Devasuda Anblagan¹, Ruta Deshpande², Nia W Jones², Carolyn Costigan¹, Nick Raine Fenning³, Peter Mansell², George Bugg², Lopa Leach⁴, and Penny A Gowland^1
1Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom, ²Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, United Kingdom, ³School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom, ⁴School of Biomedical Sciences, University of Nottingham, Nottingham, United Kingdom

High volume, low resistance blood flow in the placenta is thought to be essential for optimal materno-fetal nutrient exchange. Intrauterine Growth Restriction and maternal diabetes are often related to abnormal placental perfusion. Using IVIM we assessed placental blood flow in diabetic and healthy mothers. We report the difference in distribution of placental blood flow in diabetic placentae: in the normal placenta the flow was fairly uniformly distributed, whilst in the diabetic placenta the flow distribution was generally lower but with small areas of higher flow. This may be related to the abnormal fetal development associated with diabetic pregnancies.

Rinat Abramovitch^1,2, Nathalie Corchia¹, Uriel Elchalal³, and Yehuda Ginosar^4
1The Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel, ²MRI lab HBRC, Hadassah Hebrew University Medical Center, Israel, ³Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel, ⁴Department of Anesthesiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel

Preeclampsia and intrauterine fetal growth restriction are common disorders of pregnancy frequently associated with reduced uteroplacental blood flow (UPBF) and fetal organ perfusion. In this study we used BOLD-fMRI combined with hypercapnic and hyperoxic challenge to assess uteroplacental and fetal organ perfusion. BOLD-fMRI provided simultaneous assessments of placental and fetal organs (brain, heart, liver) perfusion in pregnant mice. Acute maternal hypercapnia caused reproducible and reversible reductions in UPBF while fetal cerebral perfusion was unchanged; suggestive of the "brain sparing" phenomenon. Moreover, the BOLD-fMRI hypercapnic challenge test was able to differentiate between normal and chronically asphyxiated pregnancies (maternal hypoxia).

David Mark Morris^1,2, Caroline Wright³, Philip A Baker⁴, Ian Crocker³, Penny A Gowland⁵, Geoff J.M. Parker^1,2, and Colin P Sibley^3
1Imaging Science & Biomedical Engineering, The University of Manchester, Manchester, United Kingdom, ²Biomedical Imaging Institute, The University of Manchester, Manchester, United Kingdom, ³Maternal and Fetal Helath Research Group, The University of Manchester, Manchester, United Kingdom, ⁴Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada, ⁵Sir Peter Mansfield Magentic Resonance Centre, University of Nottingham, Nottingham, United Kingdom

Intra Voxel Incoherent Motion allows for the non-invasive assessment of flow parameters using a bi-exponential model of water diffusion. This MRI technique has been applied to the human placenta where flow changes have been associated with Fetal Growth Retardation resulting in increased perinatal mortality and morbidity. The bi-exponential model will return erroneous results where the data does not support this complex model of diffusion. The Akaike Information Criterion has been used to exclude voxels and this results in a significant increase in the values of the flow parameters.

Sylvie Girard¹, Luc Tremblay², Guillaume Sebire², and Martin Lepage^2
1Universite de Sherbrooke, Sherbrooke, QC, Canada, ²Universite de Sherbrooke

Inflammation during gestation is known to have a major impact on fetuses neurodevelopment leading to increase risk of brain alteration. There are currently no technic that allows a non-invasive detection of in utero inflammation, which is necessary in order to treat and protect both the placenta and fetus. We used an experimental model of prenatal inflammation, known to lead to alteration of pups cerebral development and behavior. We showed that using MRI we could detect placental inflammation earlier than by histology. This allowed the determination of a therapeutic window during which the administration of anti-inflammatory treatment, even delayed, was protective.

Ulrike Wedegaertner¹, Michael Frisch¹, Inga Kopp¹, Joachim Graessner², Kurt Hecher¹, Gerhard Adam¹, and Jin Yamamura^1
1University Hospital Hamburg-Eppendorf, Hamburg, Hamburg, Germany, ²Siemens

The novel MR compatible CTG allowed an excellent trigger of the fetal heart rate. An evaluation of anatomical structures and functional information could be obtained from the cMRI. A CTG triggered fetal cardiac MRI might be of great impact in the evaluation of fetuses with complex congenital heart defects.

