Dual-Imaging Modality Approach to Evaluate Cerebral Hemodynamics in Growth-Restricted Fetuses: Oxygenation and Perfusion

Objective: To evaluate a dual-imaging modality approach to obtain a combined estimation of venous blood oxygenation (S nu O-2) using susceptibility-weighted magnetic resonance imaging (SWI-MRI), and blood perfusion using power Dopp-ler ultrasound (PDU) and fractional moving blood volume (FMBV) in the brain of normal growth and growth-restricted fetuses. Methods: Normal growth (n = 33) and growth-restricted fetuses (n = 10) from singleton pregnancies between 20 and 40 weeks of gestation were evaluated. MRI was performed and S nu O-2 was calculated using SWI-MRI data obtained in the straight section of the superior sagittal sinus. Blood perfusion was estimated using PDU and FMBV from the frontal lobe in a mid-sagittal plane of the fetal brain. The association between fetal brain S nu O-2 and FMBV, and the distribution of S nu O-2 and FMBV values across gestation were calculated for both groups. Results: In growth-restricted fetuses, the brain S nu O-2 values were similar, and the FMBV values were higher across gestation as compared to normal growth fetuses. There was a significantly positive association between S nu O-2 and FMBV values (slope = 0.38 +/- 0.12; r = 0.7; p = 0.02) in growth-restricted fetuses. In normal growth fetuses, S nu O-2 showed a mild decreasing trend (slope = -0.7 +/- 0.4; p = 0.1), whereas FMBV showed a mild increasing trend (slope = 0.2 +/- 0.2; p = 0.2) with advancing gestation, and a mild but significant negative association (slope = -0.78 +/- 0.3; r = -0.4; p = 0.04) between these two estimates. Conclusion: Combined MRI (SWI) and ultrasound (FMBV) techniques showed a significant association between cerebral blood oxygenation and blood perfusion in normal growth and growth-restricted fetuses. This dual-imaging approach could contribute to the early detection of fetal "brain sparing" and brain oxygen saturation changes in high-risk pregnancies.