Intra-voxel incoherent motion MRI of the living human foetus: technique and test–retest repeatability

Background: Our purpose was to test the within-subject (test–retest) reproducibility of the perfusion fraction, diffusion coefficient, and pseudo-diffusion coefficient measurements in various foetus organs and in the placenta based on the intra-voxel incoherent motion (IVIM) principle. Methods: In utero diffusion-weighted IVIM magnetic resonance imaging (MRI) was performed in 15 pregnant women (pregnancy age 21–36 weeks) on 1.5-T and 3.0-T clinical scanners with b-factors in the range of 0–900 s/ mm in 16 steps. A bi-exponential model was fitted on the volume-averaged diffusion values. Perfusion fraction (f), diffusion coefficient (d), and pseudo-diffusion coefficient (D*) were calculated. Within-subject reproducibility was evaluated as test–retest variability (VAR %) of the IVIM parameters in the foetal frontal cortex, frontal white matter, cerebellum, lungs, kidneys, liver, and in the placenta. Results: For the foetal lungs, liver and the placenta, test–retest variability was in the range of 14–20% for f, 12–14% for d, and 17–25% for D*. The diffusion coefficients of the investigated brain regions were moderately to highly reproducible (VAR 5–15%). However, f and D* showed inferior reproducibility compared to corresponding measures for the lungs, liver, and placenta. The IVIM parameters of the foetal kidney were revealed to be highly variable across scans. Conclusions: IVIM MRI potentially provides a novel method for examining microvascular perfusion and diffusion in the developing human foetus. However, reproducibility of perfusion and diffusion parameters depends greatly upon data quality, foetal and maternal movements, and foetal-specific image post-processing.