Evaluation of Placenta by Shear Wave Elastography in Gestational Diabetes Mellitus

Abstract

Purpose: This study aims to determine the placental elasticity by using shear wave elastography (SWE) in women with gestational diabetes mellitus (GDM), and to compare it with the placental elasticity of the control group. 

Materials and Methods: Thirty-one women with GDM and 30 healthy pregnant between August-December 2018 were included in the study. Pregnant women with a history of hypertension, systemic disease, and smoking, who were diagnosed with diabetes mellitus before pregnancy and did not have anterior placenta were excluded from the study. SWE evaluations were carried out separately by two blinded radiologists. For SWE examination, regions of the placenta with homogeneous echotexture and without vascular and calcification were preferred. For elasticity evaluation, measurements were taken from 3 different localizations using 10 mm diameter circular areas, and the average value was calculated.

Results: The mean age of the GDM group was significantly higher than that of the control group (p=0.039). Gestational weeks did not differ significantly between the two groups (p=0.55). The median (min-max) stiffness values of the placenta were 14.1 (5-21.9) kPa in the GDM group and 12.6 (7.6-39.6) kPa in the control group. There was no statistically significant difference between the two groups (p=0.26). There was no relationship between maternal age and gestational week with placental elasticity in both groups (p=0.306, p=0.23, p=0.19, p=0.27). Intraclass correlation coefficients were 0.88 for stiffness (kPa) and 0.84 for velocity (m/s).

Conclusion: SWE can be used as a complementary method to grayscale ultrasonography to evaluate the placenta, as in many organs.

Keywords

• gestational diabetes mellitus
• placenta
• shear wave elastography
• ultrasound

Gestasyonel Diabetes Mellitusta Plasentanın Shear Wave Elastografi ile Değerlendirilmesi

Abstract

Amaç: Bu çalışmada gestasyonel diabetes mellitus (GDM) tanısı almış gebelerde shear wave elastografi (SWE) kullanarak plasenta elastisite değerlerini belirlemek ve kontrol grubu plasenta elastisite değerleri ile karşılaştırmak amaçlanmıştır.

Araçlar ve Yöntem: Ağustos 2018 ile Aralık 2018 tarihleri arasında GDM tanısı almış 31 gebe ve 30 sağlıklı gebe çalışmaya dahil edildi. GDM tanısı için 75 g oral glukoz tolerans testi (OGTT) yapıldı. Hipertansiyon, sistemik hastalık ve sigara kullanım öyküsü olan, gebelik öncesi diabetes mellitus tanısı alan ve plasentası anteriorda olmayan gebeler çalışmaya dahil edilmedi. SWE değerlendirmeleri iki radyolog tarafından ayrı ayrı gerçekleştirildi. SWE incelemesi için plasentanın homojen ekotekstüre sahip, damar ve kalsifikasyon içermeyen bölgeleri tercih edildi. Elastisite değerlendirmesi için 10 mm çapında dairesel alanlar kullanılarak 3 farklı lokalizasyondan ölçümler yapıldı. Her plasenta için elde edilen üç değerin ortalaması hesaplanarak ortalama elastisite değerleri belirlendi.

Bulgular: GDM grubunda yaş ortalaması kontrol grubuna göre anlamlı derecede yüksekti (p=0.039). Her iki grup arasında gebelik haftaları anlamlı farklılık göstermemekteydi (p=0.55). Plasentanın ortanca (minimum-maksimum) sertlik değerleri GDM grubunda 14.1 (5-21.9) kPa, kontrol grubunda ise 12.6 (7.6-39.6) kPa olarak tespit edildi. Kontrol grubunda plasenta sertlik değerleri GDM grubuna göre hafif düşük olmakla birlikte iki grup arasında istatiksel olarak anlamlı farklılık yoktu (p=0.26). Her iki grupta maternal yaş ve gebelik haftası ile plasenta sertlik ve hız değerleri arasında anlamlı ilişki tespit edilmedi (p=0.306, p=0.23, p=0.19, p=0.27). Sınıf içi korelasyon katsayıları sertlik (kPa) için 0.88 ve hız (m/s) için 0.84 idi.

Sonuç: SWE pek çok organ da olduğu gibi plasentanın değerlendirilmesinde gri skala ultrasonografiyi tamamlayıcı yöntem olarak kullanılabilir. 

