Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 15 , ISSUE 3 ( July-September, 2021 ) > List of Articles

REVIEW ARTICLE

Placental Doppler Microvasculature in Normal and Abnormal Pregnancy

Toshiyuki Yoshizato, Takashi Horinouchi, Kimio Ushijima

Keywords : Doppler, Placenta, Pregnancy, Ultrasonography

Citation Information : Yoshizato T, Horinouchi T, Ushijima K. Placental Doppler Microvasculature in Normal and Abnormal Pregnancy. Donald School J Ultrasound Obstet Gynecol 2021; 15 (3):295-300.

DOI: 10.5005/jp-journals-10009-1708

License: CC BY-NC 4.0

Published Online: 30-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Superb microvascular imaging (SMI) is a new ultrasound Doppler technique that enables the assessment of fine and low-velocity blood flow profiles. This article reviews the sonographic anatomy of the normal placental microvasculature using SMI and the clinical applications for evaluating pathological conditions during pregnancy. The basal plate shows a single layer of blood flow with decidual flows and flows extending into the placenta, on which arterial Doppler waveforms can be detected, indicating jet flows from the spiral arteries into the intervillous space. Several studies have demonstrated the potential for diagnosing the placenta accreta spectrum based on direct SMI findings, including missing decidual tissues and direct invasion of the placenta into the myometrium in the lesion. In a normal pregnancy, the placental villous flows show tree forms by SMI, which is considered blood flow embedded in the stem villi. Because the stem villi provide mechanical stability for the villous trees and control autoregulation of the fetoplacental blood flow in the peripheral villi, the abnormal vasculature characteristics observed by SMI reflect morphological changes in the placenta and dysfunction of the peripheral villous vessels, such as fetal/maternal malperfusion of the placenta.


PDF Share
  1. Ma Y, Li G, Li J, et al. The diagnostic value of superb microvascular imaging (SMI) in detecting blood flow signals of breast lesions: a preliminary study comparing SMI to color Doppler flow imaging. Medicine (Baltimore) 2015;94(36):e1502. DOI: 10.1097/MD.0000000000001502.
  2. Wu L, Yen HH, Soon MS. Spoke-wheel sign of focal nodular hyperplasia revealed by superb micro-vascular ultrasound imaging. QJM 2015;108(8):669–670. DOI: 10.1093/qjmed/hcv016.
  3. Ishikawa M, Ota Y, Nagai M, et al. Ultrasonography monitoring with superb microvascular imaging technique in brain tumor surgery. World Neurosurg 2017;97:749.e11–749.e20. DOI: 10.1016/j.wneu.2016.10.111.
  4. Goeral K, Hojreh A, Kasprian G, et al. Microvessel ultrasound of neonatal brain parenchyma: feasibility, reproducibility, and normal imaging features by superb microvascular imaging (SMI). Eur Radiol 2019;29(4):2127–2136. DOI: 10.1007/s00330-018-5743-1.
  5. Hasegawa J, Suzuki N. SMI for imaging of placental infarction. Placenta 2016;47:96–98. DOI: 10.1016/j.placenta.2016.08.092.
  6. Hasegawa J, Yamada H, Kawasaki E, et al. Application of superb micro-vascular imaging (SMI) in obstetrics. J Matern Fetal Neonatal Med 2018;31(2):261–263. DOI: 10.1080/14767058.2016.1278206.
  7. Hasegawa J, Kurasaki A, Hata T, et al. Diagnosis of placenta accreta spectrum using ultra-high-frequency probe and superb microvascular imaging. Ultrasound Obstet Gynecol 2019;54(5):705–707. DOI: 10.1002/uog.20207.
  8. Hata T, Kanenishi K, Yamamoto K, et al. Microvascular imaging of thick placenta with fetal growth restriction. Ultrasound Obstet Gynecol 2018;51(6):837–839. DOI: 10.1002/uog.18837.
  9. Hata T, Hanaoka U, Mori A, et al. Superb microvascular imaging of retained placenta with placental accreta spectrum. Donald School J Ultrasound Obstet Gynecol 2019;13(3):85–87. DOI: 10.5005/jp-journals-10009-1600.
  10. Hata T, Koyanagi A, Yamanishi T, et al. Superb microvascular imaging with Doppler luminance using an 18-MHz probe to visualize fetal intra-abdominal blood vessels and organ microvasculature. J Perinat Med 2020;48(2):184–188. DOI: 10.1515/jpm-2019-0411.
  11. Mack LM, Mastrobattista JM, Gandhi R, et al. Characterization of placental microvasculature using superb microvascular imaging. J Ultrasound Med 2019;38(9):2485–2491. DOI: 10.1002/jum.14919.
  12. Jabak S, Vigneswaran TV, Charakida M, et al. Initial experience of superb microvascular imaging for key cardiac views in foetal assessment before 15 weeks gestation. Fetal Diagn Ther 2020;47(4):268–276. DOI: 10.1159/000502839.
  13. Furuya N, Hasegawa J, Homma C, et al. Novel ultrasound assessment of placental pathological function using superb microvascular imaging. J Matern Fetal Neonatal Med 2020. 1–4. DOI: 10.1080/14767058.2020.1795120Online ahead of print.
  14. Horinouchi T, Yoshizato T, Kojiro-Sanada S, et al. Missing decidual Doppler signals as a new diagnostic criterion for placenta accreta spectrum: A case described using superb microvascular imaging. J Obstet Gynaecol Res 2021;47(1):411–415. DOI: 10.1111/jog.14441.
  15. Inoue A, Horinouchi T, Yoshizato T, et al. Peculiar blood flow profiles among placental chorionic villous vessels of an abnormally thick placenta in a case of systemic lupus erythematosus characterized using microvascular imaging. J Obstet Gynaecol Res 2020. DOI: 10.1111/jog.14502.Online ahead of print.
  16. Sun L, Li N, Jia L, et al. Comparison of superb microvascular imaging and conventional Doppler imaging techniques for evaluating placental microcirculation: a prospective study. Med Sci Monit 2020;26:e926215. DOI: 10.12659/MSM.926215.
  17. Sainz JA, Carrera J, Borrero C, et al. Study of the development of placental microvascularity by Doppler SMI (superb microvascular imaging): a reality today. Ultrasound Med Biol 2020;46(12):3257–3267. DOI: 10.1016/j.ultrasmedbio.2020.08.017.
  18. Pijnenborg R, Dixon G, Robertson WB, et al. Trophoblastic invasion of human decidua from 8 to 18 weeks of pregnancy. Placenta 1980;1(1):3–19. DOI: 10.1016/s0143-4004(80)80012-9.
  19. Demir R, Kosanke G, Kohnen G, et al. Classification of human placental stem villi: review of structural and functional aspects. Microsc Res Tech 1997;38(1-2):29–41. DOI: 10.1002/(SICI)1097-0029(19970701/15)38:1/23.0.CO;2-P.
  20. Filho HAG, da Costa LLD, Júnior EA, et al. Placenta: angiogenesis and vascular assessment through three-dimensional power Doppler ultrasonography. Arch Gynecol Obstet 2008;277(3):195–200. DOI: 10.1007/s00404-007-0453-y.
  21. Cahill AG, Beigi R, Heine RP, et al., Society of Gynecologic Oncology; American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Placenta accreta spectrum. Am J Obstet Gynecol 2018;219(6):B2–B16. DOI: 10.1016/j.ajog.2018.09.042.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.