Assessment of the fetal thymus gland: Comparing MRI-acquired thymus volumes with 2D ultrasound measurements

Rebecca Myers; Jana Hutter; Jacqueline Matthew; Tong Zhang; Alena Uus; David Lloyd; Alexia Egloff; Maria Deprez; Surabhi Nanda; Mary Rutherford; Lisa Story

doi:10.1016/j.ejogrb.2021.06.026

Assessment of the fetal thymus gland: Comparing MRI-acquired thymus volumes with 2D ultrasound measurements

Rebecca Myers, Jana Hutter, Jacqueline Matthew, Tong Zhang, Alena Uus, David Lloyd, Alexia Egloff, Maria Deprez, Surabhi Nanda, Mary Rutherford, Lisa Story^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

Objectives: The fetal thymus gland has been shown to involute in response to intrauterine infection, and therefore could be used as a non-invasive marker of fetal compartment infection. The objective of this study was to evaluate how accurately 2D ultrasound-derived measurements of the fetal thymus reflect the 3D volume of the gland derived from motion corrected MRI images. Study design: A retrospective study was performed using paired ultrasound and MRI datasets from the iFIND project (http://www.ifindproject.com). To obtain 3D volumetry of the thymus gland, T2-weighted single shot turbo spin echo (ssTSE) sequences of the fetal thorax were acquired. Thymus volumes were manually segmented from deformable slice-to-volume reconstructed images. To obtain 2D ultrasound measurements, previously stored fetal cine loops were used and measurements obtained at the 3-vessel-view (3VV) and 3-vessel-trachea view (3VT): anterior-posterior diameter (APD), intrathoracic diameter (ITD), transverse diameter (TD), perimeter and 3-vessel-edge (3VE). Inter-observer and intra-observer reliability (ICC) was calculated for both MRI and ultrasound measurements. Pearson correlation coefficients (PCC) were used to compare 2D-parameters with acceptable ICC to TV. Results: 38 participants were identified. Adequate visualisation was possible on 37 MRI scans and 31 ultrasound scans. Of the 30 datasets where both MRI and ultrasound data were available, MRI had good interobserver reliability (ICC 0.964) and all ultrasound 3VV 2D-parameters and 3VT 3VE had acceptable ICC (>0.75). Four 2D parameters were reflective of the 3D thymus volume: 3VV TD r = 0.540 (P = 0.002); 3VV perimeter r = 0.446 (P = 0.013); 3VV APD r = 0.435 (P = 0.110) and 3VT TD r = 0.544 (P = 0.002). Conclusions: MRI appeared superior to ultrasound for visualization of the thymus gland and reproducibility of measurements. Three 2D US parameters, 3VV TD, perimeter and 3VT APD, correlated well with TV. Therefore, these represent a more accurate reflection of the true size of the gland than other 2D measurements, where MRI is not available.

Original language	English
Pages (from-to)	1-7
Number of pages	7
Journal	European Journal of Obstetrics and Gynecology and Reproductive Biology
Volume	264
DOIs	https://doi.org/10.1016/j.ejogrb.2021.06.026
Publication status	Published - Sept 2021

Keywords

Fetal thymus
Magnetic resonance imaging
Obstetric ultrasound thymus
Volume

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10.1016/j.ejogrb.2021.06.026

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Myers, R., Hutter, J., Matthew, J., Zhang, T., Uus, A., Lloyd, D., Egloff, A., Deprez, M., Nanda, S., Rutherford, M., & Story, L. (2021). Assessment of the fetal thymus gland: Comparing MRI-acquired thymus volumes with 2D ultrasound measurements. European Journal of Obstetrics and Gynecology and Reproductive Biology, 264, 1-7. https://doi.org/10.1016/j.ejogrb.2021.06.026

@article{54212e8db4b640059eaa23fc667477ef,

title = "Assessment of the fetal thymus gland: Comparing MRI-acquired thymus volumes with 2D ultrasound measurements",