Katherine Downey^1,2, S F Riches^1,2, V A Morgan^1,2, S L Giles^1,2, C Simpkin^1,2, D P Barton^3,4, and N M deSouza^1,2
1Clinical MRI Unit, Institute of Cancer Research, Sutton, United Kingdom, ²Clinical MRI Unit, The Royal Marsden Hospital, Sutton, United Kingdom, ³Gynaecology Unit, The Royal Marsden Hospital, Sutton, United Kingdom, ⁴Gynaecology Unit, Institute of Cancer Research, Sutton, United Kingdom

This study uses histogram analysis to establish whether ADC values are significantly different in cervical tumours according to their histological characteristics. Patients were scanned with an endovaginal coil to acquire diffusion weighted images. ADC histograms obtained from the entire tumor had 10th, 50th and 90th centile pixel values and skewness of distribution documented. Independent t-test analysis was performed. Increased cellularity of poorly differentiated tumors is reflected in their lower median ADC. ADC distribution does not appear to be associated with lymphovascular space invasion. The increased skewness in the adenocarcinomas is likely to reflect the mixture of glandular and cellular content.

Elizabeth Charles-Edwards¹, Veronica Morgan¹, Ayoma Attygalle², Sharon Giles¹, Thomas E Ind³, Michael Davis⁴, John Shepherd³, Norman McWhinney⁵, and Nandita deSouza^1
1CRUK & EPSRC Cancer Imaging Centre, Institute of Cancer Research & Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom, ²Histopathology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom, ³Gynaecology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom, ⁴Gynaecology, Kingston Hospital, Kingston, Surrey, United Kingdom, ⁵Gynaecology, Epsom & St. Helier NHS Trust, Epsom, Surrey, United Kingdom

Diffusion-weighted MRI using an endovaginal coil is a useful adjunct to T2-W imaging for detecting small tumours within the cervix. Following a cone biopsy/LLETZ procedure where distortion of normal tissue and granulation tissue is present, a tumor volume of 83 mm³ could be detected with 80% sensitivity, 94.7% specificity. A 5.3 mm maximal histological dimension was detected on MRI with 100% sensitivity, 100% specificity.

Peter Beddy¹, Penelope Moyle¹, Masako Kataoka¹, Adam K Yamamoto¹, Ilse Joubert¹, David J Lomas¹, Robin Crawford², and Evis Sala^1
1Radiology, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom, ²Gynaecological Oncology, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom

This study compared DWI and DCE-MRI in assessing the depth of myometrial invasion in endometrial cancer. 50 patients with histologically confirmed endometrial cancer underwent DWI and DCE-MRI as part of their initial preoperative staging MRI. We demonstrate that DWI is more accurate at assessing the depth of myometrial invasion compared to DCE-MRI and has significantly higher inter-reader agreement.

Nicky HGM Peters^1,2, Gail Horan³, Deborah Gregory³, Li Tee Tan³, Charlotte Coles³, Andrew J Patterson², and Evis Sala^2
1Radiology, University Medical Center Utrecht, Utrecht, Netherlands, ²Radiology, Addenbrooke’s Hospital, Cambridge, Cambridghire, United Kingdom, ³Oncology, Addenbrooke’s Hospital, Cambridge, Cambridghire, United Kingdom

With the technical advances in radiotherapy, treatment can be planned on MRI examinations on which the ovaries can be clearly depicted. We assessed the extent of ovarian movement on consecutive pelvic MRI examinations in patients that underwent pelvic radiotherapy for a gynaecological malignancy to provide a safety volume around the ovaries accounting for ovarian movement. Adding a safety volume around the ovaries of 32 cm3 and 57 cm3 for the left and right ovary respectively could reduce the high radiation dose to the ovaries during pelvic radiotherapy and resulting infertility and premature menopause could possibly be avoided.