Review of shear wave elastography in placental function evaluations

Figures & data

Figure 1. Example of reverberation artifacts of placenta. Green and red areas are artificially set colors; green area indicates precise range of stiffness measurements. In 2D-SWE, artifacts can be identified and avoided on color maps.

Table 1. Elastography in placental function evaluations.

Author	Title	Objective	Elastography Type (commercial system)	Results	Conclusion
Simoes et al., 2020 [2]	Placental ARFI elastography and biometry evaluation in bitches	Placental stiffness and biomechanics were assessed in 12 pregnant pigs.	pSWE (Siemens,VTTQ™) 2D SWE (Siemens,VTTIQ™)	median ± IQR: 9 ± 1.5 at 0 10 ± 1.5 at 5 min 10 ± 0.5 at 60 min after birth Using VTTQ™ the dorsal area (n = 24)2.62 ± 0.63 m/s,the lateral area ((n = 24)1.68 ± 0.53 m/s Using VTTIQ™ the dorsal area (n = 24)2.60 ± 0.44 m/s,the lateral area (n = 24)2.33 ± 0.56 m/s	Placental changes reflect structural and biochemical changes that occur during pregnancy.
Quibel et al., 2015 [3]	Placental elastography in a murine intrauterine growth restriction model	Utilizing SWE to assess placental elasticity between healthy and IUGR mouse pregnancies	2D SWE (Supersonic Image)	Mean (SD) Young’s modulus the IUGR: (n = 18)11.7 ± 1.5 kPa control: (n = 3)8.01 ± 3.8 kPa	The stiffness of placentas from IUGR fetuses increased with the degree of fetal growth restriction.
Edwards et al., 2021 [4]	Changes in placental elastography in the third trimester - Analysis using a linear mixed effect model	To assess longitudinal changes in SWV during pregnancy and model these changes in relation to other developing fetal and maternal physiological and biological characteristics.	SWE (Canon Medical)	In the fitted model AvgDepth and subject BMI had the greatest impact on MeanSWV, whereas AFI and GA only had minimal impact	Only gestational age, AFI, BMI, and sample depth were shown to be significant predictors of placental SWV out of a total of 10 factors used for modeling, while gestational age and AFI were found to have a negligible effect on SWV.
Alan et al., 2016 [13]	Diagnosis of pre-eclampsia and assessment of severity through examination of the placenta with acoustic radiation force impulse elastography	To evaluate the value of placental SWV measurement by ARFI imaging for pre-eclampsia diagnosis and to establish the association between the placental SWV and the severity of pre-eclampsia.	pSWE (Siemens)	median (interquartile range) Control group (n = 44)SWVmean, m/s:1.07 (1.00–1.14) Mild pre-eclampsia (n = 26)SWVmean, m/s 1.34 (1.31–1.39) Severe pre-eclampsia (n = 16)SWVmean, m/s 1.56 (1.53–1.59)	The measurement of the placental SWV with ARFI imaging is an additional method for diagnosing pre-eclampsia and determining disease severity.
Ohmaru et al., 2015 [14]	Placental elasticity evaluation using virtual touch tissue quantification during pregnancy	To look into changes in placental elasticity during pregnancy, particularly in complicated pregnancies.	pSWE (Siemens)	The mean ± SD SWVs the normal (n = 143):0.98 ± 0.21m/s the FGR (n = 21):1.28 ± 0.39m/s the PIH (n = 15):1.60 ± 0.45m/s	SWV changes during pregnancy have been linked to placental fibrosis, and increased SWV in PIH and/or FGR cases may be influenced by infarction, ischemic changes, inflammation, and fibrosis.
Wu et al., 2016 [15]	Measurement of elasticity of normal placenta using the Virtual Touch quantification technique	The goal of this study was to use the Virtual Touch Quantification (VTQ) technique to measure the elasticity of normal placentas.	pSWE (Siemens)	mean ± SD the normal placenta (n = 100):0.983 ± 0.260 m/s	Normal placental tissue SWV varies little between the second and third trimesters.