abstract = "Objectives: The fetal thymus gland has been shown to involute in response to intrauterine infection, and therefore could be used as a non-invasive marker of fetal compartment infection. The objective of this study was to evaluate how accurately 2D ultrasound-derived measurements of the fetal thymus reflect the 3D volume of the gland derived from motion corrected MRI images. Study design: A retrospective study was performed using paired ultrasound and MRI datasets from the iFIND project (http://www.ifindproject.com). To obtain 3D volumetry of the thymus gland, T2-weighted single shot turbo spin echo (ssTSE) sequences of the fetal thorax were acquired. Thymus volumes were manually segmented from deformable slice-to-volume reconstructed images. To obtain 2D ultrasound measurements, previously stored fetal cine loops were used and measurements obtained at the 3-vessel-view (3VV) and 3-vessel-trachea view (3VT): anterior-posterior diameter (APD), intrathoracic diameter (ITD), transverse diameter (TD), perimeter and 3-vessel-edge (3VE). Inter-observer and intra-observer reliability (ICC) was calculated for both MRI and ultrasound measurements. Pearson correlation coefficients (PCC) were used to compare 2D-parameters with acceptable ICC to TV. Results: 38 participants were identified. Adequate visualisation was possible on 37 MRI scans and 31 ultrasound scans. Of the 30 datasets where both MRI and ultrasound data were available, MRI had good interobserver reliability (ICC 0.964) and all ultrasound 3VV 2D-parameters and 3VT 3VE had acceptable ICC (>0.75). Four 2D parameters were reflective of the 3D thymus volume: 3VV TD r = 0.540 (P = 0.002); 3VV perimeter r = 0.446 (P = 0.013); 3VV APD r = 0.435 (P = 0.110) and 3VT TD r = 0.544 (P = 0.002). Conclusions: MRI appeared superior to ultrasound for visualization of the thymus gland and reproducibility of measurements. Three 2D US parameters, 3VV TD, perimeter and 3VT APD, correlated well with TV. Therefore, these represent a more accurate reflection of the true size of the gland than other 2D measurements, where MRI is not available.",

keywords = "Fetal thymus, Magnetic resonance imaging, Obstetric ultrasound thymus, Volume",

author = "Rebecca Myers and Jana Hutter and Jacqueline Matthew and Tong Zhang and Alena Uus and David Lloyd and Alexia Egloff and Maria Deprez and Surabhi Nanda and Mary Rutherford and Lisa Story",

note = "Funding Information: Dr Jana Hutter is a UKRI Future Leaders fellow and Dr Lisa Story is an NIHR funded Clinical lecturer. This work was supported by the Wellcome Trust IEH Award [102431] and by core funding from the Wellcome/EPSRC Centre for Medical Engineering [WT203148/Z/16/Z]. The research was funded/supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London and supported by the NIHR Clinical Research Facility (CRF) at Guy's and St Thomas?. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding Information: Dr Jana Hutter is a UKRI Future Leaders fellow and Dr Lisa Story is an NIHR funded Clinical lecturer. This work was supported by the Wellcome Trust IEH Award [102431] and by core funding from the Wellcome/EPSRC Centre for Medical Engineering [WT203148/Z/16/Z]. The research was funded/supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London and supported by the NIHR Clinical Research Facility (CRF) at Guy{\textquoteright}s and St Thomas{\textquoteright}. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Publisher Copyright: {\textcopyright} 2021 King's College London Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = sep,

doi = "10.1016/j.ejogrb.2021.06.026",

language = "English",

volume = "264",

pages = "1--7",

journal = "European Journal of Obstetrics and Gynecology and Reproductive Biology",

issn = "0301-2115",

publisher = "Elsevier Ireland Ltd",

}

Myers, R, Hutter, J , Matthew, J, Zhang, T, Uus, A , Lloyd, D , Egloff, A , Deprez, M, Nanda, S, Rutherford, M & Story, L 2021, 'Assessment of the fetal thymus gland: Comparing MRI-acquired thymus volumes with 2D ultrasound measurements', European Journal of Obstetrics and Gynecology and Reproductive Biology, vol. 264, pp. 1-7. https://doi.org/10.1016/j.ejogrb.2021.06.026

TY - JOUR

T1 - Assessment of the fetal thymus gland

T2 - Comparing MRI-acquired thymus volumes with 2D ultrasound measurements

AU - Myers, Rebecca

AU - Hutter, Jana

AU - Matthew, Jacqueline

AU - Zhang, Tong

AU - Uus, Alena

AU - Lloyd, David

AU - Egloff, Alexia

AU - Deprez, Maria

AU - Nanda, Surabhi

AU - Rutherford, Mary

AU - Story, Lisa

N1 - Funding Information: Dr Jana Hutter is a UKRI Future Leaders fellow and Dr Lisa Story is an NIHR funded Clinical lecturer. This work was supported by the Wellcome Trust IEH Award [102431] and by core funding from the Wellcome/EPSRC Centre for Medical Engineering [WT203148/Z/16/Z]. The research was funded/supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London and supported by the NIHR Clinical Research Facility (CRF) at Guy's and St Thomas?. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding Information: Dr Jana Hutter is a UKRI Future Leaders fellow and Dr Lisa Story is an NIHR funded Clinical lecturer. This work was supported by the Wellcome Trust IEH Award [102431] and by core funding from the Wellcome/EPSRC Centre for Medical Engineering [WT203148/Z/16/Z]. The research was funded/supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London and supported by the NIHR Clinical Research Facility (CRF) at Guy’s and St Thomas’. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Publisher Copyright: © 2021 King's College London Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/9

