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• Clinical Article •
Evaluation of placental stiffness in pregnancy-induced hypertension syndrome at high altitude using IVIM-DWI-based virtual MR elastography
LIU Fei  YAN Zhanyue  LIU Chenghuan  LI Xiaohua  GAN Zhengning  QIN Pingwu  WANG Shenglan  LIU Gang  SHENG Wei 

DOI:10.12015/issn.1674-8034.2026.02.016.


[Abstract] Objective : A quantitative comparison of placental stiffness was performed using intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) based virtual magnetic resonance elastography (vMRE) between normal and pregnancy-induced hypertension (PIH) syndrome pregnancies at high altitude.Materials and Methods This study retrospectively collected data from pregnant women who underwent MRI-IVIM examinations at Qinghai Red Cross Hospital between August 2019 and January 2022, including 44 cases (5 cases in the second trimester, 19 cases in the third trimester, and 20 cases with PIH). The virtual shear modulus (μdiff), apparent diffusion coefficient (ADC), shifted ADC (sADC) values of different placental regions, and relevant clinical data were measured and recorded. Compare the differences in quantitative parameters and clinical data of placentas between the two groups. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were employed to quantify and compare the diagnostic value of different parameters. A linear regression model was applied to analyze the influence of different factors on placental stiffness in PIH, while Pearson correlation analysis was used to examine the relationship between placental stiffness and various factors in both groups.Results The whole, fetal compartment, and maternal compartment placental stiffness values in the normal group were significantly lower than those in the PIH group (P < 0.05). Conversely, the whole, fetal compartment, and maternal compartment sADC and ADC values in the normal group were significantly higher than those in the PIH group (P < 0.05). Additionally, the whole placental volume and thicknessmax in the normal group were greater than those in the PIH group (P < 0.05). The ROC analysis of various parameters indicated that the placental maternal compartment stiffness value demonstrated superior diagnostic efficacy for PIH [AUC = 0.902, 95% confidence interval (CI): 0.808 to 0.995], with an optimal cutoff value of 5.99 kPa. Furthermore, while normal placental stiffness showed no significant correlation with gestational age (P > 0.05), it reached lowest level at 24 weeks of gestation and exhibited an increasing trend from 28 to 32 weeks. Notably, before 30 weeks of gestation, the maternal compartment of the placenta was more stiffness than the fetal side, whereas after 30 weeks, this pattern reversed. Additionally, in cases of pregnancy-induced hypertension, the maternal compartment stiffness was positively correlated with systolic blood pressure (r = 0.467, P < 0.05).Conclusions High-altitude hypoxia may alter the biomechanical properties of the normal placenta. Furthermore, vMRE-measured placental stiffness is more reliable than sADC and ADC in distinguishing PIH, as PIH placentas show increased stiffness, which is influenced by systolic blood pressure.
[Keywords] placenta；pregnancy-induced hypertension；plateau；stiffness；elasticity；virtual magnetic resonance elastography；intravoxel incoherent motion；magnetic resonance imaging

LIU Fei1   YAN Zhanyue1   LIU Chenghuan1   LI Xiaohua1   GAN Zhengning1   QIN Pingwu1   WANG Shenglan2   LIU Gang1*   SHENG Wei3  

1 Department of Radiology and Intervention, Qinghai Red Cross Hospital, Xining 810000, China

2 Department of Obstetrics, Qinghai Red Cross Hospital, Xining 810000, China

3 MR Research collaboration, Siemens Healthineers, Shanghai 201318, China

Corresponding author: LIU G, E-mail: Liu_gang197508@163.com

Conflicts of interest   None.

Received  2025-11-06
Accepted  2026-01-26
DOI: 10.12015/issn.1674-8034.2026.02.016
DOI:10.12015/issn.1674-8034.2026.02.016.

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