Yuksel et al., 2016 [16]	Shear wave elastography of the placenta in patients with gestational diabetes mellitus	To compare the placental elasticty of women with and without gestational diabetes mellitus (GDM).	SWE (SuperSonic Imagine)	mean ± standard deviation the controls (n = 43): the central :5.47 ± 1.74 kPa the peripheral:5.23 ± 1.31 kPa women with GDM (n = 33): the central :10.63 ± 5.97 kPa the peripheral:10.67 ± 7.41 kPa	In GDM pregnancies, the mean elasticity values of both the central and peripheral parts of the placenta were significantly higher.
Liu et al., 2021 [17]	Study on the clinical value of real-time SWE in detecting placenta elasticity of patients with GDM	Investigating the usefulness of SWE in identifying placental elasticity in late pregnancy of GDM, which can be utilized to predict delivery difficulties and delivery outcomes.	SWE (Supersonic Imagine)	mean ± SD the controls (n = 153): the central:5.2 ± 1.5 kPa the peripheral:5.4 ± 1.9kPa women with GDM (n = 82): the central:9.3 ± 4.2 kPa the peripheral:9.5 ± 5.3 kPa	GDM patients’ placental SWE values increased, and this increase was strongly related to the adverse pregnancy and delivery outcomes.
Chen 2019 [18]	Application values of real-time shear wave elastography evaluated placental elasticity of pre-eclampsia in the third trimester of pregnancy	In order to assess the application value of SWE in assessing the elasticity of the placenta in patients with pre-eclampsia (PE) and a normal control group in late pregnancy.	SWE (Supersonic Imagine)	The mean ± SD YM the controls (n = 171):6.29 ± 1.16kPa women with PE (n = 60):14.34 ± 6.91kPa	Young’s modulus differences between placenta parts were not statistically significant. The PE group’s young’s modulus value of placenta was greater than that of the normal control group.
Yuan et al., 2017 [19]	The Application Research of Shear Wave Elasticity Imaging Placenta of Gestational Hypertension Disease.	SWE detection of trimester placenta elasticmodukus with gestational hypertension. To determine if SWE can predict gestational hypertension placenta function.	SWE (Supersonic Imagine)	The mean ± SD YM the normal group (n = 30): 6.42 ± 0.43kPa women with pregnancy hypertension (n = 30):12.25 ± 2.02kPa	Pregnancy hypertension has higher placenta elastic modulus values during late pregenancy than the control group.
Ge et al., 2020 [20]	Evaluation of the placental elastic modulus in the normal second or third trimester of pregnancy and its influencing factors	To explore the factors that affect evaluation of normal placental elasticity by shear wave elastography (SWE) technology	SWE (Mindray)	mean ± SD The placental elastic YM the second trimester (n = 23):5.79 ± 0.67kPa the third trimester were (n = 46):6.17 ± 0.88kPa	In the second or third trimester, the normal placental elastic modulus value is not significantly correlated with the sampling area, gestational week, or hemodynamic parameters.
Spiliopoulos et al., 2020 [21]	Characterizing placental stiffness using ultrasound shear-wave elastography in healthy and preeclamptic pregn	To assess placenta stiffness in healthy and preeclamptic patients in the second and third trimesters using ultrasonic shear-wave elastography (SWE). We also examined how age, gestational age, gravidity, parity, and BMI affect placental stifness and perinatal outcomes.	SWE (Supersonic Image)	mean ± SD Controls (n = 24) 2nd trimester:18.16 ± 11.6 kPa 3rd trimester:10.45 ± 7.6 kPa PE (n = 23) 2nd trimester:27.23 ± 10.1 kPa 3rd trimester:26.36 ± 14.1 kPa	The placentas of preeclamptic pregnancies are stiffer and more diverse than those of healthy pregnancies. Preeclampsia severity or gestational age have no effect on placental stifness, although there is a link between a greater BMI and adverse perinatal outcomes.
Edwards et al., 2022 [22]	Relationship between placental elastography, maternal pre-pregnancy body mass index and gestational weight gain	To connect ultrasound elastography-measured placental stiffness to maternal pre-pregnancy BMI and gestational weight gain.	2D SWE (Canon Medical)	Obese women, on average, had a MeanSWV 0.11 m/s (95% CI (0.061–0.15) m/s, p < 0.001) above the healthy group throughout the 3rd trimester.	Placental structural changes detected using ultrasound elastography techniques are not limited to placental dysfunction conditions (pre-eclampsia and growth restriction), but are also associated with maternal obesity.
