Structural changes of the placenta in hypertensive pregnancy disorders based on magnetic resonance imaging and histopathological findings: a pilot study
E. A. Kirillova,
I. A. Mashchenko,
E. D. Durnova,
D. D. Dorokhova,
T. Yu. Roshchina,
V. A. Markina,
N. R. Ryabokon',
N. A. Osipova,
V. V. Ishkaraeva,
I. E. Zazerskaya,
G. E. Trufanov https://doi.org/10.20340/vmi-rvz.2025.5.MIM.2
Abstract
Relevance. Hypertensive disorders complicate up to 10% of pregnancies, making a significant contribution to the statistics of maternal and perinatal morbidity and mortality. Placental dysfunction is a key factor in the pathogenesis of these complications. Ultrasound examination (US) with Dopplerometry, although it is considered the standard for assessing blood flow in the mother-placenta-fetus system, is limited in its ability to visualize structural changes in the placenta. Magnetic resonance imaging (MRI), due to its high tissue contrast and spatial resolution, is considered as a promising non-invasive method that can complement existing approaches to assessing the placental condition in hypertensive disorders.
Objective. To describe placental structural changes in pregnancies complicated by hypertensive disorders based on MRI data and to compare the results with those of ultrasound and histopathological examination.
Materials and methods. A prospective case-control pilot study was conducted involving 13 pregnant women with hypertensive disorders in the second and third trimesters. Each placenta was studied using 3T MRI (standard sequences), ultrasound with Dopplerometry, and subsequent histopathological examination after delivery.
Results. In 13 patients (mean age 33.7±6.1 years), MRI revealed characteristic structural changes: diffuse areas of reduced MR signal on T2-weighted images (in 100% of cases), high lobularity (54%) and granularity (54%), as well as circulatory disorders: infarcts (69%) and hematomas (38%). Histopathological changes were detected in 85% of cases. In 38% of cases, MRI detected alterations when the Dopplerometry results were within normal ranges. The severity of the changes correlated with the severity of hypertensive disorder and adverse pregnancy outcomes.
Conclusion. MRI enables the detection of characteristic structural changes in the placenta in hypertensive disorders, which directly reflect vascular, immune-inflammatory, and other microscopic lesions. These changes can be pronounced even with normal Doppler measurements and are associated with adverse pregnancy outcomes. MRI provides additional information about the condition of the placenta in hypertensive disorders, opening up prospects for improving the management of such pregnancies.
Supporting agencies: This work was supported by Federal State Budgetary Institution «Almazov National Medical Research Centre» of the Ministry of Health of the Russian Federation.
About the Authors
E. A. Kirillova
Almazov National Medical Research Center
Россия
Россия
Elizaveta A. Kirillova, Radiologist, postgraduate student, Department of Radiology and Medical Imaging,
Akkuratova St., 2, St. Petersburg, 197341
I. A. Mashchenko
Almazov National Medical Research Center
Россия
Россия
Irina A. Mashchenko, Cand. Sci. (Med.), Associate Professor, radiologist, Department of Radiology and Medical Imaging,
Akkuratova St., 2, St. Petersburg, 197341
E. D. Durnova
Almazov National Medical Research Center
Россия
Россия
Elizaveta D. Durnova, 3rd year student of the Faculty of Medicine,
Akkuratova St., 2, St. Petersburg, 197341
D. D. Dorokhova
Almazov National Medical Research Center
Россия
Россия
Dar'ya D. Dorokhova, First-year clinical resident in the specialty "Radiology",
Akkuratova St., 2, St. Petersburg, 197341
T. Yu. Roshchina
Almazov National Medical Research Center
Россия
Россия
Gennadiy E. Trufanov, Dr. Sci. (Med.), Professor, Principal Researcher of Department of Research in Diagnostic Radiology, Head of Department of Radiology and Medical Imaging,
Akkuratova St., 2, St. Petersburg, 197341
V. A. Markina
Almazov National Medical Research Center
Россия
Россия
Valentina A. Markina, Obstetrician-gynecologist, postgraduate student, Department of Obstetrics and Gynecology,
Akkuratova St., 2, St. Petersburg, 197341
N. R. Ryabokon'
Almazov National Medical Research Center
Россия
Россия
Nikita R. Ryabokon’, Cand. Sci. (Med.), radiologist (ultrasound specialist), Assistant of the Department of Obstetrics and Gynecology,
Akkuratova St., 2, St. Petersburg, 197341
N. A. Osipova
Almazov National Medical Research Center
Россия
Россия
Natal'ya A. Osipova, Dr. Sci. (Med.), Docent, Professor of Department of Obstetrics and Gynecology, Head of the Department of Obstetrics (Pregnancy Disorders),
Akkuratova St., 2, St. Petersburg, 197341
V. V. Ishkaraeva
Almazov National Medical Research Center
Россия
Россия
Valentina V. Ishkaraeva, Cand. Sci. (Med.), obstetrician and gynecologist, Associate Professor, Department of Obstetrics and Gynecology,
Akkuratova St., 2, St. Petersburg, 197341
I. E. Zazerskaya
Almazov National Medical Research Center
Россия
Россия
Irina E. Zazerskaya, Dr. Sci. (Med.), Professor, Head of Department of Obstetrics and Gynecology,
Akkuratova St., 2, St. Petersburg, 197341
G. E. Trufanov
Almazov National Medical Research Center
Россия
Россия
Gennadiy E. Trufanov, Dr. Sci. (Med.), Professor, Principal Researcher of Department of Research in Diagnostic Radiology, Head of Department of Radiology and Medical Imaging,
Akkuratova St., 2, St. Petersburg, 197341
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Kirillova E.A., Mashchenko I.A., Durnova E.D., Dorokhova D.D., Roshchina T.Yu., Markina V.A., Ryabokon' N.R., Osipova N.A., Ishkaraeva V.V., Zazerskaya I.E., Trufanov G.E. Structural changes of the placenta in hypertensive pregnancy disorders based on magnetic resonance imaging and histopathological findings: a pilot study. Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH). 2025;15(5):275-288. (In Russ.) https://doi.org/10.20340/vmi-rvz.2025.5.MIM.2
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