Background
Cervical remodeling is an important aspect of birth timing. Before cervical ripening,
the collagen fibers are arranged in a closely interweaved network, but during ripening,
the fibers become disorganized and the cervix becomes more hydrated. To quantitatively
measure cervical remodeling, we need a noninvasive method to monitor changes in cervical
collagen fiber organization and hydration in vivo.
Objective
To use diffusion tensor imaging to image and quantify the spatial and temporal differences
in cervical microstructure between normal early and late pregnancies.
Study Design
After institutional review board approval and consent, a group of healthy women in
early pregnancy (22 patients at 12–14 weeks’ gestation) and a group in late pregnancy
(27 patients at 36–38 weeks’ gestation) underwent magnetic resonance imaging on a
Siemens MAGNETOM Vida 3 Tesla unit. Diffusion tensor imaging of the cervix in the
axial plane was performed with a two-dimensional single-shot echo planar imaging diffusion-weighted
sequence. In early and late pregnancy groups, the differences of the diffusion tensor
imaging measures were compared between the subglandular zone and the outer stroma
regions of the cervix. In addition, the diffusion tensor imaging measures were compared
between the early and late pregnancy groups. Finally, for the late pregnancy group,
the diffusion tensor imaging measures were compared between the primipara and multipara
groups.
Results
Diffusion tensor imaging measures of microstructure significantly differed between
the subglandular zone and outer stroma regions of the cervix in both early and late
pregnancies. In the subglandular zone, fractional anisotropy was lower in the late
pregnancy group than in the early pregnancy group (0.37 [0.34–0.42] vs 0.50 [0.43–0.58];
P<.0005), suggesting increased collagen fiber disorganization in this zone. In addition,
mean diffusivity was higher in the late pregnancy group than in the early pregnancy
group (1.84 [1.73–2.02] mm2/sec×10–3 vs 1.56 [1.42–1.69] mm2/sec×10–3; P=.001), suggesting increased hydration in the subglandular zone. In the outer stroma,
neither fractional anisotropy (0.44 [0.40–0.50] vs 0.41 [0.37–0.43]; P=.095) nor mean diffusivity (2.09 [1.92–2.25] mm2/sec×10–3 vs 2.12 [2.04–2.24] mm2/sec×10–3; P=.269) significantly differed between early pregnancy and late pregnancy, suggesting
insignificant temporal microstructural changes in this cervical zone. Diffusion tensor
imaging measures did not significantly differ between cervixes from primiparous and
multiparous women in late pregnancy.
Conclusion
This in vivo study demonstrates that diffusion tensor imaging can noninvasively quantify
the microstructural differences in collagen fiber organization and hydration in cervical
subregions between early pregnancy and late pregnancy.
Key words
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Article Info
Publication History
Published online: July 12, 2020
Accepted:
July 9,
2020
Received in revised form:
June 6,
2020
Received:
February 4,
2020
Footnotes
The authors report no conflict of interest.
This study was primarily supported by grants from the National Institutes of Health (NIH) and National Institute of Child Health and Human Development (Y.W. and A.G.C.; R01HD094381) and was also supported, in part, by grants from the March of Dimes (March of Dimes Prematurity Research Center at Washington University), the NIH and National Institute of Aging (Y.W.; R01AG053548), and the BrightFocus Foundation (Y.W.; A2017330S). The funders had no role in the study design, data collection, data analysis, data interpretation, writing of the report, or decision to submit the article for publication.
Cite this article as: Qi W, Zhao P, Sun Z, et al. Magnetic resonance diffusion tensor imaging of cervical microstructure in normal early and late pregnancy in vivo. Am J Obstet Gynecol 2021;224:101.e1-11.
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