     

Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

We conducted a comprehensive evidence-based review on the epidemiology and current standard of care of gastroschisis management as well as the pathophysiology, rationale and feasibility of fetal therapy as a viable alternative. Gastroschisis is a periumbilical abdominal wall defect characterized by abdominal viscera herniation in utero. It affects 4 in 10 000 live births, but the prevalence has steadily increased in recent years. Gastroschisis is typically diagnosed on routine second-trimester ultrasound. The overall prognosis is favorable, but complex gastroschisis, which accounts for about 10% to 15% of cases, is associated with a higher mortality, significant disease burden and higher healthcare costs due to long- and short-term complications. The current standard of care has yet to be established but generally involves continued fetal surveillance and multidisciplinary perinatal care. Postnatal surgical repair is achieved with primary closure, staged silo closure or sutureless repair. Experimental animal studies have demonstrated the feasibility of in utero closure, antiinflammatory therapy and prenatal regenerative therapy. However, reports of early preterm delivery and amnioinfusion trials have failed to show any benefit in humans. Further experimental studies and human trials are necessary to demonstrate the potential benefit of fetal therapy in gastroschisis.     

Spatiotemporal Associations of Reservoir Nutrient Characteristics and the Invasive,Harmful Alga Prymnesium parvum in West Texas

Golden alga (Prymnesium parvum) is a harmful alga that has caused ecological and economic harm in freshwater and marine systems worldwide. In inland systems of North America, toxic blooms have nearly eliminated fish populations in some systems. Modifying nutrient profiles through alterations to land or water use may be a viable alternative for golden alga control in reservoirs. The main objective of this study was to improve our understanding of the nutrient dynamics that influence golden alga bloom formation and toxicity in west Texas reservoirs. We examined eight sites in the Upper Colorado River basin, Texas: three impacted reservoirs that have experienced repeated golden alga blooms; two reference reservoirs where golden alga is present but nontoxic; and three confluence sites downstream of the impacted and reference sites. Total, inorganic, and organic nitrogen and phosphorus and their ratios were quantified monthly along with golden alga abundance and ichthyotoxicity between December 2010 and July 2011. Blooms persisted for several months at the impacted sites, which were characterized by high organic nitrogen and low inorganic nitrogen. At impacted sites, abundance was positively associated with inorganic phosphorus and bloom termination coincided with increases in inorganic nitrogen and decreases in inorganic phosphorus in late spring. Management of both inorganic and organic forms of nutrients may create conditions in reservoirs unfavorable to golden alga.