Wonsang You - Fetal Imaging

Intelligent Imaging

for Prenatal Diagnosis

Imaging Improves Fetal Brain Diagnosis

Impaired fetal circulation, including congenital heart disease (CHD) and intrauterine fetal growth restriction (IUGR), may lead to abnormal development of the fetal brain. My research group in Children's National Hospital, Washington, DC, has demonstrated that the fetuses with CHD exhibited significantly impaired volumetric and metabolic development of the brain in third trimester (Limperopoulos et al. 2010 Circulation). However, the effects of CHD on fetal brain function and its underlying mechanism remain unclear. In particular, the role of placental insufficiency in CHD-related brain injury has not been well understood.

Our challenge was to find out reliable biomarkers for early diagnosis of fetal brain injuries using noninvasive imaging tools including magnetic resonance imaging (MRI). It was technically challenging since fetal MR images tend to be seriously degraded by motion artifacts (example video). We have developed a robust preprocessing pipeline which addresses fetal motion artifacts and physiological noises in utero (JMI 2016, SPIE 2015, EMBS 2014).

Using the proposed pipeline, we had examined the effects of maternal hyperoxia on the hemodynamic responses of the placenta and fetal brain through functional MRI. In this study, my team first demonstrated that fetal cerebral blood oxygenation was significantly increased during short-term (3-5 minutes) maternal hyperoxia in fetuses with single ventricle physiology of congenital heart disease (Radiology 2019; see highlight). We also have carried out diffusion-weighted imaging (DWI) of the placenta, followed by ex vivo placental dissection for pathology test (see examples), to figure out how placental structure and function are impaired in such high-risk pregnancies as diabetes and IUGR.

AI Empowers Fetal Diagnostic Imaging

Using the state-of-the-arts artificial intelligence (AI) and deep learning technologies, we have actively developed not only robust tools for data processing and analyses (including fetal motion correction and image segmentation) dedicated to the moving fetus (SPIE 2017, SPIE 2017a, ISMRM 2017), but also diagnostic methods for fetal brain impairment for pediatric applications (ISBI 2018, ISPD 2015). We recently developed a deep learning application for fully automatic segmentation of fetal brain and placenta in T2-weighted MR images using convolutional neural networks (ISMRM 2019, ISMRM 2018; see details). We also have developed an integrated software platform, called 'Fetalove', which makes it convenient for doctors and researchers to automatically carry out the entire processes of fetal MRI data processing and statistical analyses.

Software

Fetalove: the Fetal MRI Toolbox

Resources

Lab newsletter: Non-invasive MR imaging of in vivo feto-placental oxygenation (9/2017)
News article on the Innovation District: Sharp Images Key to Spotting the Earliest Signs of Compromised Pregnancies (7/2016)
Conference presentation (AHA): Maternal hyperoxia increases cerebral oxygenation in fetuses with congenital heart disease (11/2015)

Publications

Nickie Andescavage, Wonsang You, Marni Jacobs, Kushal Kapse, Jessica Quistorff, Dorothy Bulas, Homa Ahmadzia, Alexis Gimovsky, Ahmet Baschat, Catherine Limperopoulos, "Exploring in vivo placental microstructure in healthy and growth-restricted pregnancies through diffusion-weighted magnetic resonance imaging," Placenta, vol. 93, 113-118 (2020).
Wonsang You, Nickie Andescavage, Kushal Kapse, Mary Donofrio, Marni Jacobs, Catherine Limperopoulos, "Hemodynamic Responses of the Placenta and Brain to Maternal Hyperoxia in Fetuses with Congenital Heart Disease by Using Blood Oxygen–Level Dependent MRI", Radiology 294:1, 141-148 (2020).
Wonsang You, Iordanis E. Evangelou, Zungho Zun, Nickie Andescavage, Catherine Limperopoulos, "Robust preprocessing for stimulus-based functional MRI of the moving fetus", Journal of Medical Imaging 3(2), 026001 (Apr 05, 2016).
Wonsang You, Feng Xu, Catherine Limperopoulos, "Linear convolution model of fetal circulation for hemodynamic responses to maternal hyperoxia using in utero functional MRI," in 2018 IEEE International Symposium on Biomedical Imaging (April 2018).
Wonsang You, Catherine Limperopoulos, "Inter-slice motion correction using spatiotemporal interpolation for functional magnetic resonance imaging of the moving fetus," bioRxiv 204404 (October 2017).
Antonio R. Porras, Gemma Piella, Wonsang You, Catherine Limperopoulos, Marius G. Linguraru, "Quantification of oxygen changes in the placenta from BOLD MR image sequences," Proc. SPIE, Medical Imaging 2017: Computer-Aided Diagnosis, 1013406 (March 3, 2017) .
Wonsang You, Nickie Andescavage, Zungho Zun, Catherine Limperopoulos, "Semi-automatic segmentation of the placenta into fetal and maternal compartments using intravoxel incoherent motion MRI," Proc. SPIE, Medical Imaging 2017: Biomedical Applications in Molecular, Structural, and Functional Imaging, 1013726 (March 13, 2017).
Wonsang You, M. Donofrio, D. Wessel, Z. Zun, J. De Asis-Cruz, G. Vezina, D. Bulas, R. Jonas, A. du Plessis, and C. Limperopoulos, "Maternal Hyperoxia Increases Cerebral Oxygenation in Fetuses With Complex Congenital Heart Disease: A Functional MRI Study," Circulation, vol. 132, no. Suppl 3, pp. A19532–A19532 (November 2015). - View presentation.
Wonsang You, Shuo-Tse Hsu, Iordanis Evangelou, Mary Donofrio, Nickie Andescavage, Gilbert Vezina, Dorothy Bulas, Adre J. DuPlessis, Catherine Limperopoulos, "Altered fetal brain-placenta hemodynamic interaction in fetuses with complex congenital heart disease: A functional MRI study," Prenatal Diagnosis 2015, 35(Suppl. 1): 1–26.
Wonsang You, Ahmed Serag, Iordanis E. Evangelou, Nickie Andescavage, Catherine Limperopoulos, "Robust motion correction and outlier rejection of in vivo functional MR images of the fetal brain and placenta during maternal hyperoxia," Proc. SPIE 9417, Medical Imaging 2015: Biomedical Applications in Molecular, Structural, and Functional Imaging, 94170O (March 17, 2015). - View presentation.

