# Perfusion and apparent oxygenation in the human placenta (PERFOX)

## TL;DR

This study introduces PERFOX, a novel MRI protocol that simultaneously measures placental perfusion and oxygenation, providing new insights into placental function and its changes during pregnancy.

## Contribution

The paper presents a combined perfusion and T2* measurement method in vivo, enabling simultaneous, co-registered assessment of placental blood flow and oxygenation in pregnant women.

## Key findings

- Successful visualization and quantification of perfusion and T2* in all subjects
- High T2* and perfusion areas correspond to placental sub-units and vary along the maternal-fetal axis
- Strong negative correlation of gestational age with T2*; weak negative correlation with perfusion

## Abstract

Purpose: To study placental function - both perfusion and an oxygenation surrogate (T2*)-simultaneously and quantitatively in-vivo. Methods: 15 pregnant women were scanned on a 3T MR scanner. For perfusion measurements, a velocity selective arterial spin labelling preparation module was placed before a multi-echo gradient echo EPI readout to integrate T2* and perfusion measurements in one joint perfusion-oxygenation (PERFOX) acquisition. Joint motion correction and quantification were performed to evaluate changes in T2* and perfusion over GA. Results: The optimised integrated PERFOX protocol and post-processing allowed successful visualization and quantification of perfusion and T2* in all subjects. Areas of high T2* and high perfusion appear to correspond to placental sub-units and show a systematic offset in location along the maternal-fetal axis. The areas of highest perfusion are consistently closer to the maternal basal plate and the areas of highest T2* closer to the fetal chorionic plate. Quantitative results show a strong negative correlation of gestational age with T2* and weak negative correlation with perfusion. Conclusion: A strength of the joint sequence is that it provides truly simultaneous and co-registered estimates of local T2* and perfusion, however, to achieve this, the time per slice is prolonged compared to a perfusion only scan which can potentially limit coverage. The achieved interlocking can be particularly useful when quantifying transient physiological effects such as uterine contractions. PERFOX opens a new avenue to elucidate the relationship between maternal supply and oxygen uptake, both of which are central to placental function and dysfunction.