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Ultrasound elastography can detect placental tissue abnormalities

Tomoya Hasegawa

Tomoya Hasegawa

Department of Obstetrics and Gynecology, Tokyo Medical UniversityTokyo, Japan
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Hasegawa, Tomoya
, 
Naoaki Kuji

Naoaki Kuji

Department of Obstetrics and Gynecology, Tokyo Medical UniversityTokyo, Japan
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Kuji, Naoaki
, 
Fumiaki Notake

Fumiaki Notake

Radiation Division, Tokyo Medical University Hachioji Medical CenterTokyo, Japan
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Notake, Fumiaki
, 
Tetsu Tsukamoto

Tetsu Tsukamoto

Diagnostic Pathology Division, Tokyo Medical University Hachioji Medical CenterTokyo, Japan
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Tsukamoto, Tetsu
, 
Toru Sasaki

Toru Sasaki

Department of Obstetrics and Gynecology, Tokyo Medical UniversityTokyo, Japan
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Sasaki, Toru
, 
Motohiro Shimizu

Motohiro Shimizu

Obstetrics and Gynecology, Tokyo Medical University Hachioji Medical CenterTokyo, Japan
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Shimizu, Motohiro
, 
Kazunori Mukaida

Kazunori Mukaida

Department of Obstetrics and Gynecology, Tokyo Medical UniversityTokyo, Japan
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Mukaida, Kazunori
, 
Hiroe Ito

Hiroe Ito

Department of Obstetrics and Gynecology, Tokyo Medical UniversityTokyo, Japan
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Ito, Hiroe
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Keiichi Isaka

Keiichi Isaka

Department of Obstetrics and Gynecology, Tokyo Medical UniversityTokyo, Japan
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Isaka, Keiichi
 and 
Hirotaka Nishi

Hirotaka Nishi

Department of Obstetrics and Gynecology, Tokyo Medical UniversityTokyo, Japan
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Nishi, Hirotaka
  
Jun 06, 2018
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Article Category: Research Article
Published Online: Jun 06, 2018
Page range: 129 - 135
Received: Nov 20, 2017
Accepted: Apr 23, 2018
DOI: https://doi.org/10.2478/raon-2018-0024
Keywords
© 2018 Tomoya Hasegawa, Naoaki Kuji, Fumiaki Notake, Tetsu Tsukamoto, Toru Sasaki, Motohiro Shimizu, Kazunori Mukaida, Hiroe Ito, Keiichi Isaka, Hirotaka Nishi, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Representative ultrasound images of hardness of tissue (HT) score (A) The HT score was 1 when the blue area in the ROI was 50% or less. A strain graph, used to assess proper application of compression, is indicated in the lower right (B) The blue and green areas are shown mixed together in relatively equal percentages in the placenta (C) Most of the placenta is indicated in blue. In the left image, the strain ratio is calculated from the region of interest of the fat and placental tissue. In this case, the placental index is 19.83.
Representative ultrasound images of hardness of tissue (HT) score (A) The HT score was 1 when the blue area in the ROI was 50% or less. A strain graph, used to assess proper application of compression, is indicated in the lower right (B) The blue and green areas are shown mixed together in relatively equal percentages in the placenta (C) Most of the placenta is indicated in blue. In the left image, the strain ratio is calculated from the region of interest of the fat and placental tissue. In this case, the placental index is 19.83.

Figure 2

The correlation between the placental index (PI) and z score for estimated fetal weight at prenatal examination (EFW) . There is a significant correlation between the PI and z score for EFW (correlation coefficient, r = -0.55; p < 0.01).
The correlation between the placental index (PI) and z score for estimated fetal weight at prenatal examination (EFW) . There is a significant correlation between the PI and z score for EFW (correlation coefficient, r = -0.55; p < 0.01).

Figure 3

A significant positive correlation was observed between the placental index (PI) and z score of birth weight (correlation coefficient, r = -0.39; p < 0.01).
A significant positive correlation was observed between the placental index (PI) and z score of birth weight (correlation coefficient, r = -0.39; p < 0.01).

Figure 4

Gross pathological findings of the placenta. A macro-photograph of the placenta after delivery. The neonate had fetal growth restriction, diagnosed during elastography evaluation at week 28 of pregnancy. White placental infarction is observed at the bottom right of the photo.
Gross pathological findings of the placenta. A macro-photograph of the placenta after delivery. The neonate had fetal growth restriction, diagnosed during elastography evaluation at week 28 of pregnancy. White placental infarction is observed at the bottom right of the photo.

Figure 5

Histopathological findings of the placenta. Objective lens with 4× magnification. A micro-photograph of the same case as that shown in Figure 4. Complete infarction and incomplete infarction with remaining nuclear stainability are observed. The outlines of the villus remain in the upper right area.
Histopathological findings of the placenta. Objective lens with 4× magnification. A micro-photograph of the same case as that shown in Figure 4. Complete infarction and incomplete infarction with remaining nuclear stainability are observed. The outlines of the villus remain in the upper right area.

HT score and pathological findings related to placental ischemia after delivery

HT score 1 2 3
(n = 15) (n = 16) (n = 9)
Accelerated maturation of villi (+), (n) 1 2 2
Infarction (+), (n) 2 1 3
Villous inflammation (+), (n) 0 1 1
Total, n, (%) 3 (20) 4 (25) 6 (67)

Population features between the Normal group and SGA group

Normal group SGA group P
Number 101 10
Maternal age (years) 34.4 (±5.6) 33.6 (±4.7) NS
Gravidity 0.9 (±1.2) 1.3 (±1.3) NS
Parity 0.5 (±0.9) 0.6 (±0.7) NS
Gestational age (weeks) 31.7 (±6.3) 32.8 (±4.2) NS
EFW (SD) +0.11 (±0.74) -2.33 (±0.84) P<0.01
Placental Index 8.8 (±10.0) 44.3 (±29.4) P<0.01
HT score 1.56 (±0.68) 2.70 (±0.67) P<0.01
Birth weight (SD) 0.11 (±1.13) -2.19 (±1.07) P<0.01
Placenta weight (g) 562.3 (±119.7) 366 (±120.0) P<0.01
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