Y1 - 2021/9

N2 - Objectives: The fetal thymus gland has been shown to involute in response to intrauterine infection, and therefore could be used as a non-invasive marker of fetal compartment infection. The objective of this study was to evaluate how accurately 2D ultrasound-derived measurements of the fetal thymus reflect the 3D volume of the gland derived from motion corrected MRI images. Study design: A retrospective study was performed using paired ultrasound and MRI datasets from the iFIND project (http://www.ifindproject.com). To obtain 3D volumetry of the thymus gland, T2-weighted single shot turbo spin echo (ssTSE) sequences of the fetal thorax were acquired. Thymus volumes were manually segmented from deformable slice-to-volume reconstructed images. To obtain 2D ultrasound measurements, previously stored fetal cine loops were used and measurements obtained at the 3-vessel-view (3VV) and 3-vessel-trachea view (3VT): anterior-posterior diameter (APD), intrathoracic diameter (ITD), transverse diameter (TD), perimeter and 3-vessel-edge (3VE). Inter-observer and intra-observer reliability (ICC) was calculated for both MRI and ultrasound measurements. Pearson correlation coefficients (PCC) were used to compare 2D-parameters with acceptable ICC to TV. Results: 38 participants were identified. Adequate visualisation was possible on 37 MRI scans and 31 ultrasound scans. Of the 30 datasets where both MRI and ultrasound data were available, MRI had good interobserver reliability (ICC 0.964) and all ultrasound 3VV 2D-parameters and 3VT 3VE had acceptable ICC (>0.75). Four 2D parameters were reflective of the 3D thymus volume: 3VV TD r = 0.540 (P = 0.002); 3VV perimeter r = 0.446 (P = 0.013); 3VV APD r = 0.435 (P = 0.110) and 3VT TD r = 0.544 (P = 0.002). Conclusions: MRI appeared superior to ultrasound for visualization of the thymus gland and reproducibility of measurements. Three 2D US parameters, 3VV TD, perimeter and 3VT APD, correlated well with TV. Therefore, these represent a more accurate reflection of the true size of the gland than other 2D measurements, where MRI is not available.

AB - Objectives: The fetal thymus gland has been shown to involute in response to intrauterine infection, and therefore could be used as a non-invasive marker of fetal compartment infection. The objective of this study was to evaluate how accurately 2D ultrasound-derived measurements of the fetal thymus reflect the 3D volume of the gland derived from motion corrected MRI images. Study design: A retrospective study was performed using paired ultrasound and MRI datasets from the iFIND project (http://www.ifindproject.com). To obtain 3D volumetry of the thymus gland, T2-weighted single shot turbo spin echo (ssTSE) sequences of the fetal thorax were acquired. Thymus volumes were manually segmented from deformable slice-to-volume reconstructed images. To obtain 2D ultrasound measurements, previously stored fetal cine loops were used and measurements obtained at the 3-vessel-view (3VV) and 3-vessel-trachea view (3VT): anterior-posterior diameter (APD), intrathoracic diameter (ITD), transverse diameter (TD), perimeter and 3-vessel-edge (3VE). Inter-observer and intra-observer reliability (ICC) was calculated for both MRI and ultrasound measurements. Pearson correlation coefficients (PCC) were used to compare 2D-parameters with acceptable ICC to TV. Results: 38 participants were identified. Adequate visualisation was possible on 37 MRI scans and 31 ultrasound scans. Of the 30 datasets where both MRI and ultrasound data were available, MRI had good interobserver reliability (ICC 0.964) and all ultrasound 3VV 2D-parameters and 3VT 3VE had acceptable ICC (>0.75). Four 2D parameters were reflective of the 3D thymus volume: 3VV TD r = 0.540 (P = 0.002); 3VV perimeter r = 0.446 (P = 0.013); 3VV APD r = 0.435 (P = 0.110) and 3VT TD r = 0.544 (P = 0.002). Conclusions: MRI appeared superior to ultrasound for visualization of the thymus gland and reproducibility of measurements. Three 2D US parameters, 3VV TD, perimeter and 3VT APD, correlated well with TV. Therefore, these represent a more accurate reflection of the true size of the gland than other 2D measurements, where MRI is not available.

KW - Fetal thymus

KW - Magnetic resonance imaging

KW - Obstetric ultrasound thymus

KW - Volume

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DO - 10.1016/j.ejogrb.2021.06.026

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JO - European Journal of Obstetrics and Gynecology and Reproductive Biology

JF - European Journal of Obstetrics and Gynecology and Reproductive Biology

ER -

Assessment of the fetal thymus gland: Comparing MRI-acquired thymus volumes with 2D ultrasound measurements

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