Habibi et al., 2017 [28]	In vivo assessment of placental elasticity in intrauterine growth restriction by shear-wave elastography	We measured placental elasticity in vivo using SWE in pregnant women being monitored for intrauterine growth restriction (IUGR) and compared the results to normal pregnancies.	SWE (SuperSonic Imagine)	SWE values are given in kPa. Data are presented as median, 25th and 75th interquartile ranges (in parentheses) Control (n = 42) Central placentamaternal surface:6 (4.38–7.45) Central placenta-fetal surface:5 (3.73–6.55) Peripheral placentamaternal surface:5.35 (4.78–6.28) Peripheral placenta-fetal surface:5.30 (4–6.85) IUGR (n = 42) Central placentamaternal surface:28 (16.8–35) Central placenta-fetal surface:21.5 (13.5–28.3) Peripheral placentamaternal surface:22 (13.8–31.3) Peripheral placenta-fetal surface:22.5 (14.8–29.5)	Patients with IUGR have significantly higher placental stiffness values.
Deeba et al., 2022 [30]	SWAVE 2.0 Imaging of Placental Elasticity and Viscosity: Potential Biomarkers for Placenta-Mediated Disease Detection.	By combining a multi-frequency acquisition system and employing a 3-D local frequency estimation (LFE) method to identify and monitor placental pathology	SWAVE (an ultrasound machine (Ultrasonix SonixTouch) with a transducer (Ultrasonix))	Elasticity measurements are expressed as the mean ± standard deviation of Young’s modulus (E) measures normal (n = 20)：8.32 ± 3.67 kPa PE (n = 10)：12.33 ± 4.88 kPa IUGR (n = 16)：15.30 ± 2.96 kPa	This study demonstrates the potential utility of SWAVE 2.0 elasticity and viscosity imaging as a noninvasive technology for detecting placental abnormalities and predicting pregnancy outcomes.
Akbas et al., 2019 [31]	Placental elasticity assessment by point shear wave elastography in pregnancies with intrauterine growth restriction	To assess placental elasticity in pregnancies with intrauterine growth restriction (IUGR) using point shear wave elastography .	pSWE (Philips Healthcare)	Elasticity measurements are expressed as the mean ± standard deviation of Young’s modulus (E) measures control group (n = 81):3.85 ± 1.2 kPa IUGR group (n = 66)：5.51 ± 2.09kPa	The placentas in IUGR pregnancies were stiffer than those in healthy controls.
Anuk et al., 2022 [32]	Value of shear-wave elastography and cerebral-placental-uterine ratio in women diagnosed with preeclampsia and fetal growth restriction in prediction of adverse perinatal outcomes	The purpose of this study was to assess the relationship between placental stiffness and adverse perinatal outcomes in patients with PE and FGR using SWE.	SWE (Toshiba Medical Systems)	SWE values are shown in kPa.Data are shown as mean, standard deviation. Placental stiffness (kPa) SWE mean elasticity values LRP (n = 54):8.2 ± 2.52kPa FGR (n = 53):14 ± 5.95kPa PE (n = 40):17.7 ± 5.73kPa	Both the PE and FGR groups had increased placental stiffness. This technique may improve the usefulness of Doppler parameters in predicting adverse perinatal outcomes in high-risk pregnancies.
Akbas et al., 2021 [33]	The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies	To investigate the relationship between second-trimester placentalelasticity and poor obstetric outcomes in low-risk pregnant women.	pSWE (Philips Healthcare)	Data are presented as mean ± standard deviation. Placental elasticity (n = 143):3.14 ± 0.99 kPa	Pregnancies with a stiffer placenta were associated with a higher risk of having a poor obstetric outcome.
Fujita et al., 2019 [34]	Placental Elasticity as a New Noninvasive Predictive Marker of Pre-eclampsia	To see if placental elasticity can help predict the onset of pre-eclampsia.	pSWE (Siemens)	median SWV values (range) low-risk non-onset groups (n = 185):1.03 (0.64–1.46) high risk non-onset groups (n = 36):1.07 (0.76–2.28)	Placental elasticity increased significantly before the onset of pre-eclampsia and may thus be used to predict the onset of pre-eclampsia.
