Diffusion Tensor Imaging (DTI) of the Cesarean‐Scarred Uterus in vivo at 3T: Comparison Study of DTI Parameters Between Nonpregnant and Pregnant Cases

• Published in: Journal of magnetic resonance imaging Vol. 51; no. 1; pp. 124 - 130
• Main Authors: Zhang, Wenting, Chen, Juan
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.01.2020; Wiley Subscription Services, Inc
• Subjects: Adult; Anisotropy; Architecture; Case-Control Studies; cesarean scar; Cesarean Section; Cicatrix - diagnostic imaging; Density; Diffusion; Diffusion coefficient; Diffusion Tensor Imaging - methods; Dithiothreitol; DTI; Female; fiber tractography; Fibrous structure; Field strength; Humans; Image Processing, Computer-Assisted - methods; In vivo methods and tests; Magnetic resonance imaging; Mathematical analysis; Myometrium; Parameters; Pregnancy; pregnant uterus; Prospective Studies; Statistical analysis; Statistical tests; Tensors; Uterus; Uterus - anatomy & histology; Young Adult; DTI; pregnant uterus; cesarean scar; fiber tractography
• ISSN: 1053-1807; 1522-2586; 1522-2586
• DOI: 10.1002/jmri.26868

Background Fiber architecture of the human uterus can be depicted in vivo using 3T MR‐DTI (diffusion tensor imaging). Purpose To investigate the differences in fibrous structure and DTI‐related parameters between nonpregnant and pregnant cases in vivo. Study Type Prospective case–control study. Subjects Thirty‐one subjects were divided into two groups; 18 nonpregnant volunteers with previous cesarean deliveries (Group 1) and 13 patients in early pregnancy also with previous cesarean section (Group 2). Field Strength/Sequence 3T Ssh‐EPI (single‐shot echo planar imaging) fast sequence with b values of 0 and 600 s/mm2 along 30 directions. Assessment Fiber density, fiber length, apparent diffusion coefficient (ADC) value, and the fractional anisotropy (FA) value measured in the mid‐sagittal plane of the uterus were obtained from the outer myometrium (OM), junctional zone (JZ), and the cesarean section scar (CSS). Fiber architecture in vivo was depicted by 3D diffusion tensor tractography (DTT). Statistical Tests A t‐test of independent sample or Wilcoxon rank sum test were used for comparison. Results Pregnant scarred‐uterus (Group 2) showed a decrease in fiber density, FA value, and an increase in fiber length, ADC value than the nonpregnant scarred‐uterus (Group 1) on OM, JZ, and CSS. Among the above parameters between the two groups, for OM, significant differences were found in fiber density (P < 0.001), length (P = 0.0306), and ADC (P = 0.0039). For JZ, significant differences were found in fiber density (P = 0.0093), FA (P = 0.0002), and ADC (P < 0.001). The scar's fiber density (P = 0.0794), length (P = 0.6167), FA (P = 0.6305), and ADC value (P = 0.1865) showed no statistically significant difference during early pregnancy. Data Conclusion Our results indicate considerable diffusional changes in uterine fiber architecture during pregnancy. The microenvironment of scar tissue appears to change little during early pregnancy. Level of Evidence: 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:124–130.