Presentations

Andescavage Nickie, Chornock Rebecca L, Kapse Kushal, You Wonsang, Limperopoulos Catherine, "Placental microstructure in diabetic pregnancies assessed by diffusion-weighted magnetic resonance imaging (DW-MRI)," The 16th biennial meeting of the Diabetes in Pregnancy Study Group of North America (DPSG-NA), Washington, DC (October 2019).
Dhineshvikram Krishnamurthy, Wonsang You, Kushal Kapse, Catherine Limperopoulos, "Real-time Ultrafast Fetal Brain Localization using Convolutional Neural Networks," ISMRM 27th Annual Meeting & Exhibition 2019, Montréal, QC, Canada (May 2019).
Wonsang You, Nickie Andescavage, Kushal Kapse, Mary Donofrio, Catherine Limperopoulos, "Altered hemodynamic response of the placenta to maternal hyperoxia in the fetus with congenital heart disease," Pediatric Academic Societies Meeting, Baltimore, MD (April 2019).
Zhao Li, Wonsang You, Josepheen De Asis-Cruz, Subechhya Pradhan, Zungho Zun, Catherine Limperopoulos, "Improved data availability in neonatal and placental BOLD studies with a fast correction of non-physiological shift," The Pediatric Academic Societies (PAS) Meeting, Baltimore, MD (April 2019).
Wonsang You, Nickie Andescavage, Kushal Kapse, Mary Donofrio, Catherine Limperopoulos, "Altered placental hemodynamic response following maternal hyperoxia in pregnancies complicated by fetal congenital heart disease," The 5th annual meeting of the Human Placenta Project, Bethesda, MD (November 2018).
Wonsang You, Kushal Kapse, Yao Wu, Dhineshvikram Krishnamurthy, Catherine Limperopoulos, "Automatic segmentation of the fetal brain using multi-scale 3D convolutional neural network: a pilot study," The ISMRM Workshop on Machine Learning, Part II, Washington, DC (October 2018). - View news.
Wonsang You, Kushal Kapse, Ian Messing, Feng Xu, Mary Donofrio, Catherine Limperopoulos, "Altered placental hemodynamic response to maternal hyperoxia in fetuses with congenital heart disease using functional magnetic resonance imaging," The Pediatric Academic Societies (PAS) Meeting, Toronto, Canada (May 2018).
Nickie Andescavage, Wonsang You, Kushal Kapse, Ian Messing, Sonia Dahdouh, Dorothy Bulas, Ahmet Baschat, Adre du Plessis, Catherine Limperopoulos, "Placental microcirculation in healthy and high risk human pregnancies using advanced MRI," The Pediatric Academic Societies (PAS) Meeting, Toronto, Canada (May 2018).
Nickie Andescavage, Wonsang You, Sonia Dahdouh, Dorothy Bulas, Adre du Plessis, Catherine Limperopoulos, "Placental diffusion and perfusion in healthy and growth-restricted fetuses using IVIM," ISMRM Workshop on MRI of the Placenta, Atlanta, GA (February 2018).
Wonsang You, Anita Krishnan, Linda White, Kushal Kapse, Zungho Zun, Catherine Limperopoulos, "Diffusion weighted imaging of the placenta in gestational diabetes: a feasibility study," ISMRM Workshop on MRI of the Placenta, Atlanta, GA (February 2018).
Wonsang You, Kushal Kapse, Ian Messing, Feng Xu, Mary Donofrio, Catherine Limperopoulos, "Hyperoxic R2* changes in the placenta and brain in fetuses with congenital heart disease," ISMRM Workshop on MRI of the Placenta, Atlanta, GA (February 2018).
Yao Wu, Sonia Dahdouh, Marine Bouyssi-Kobar, Manoj Kumar, Josepheen Cruz, Wonsang You, Catherine Limperopoulos, "Improved infant MRI brain extraction utilizing clustering and morphological approaches," International Society for Magnetic Resonance in Medicine (ISMRM) (April 2017).
Wonsang You, Iordanis Evangelou, Nickie Andescavage, Catherine Limperopoulos, "Outlier rejection, data imputation and denoising in stimulus-based fMRI of the moving fetus," IEEE EMBS Brain Grand Challenges Conference (November 2014).

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