Ge et al., 2019 [36]	Preliminary study of shear wave elastography in evaluation of placental elasticity in preeclampsia	To investigate the clinical utility of SWE in quantitatively assessing placental elasticity in preeclamptic patients.	SWE (Mindray)	the control (n = 54) the central fetal surface:6.38 ± 1.87kPa, the central maternal surface:6.51 ± 1.52kPa, the marginal fetal surface:6.37 ± 1.55kPa, the marginal maternal surface:6.48 ± 1.58kPa. the PE group (n = 22) the central fetal surface:8.54 ± 3.74kPa, the central maternal surface:9.46 ± 3.64kPa, the marginal fetal surface:8.48 ± 2.66kPa, the marginal maternal surface:9.25 ± 3.00kPa.	SWE can aid in the evaluation of placental function in pregnant women with preeclampsia.
Cimsit et al., 2015 [37]	Strain elastography in placental dysfunction: placental elasticity differences in normal and preeclamptic pregnancies in the second trimester	The SE of the placenta is measured differently in normal pregnancies and pregnancies complicated by PE.	SE (GE Healthcare)	95 % Confidence interval for geometric mean control (n = 101)0.9 (0.82–0.97) PE (n = 28)1.56 (1.12–2.16)	Normal pregnancies and pregnancies complicated by PE have different placental elasticity ratios.
Arslan et al., 2019 40]	Shear-wave elastography - virtual touch tissue quantification of fetal placentas with a single umbilical artery	The SWE was used to assess the elasticities of fetal placentas with a single umbilical artery.	pSWE (Siemens Healthcare)	shear-wave velocity mean ± SD (m/s) Control group (n = 20)1.125 ± 0.34 m/s SUA group (n = 20)1.099 ± 0.43 m/s	The difference in fetal placenta elasticity measured by SWE between normal and SUA is minor.
Cetin et al., 2017 41]	Acoustic radiation force impulse elastosonography of placenta in maternal red blood cell alloimmunization: a preliminary and descriptive study	To compare placental elasticity in Rh alloimmunized pregnant women with hydropic and nonhydropic fetuses to healthy pregnant women utilizing ARFI.	pSWE (Siemens)	Median (Minimum and Maximum) Healthy controls (n = 28)0.84 (0.63–0.98)m/s Rh alloimmunized pregnant women with nonhydropic fetuses (n = 14)0.88 (0,62–1.16)m/s Rh alloimmunized pregnant women with hydropic fetuses (n = 16)1.13 (0.58–1.87)m/s	In Rh alloimmunized pregnancies complicated by hydrops fetalis, the placenta stiffens.
Tolunay et al., 2021 [42]	Can placental elasticity predict the time of delivery in cases of threatened preterm labor?	To assess placental flexibility for the quick delivery prediction in cases of threatened preterm labor (TPL).	SE (Esaote Group)	placental strain ratio PSR median women who have not given birth within a week (n = 54) (Md = 1.5) women gave birth within a week (n = 54) (Md = 8.2)	Elastography may help predict delivery time in high-risk pregnant women with TPL.
Tepe et al., 2020 [43]	Subgroup analysis of accreta, increta and percreta cases using acoustic radiation force impulse elastography	ARFI elastography values were compared with histopathological diagnoses in patients suspected of having abnormal placental invasion (API).	pSWE (Siemens Healthcare)	(mean ± SD)Average ARFI scores m/s Control group (n = 35)0.78 ± 0.18m/s Patient group (n = 54)1.42 ± 0.46m/s	They conclude that while ARFI elastography is effective at detecting invasion, it does not contribute significantly to determining the degree of invasion.
Dokumaci et al., 2022 [44]	Shear-wave elastography for detection of placenta percreta: a case-controlled study	The purpose of this study was to determine the role of SWE in the prenatal diagnosis of PP.	SWE (Siemens Healthcare)	mean ± SD m/s control group (n = 20)1.69 ± 0.23m/s PP group (n = 18)1.95 ± 0.19m/s	Patients with PP had significantly higher placental stiffness than pregnant women with normally localized placentas.

SWE: shear wave elastography, SE: strain elastography,ARFI: acoustic radiation force impulse, IUGR: intrauterine growth restriction, SUA: single umbilical artery, GDM: gestational diabetes mellitus, GH: gestational hypertension; pSWE: point shear wave elastography, FGR: fetal growth restriction, Vs: velocities of lateral shear waves, SWAVE: shear wave absolute vibro elastography, SWV:shear wave velocity, VTQ: Virtual Touch quantification.

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