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Low-Field Magnetic Resonance Imaging of the Late Gestation Cervix and Birth Outcome Correlation: A Prospective Cohort
Simi Bansal1,2, Alena U Uus1, Agnieszka Glazewska-Hallin2,3
1School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
Objective:
To use low-field MRI to produce reconstructions and 3D models of the cervix and to automate measurements for correlation with demographics and birth outcomes.
Design:
Prospective cohort study.
Setting:
KCL Advanced Imaging Centre, St Thomas's Hospital.
Population:
Late gestation (36-41w) women attempting their first vaginal birth, recruited to the MiBirth study (n = 97).
Methods:
Reconstructed images were produced from 2D T2-weighted Turbo-Spin-Echo 2D sequences acquired with a 0.55 T Freemax MRI scanner. Segmentations and anatomical landmarks were automated using an in-house 3D deep learning segmentation network, from which cervical 2D measurements and 3D volumes were generated.
Main Outcome Measures:
Quality of reconstructed images and segmentations. Inter-rater variability for cervical biometry. Correlation between cervical measurements, maternal demographics and birth outcomes.
Results:
Successful reconstructions were obtained for 92.9%; 84.9% were good quality. Excellent or good quality segmentations were obtained for all successful reconstructions (n = 99). Inter-rater variability between automated and manual biometry was excellent or good for cervical measurements. Total cervical and stroma volumes significantly increased with cervical length (p < 0.01). Os diameters and utero-cervical angle significantly decreased as cervical length increased (p < 0.001). Cervical stroma volume increased with maternal age (p = 0.02). Controlling for maternal age, an increased cervical volume was associated with an increased risk of caesarean section (OR 1.09, p = 0.04).
Conclusions:
This is a novel, accurate automated system to assess MRI late gestation cervical biometry and volumetry. We have shown that the late gestation cervical phenotype may influence birth outcomes and provided a new mechanism for increased risk of caesarean with maternal age.
