孕妇子宫收缩的肌电图成像
1Department of Physics,Washington University, 2Center for Reproductive Health Sciences,Washington University School of Medicine, 3Department of Obstetrics and Gynecology,Washington University School of Medicine, 4Department of Biomedical Engineering,Washington University, 5Mallinckrodt Institute of Radiology,Washington University School of Medicine, 6Department of Pediatrics,Washington University School of Medicine, 7Department of Cardiology,Washington University School of Medicine, 8Department of Women’s Health,University of Texas at Austin, Dell Medical School
Summary
我们提出了进行肌电成像 （EMMI） 的方案，包括以下程序：来自体表的多个肌电图电极传感器记录、磁共振成像和子宫电信号重建。
Abstract
在正常怀孕期间，子宫平滑肌（子宫肌层）在妊娠晚期开始出现微弱、不协调的收缩，以帮助子宫颈重塑。在分娩时，子宫肌层具有强烈、协调的收缩来分娩胎儿。已经开发了各种方法来监测子宫收缩模式以预测分娩开始。然而，目前的技术具有有限的空间覆盖范围和特异性。我们开发了肌电成像 （EMMI），以在宫缩期间无创地将子宫电活动映射到三维子宫表面。EMMI 的第一步是使用 T1 加权磁共振成像来获取受试者特定的身体-子宫几何形状。接下来，使用放置在体表上的多达 192 个针型电极来收集子宫肌层的电记录。最后，执行EMMI数据处理流水线，将体-子宫几何形状与体表电数据相结合，对子宫表面的子宫电活动进行重建和成像。EMMI可以安全、无创地对整个子宫的早期激活区域和传播模式进行三维成像、识别和测量。
Introduction
临床上，通过使用宫内压力导管或进行宫缩力测定法来测量子宫收缩1.在研究环境中，可以通过肌电图 （EMG） 测量子宫收缩，其中将电极放置在腹部表面以测量子宫肌层2、3、4、5、6、7 产生的生物电信号。人们可以使用源自肌电图的电爆发8、9、10、11、12 的幅度、频率和传播特征来预测早产儿分娩的开始。然而，在传统的肌电图中，子宫收缩的电活动仅从腹表面的一个小区域测量，电极数量有限（腹面中央的两个 13 和四个7、14、15、16，下腹表面 64 17）。此外，传统的肌电图在研究分娩机制方面的能力有限，因为它只能反映整个子宫的平均电活动，而无法检测宫缩期间子宫表面的特定电启动和激活模式。
最近引入了一种称为肌电成像 （EMMI） 的发展，以克服传统肌电图的缺点。EMMI能够在子宫收缩期间对整个子宫肌层的电激活序列进行无创成像18,19,20,21。为了获得体与子宫的几何形状，EMMI 使用 T1 加权磁共振成像 （MRI）22、23、24，该成像已广泛用于孕中期和孕晚期的孕妇。接下来，使用放置在体表上的多达 192 个针型电极来收集子宫肌层的电记录。最后，执行EMMI数据处理流水线，将体-子宫几何形状与电数据相结合，以重建和成像子宫表面的电活动21。EMMI可以在三维空间上准确定位子宫收缩的开始和子宫收缩过程中的图像传播模式。本文旨在介绍EMMI程序并展示从孕妇那里获得的代表性结果。
Protocol
此处描述的所有方法均已获得华盛顿大学机构审查委员会的批准。 1. MRI安全标记贴片、电极贴片和标尺（图1） 将MRI和电极贴片模板（图1A）打印在纸上。 将透明乙烯基和硅橡胶板（材料表）切割成 22（乙烯基）和 44（橡胶）矩形 （120 mm x 60 mm） 以及 4 个（乙烯基）和 8（硅橡?…
Representative Results
具有代表性的MRI安全贴片和电极贴片如图1B，C所示，由图1A所示的模板创建。生物电测绘硬件如图1C所示，并详细标注了每个组件的连接。图 2 显示了整个 EMMI 程序，包括佩戴 MRI 贴片的受试者的 MRI 扫描（图 2A）、3D 光学扫描（图 2B）、生物电映射（图 2C）、体子宫几何形状的生成（图 2D）和 EMMI 数据示意图（<strong c…
Discussion
肌电图表明，子宫电信号的频率和振幅在妊娠期发生变化 2,16,25。几项研究探讨了积极分娩患者子宫收缩的子宫增殖模式 10,17,26,27,28。尽管如此，由于数量和覆盖范围有限，以及体表电极的非标准配置，?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
我们感谢黛博拉·弗兰克（Deborah Frank）编辑了这份手稿，并感谢杰西卡·丘比兹（Jessica Chubiz）组织了这个项目。 资金：这项工作得到了 March of Dimes Center Grant （22-FY14-486） 的支持，得到了 NIH/National Institute of Child Health and Human Development （R01HD094381 to PIs Wang/Cahill 的资助;R01HD104822给 PI Wang/Schwartz/Cahill），来自 Burroughs Wellcome Fund 早产倡议（NGP10119给 PI Wang）的赠款，以及比尔和梅琳达·盖茨基金会的赠款（INV-005417、INV-035476 和 INV-037302 给 PI Wang）。
Materials
| 16 G Vinyl 54" Clear | Jo-Ann Stores | 1532449 | |
| 3 T Siemens Prisma | Siemens | N/A | MRI scanner |
| 3M double coated medical tape – transparent | MBK tape solutions | 1522 | Width – 0.5" |
| Active electrode holders with X -ring | Biosemi | N/A | 17 mm |
| Amira | Thermo Fisher Scientific | N/A | Data analysis software |
| Bella storage solution 28 Quart clear underbed storage tote | Mernards | 6455002 | |
| Extreme-temperature silicone rubber translucent | McMaster-Carr | 86465K71 | Thickness 1.32” |
| Gorilla super glue gel | Amazon | N/A | |
| LifeTime carbide punch and die set, 9 Pc. | Harbor Freight | 95547 | |
| Optical 3D scan | Artec 3D | Artec Eva Lite | |
| PDI super sani cloth germicidal wipes | McKesson medical supply company | Q55172 | Santi-cloth |
| Pin-type active electrodes | Biosemi | Pin-type | |
| REDUX electrolyte gel | Amazon | 67-05 | |
| Soft cloth measuring tape | Amazon | N/A | any brand can be used |
| Sterilite layer handle box | Walmart | 14228604 | Closed box |
| TD-22 Electrode collar 8 mm | Discount disposables | N/A | |
| Vida scanner | Siemens | N/A | MRI scanner |
| Vitamin E dl-Alpha 400 IU – 100 liquid softgels | Nature made | SU59FC52EE73DC3 |
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Cite This Article
Wang, H., Wen, Z., Wu, W., Sun, Z., Wang, Q., Schwartz, A. L., Cuculich, P., Cahill, A. G., Macones, G. A., Wang, Y. Electromyometrial Imaging of Uterine Contractions in Pregnant Women. J. Vis. Exp. (195), e65214, doi:10.3791/65214 (2023).