Keywords

• gestasyonel diabetes mellitus
• plasenta
• shear wave elastografi
• ultrason

References

1. 1. Metzger BE. Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes. 1991;40(2):197-201.
2. 2. Nordin NM, Wei JW, Naing NN, Symonds EM. Comparison of maternal-fetal outcomes in gestational diabetes and lesser degrees of glucose intolerance. J Obstet Gynaecol Res. 2006;32(1):107-114.
3. 3. Li Z, Cheng Y, Wang D, et al. Incidence Rate of Type 2 Diabetes Mellitus after Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of 170,139 Women. J Diabetes Res. 2020;2020:3076463.
4. 4. Huynh J, Dawson D, Roberts D, Bentley-Lewis R. A systematic review of placental pathology in maternal diabetes mellitus. Placenta. 2015;36(2):101-114.
5. 5. Evers IM, Nikkels PG, Sikkema JM, Visser GH. Placental pathology in women with type 1 diabetes and in a control group with normal and large-for-gestationalage infants. Placenta. 2003;24(8-9):819-825.
6. 6. Leushner JR, Tevaarwerk GJ, Clarson CL, Harding PG, Chance GW, Haust MD. Analysis of the collagens of diabetic placental villi. Cell Mol Biol. 1986;32(1):27-35.
7. 7. Pathak S, Lees CC, Hackett G, Jessop F, Sebire NJ. Frequency and clinical significance of placental histological lesions in an unselected population at or near term. Virchows Arch. 2011;459(6):565-572.
8. 8. Lee EJ, Jung HK, Ko KH, Lee JT, Yoon JH. Diagnostic performances of shear wave elastography: which parameter to use in differential diagnosis of solid breast masses? Eur Radiol. 2013;23(7):1803-1811.

9. 9. Uysal E, Öztürk M. Quantitative Assessment of Thyroid Glands in Healthy Children With Shear Wave Elastography. Ultrasound Q. 2019;35(3):297-300.
10. 10. Cosgrove DO, Berg WA, Doré CJ, et al. Shear wave elastography for breast masses is highly reproducible. European radiology. 2012;22(5):1023-1032.
11. 11. Saw SN, Low JYR, Mattar CNZ, Biswas A, Chen L, Yap CH. Motorizing and Optimizing Ultrasound Strain Elastography for Detection of Intrauterine Growth Restriction Pregnancies. Ultrasound Med Biol. 2018;44(3):532-543.
12. 12. Cimsit C, Yoldemir T, Akpinar IN. Shear wave elastography in placental dysfunction: comparison of elasticity values in normal and preeclamptic pregnancies in the second trimester. J Ultrasound Med. 2015;34(1):151-159.
13. 13. Alıcı Davutoglu E, Ariöz Habibi H, Ozel A, Yuksel MA, Adaletli I, Madazlı R. The role of shear wave elastography in the assessment of placenta previa-accreta. J Matern Fetal Neonatal Med. 2018;31(12):1660-1662.
14. 14. Shiina T, Nightingale KR, Palmeri ML, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol. 2015;41(5):1126-1147.
15. 15. Yuksel MA, Kilic F, Kayadibi Y, et al. Shear wave elastography of the placenta in patients with gestational diabetes mellitus. J Obstet Gynaecol. 2016;36(5):585-588.
16. 16. Lai HW, Lyv GR, Wei YT, Zhou T. The diagnostic value of two-dimensional shear wave elastography in gestational diabetes mellitus. Placenta. 2020;101:147-153.
17. 17. Bildacı TB, Çevik H, Aksan Desteli G, Tavaslı B, Özdoğan S. Placental elasticity on patients with gestational diabetes: Single institution experience. J Chin Med Assoc. 2017;80(11):717-720.
18. 18. Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-682.
19. 19. Shahbazian H, Nouhjah S, Shahbazian N, et al. Gestational diabetes mellitus in an Iranian pregnant population using IADPSG criteria: Incidence, contributing factors and outcomes. Diabetes Metab Syndr. 2016;10(4):242-246.
20. 20. Roescher AM, Hitzert MM, Timmer A, Verhagen EA, Erwich JJ, Bos AF. Placental pathology is associated with illness severity in preterm infants in the first twenty-four hours after birth. Early Hum Dev. 2011;87(4):315-319.
21. 21. Li WJ, Wei ZT, Yan RL, Zhang YL. Detection of placenta elasticity modulus by quantitative real-time shear wave imaging. Clin Exp Obstet Gynecol. 2012;39(4):470-473.
22. 22. Ohmaru T, Fujita Y, Sugitani M, Shimokawa M, Fukushima K, Kato K. Placental elasticity evaluation using virtual touch tissue quantification during pregnancy. Placenta. 2015;36(8):915-920.
23. 23. Yuan Y, Liu H, Shengli L, et al. Preliminary study of acoustic radiation force impulse in the placental function of normal population and patients with severe preeclampsia. Chinese Journal of Ultrasonography. 2015;12(7):601-605.