MATERNAL-FETAL MEDICINE Strain elastography in placental dysfunction: placental elasticity differences in normal and preeclamptic pregnancies in the second trimester Canan Cimsit • Tevfik Yoldemir • Ihsan Nuri Akpinar Received: 28 April 2014 / Accepted: 12 September 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Purpose The aim of this study is to determine if the Strain elastography (SE) of the placenta measured in the second trimester differs between normal pregnancies and pregnancies complicated by preeclampsia (PE). Methods 219 singleton pregnancies who had routine anomaly scanning between the 20th and 23rd weeks of gestation were included in this observational study. Women with either posterior placentations (n = 63) or other obstetric pathologies (n = 12) were excluded from the study, leaving 144 pregnant women for the evaluation of strain ratio with SE. One hundred and one women with normal pregnancies and normal deliveries without any perinatal complications formed Group A. Twenty-eight patients who were clinically diagnosed with early onset PE before anomaly scanning formed Group B. Fifteen nor- motensive pregnant women with either mild proteinuria, and past history of preeclampsia during their previous pregnancies formed Group C. The strain ratios were com- pared between the groups. Results The strain ratio of Group B was significantly higher than those of Group A and Group C (p \ 0.05). Conclusions The placental elasticity ratios measured by SE imaging during the second trimester differ between the normal pregnancies and the pregnancies complicated by PE. SE might be used as a supplement tool in addition to the existing methods for the prediction of PE. Keywords Sonoelastography Á Placental elasticity Á Placental dysfunction Á Preeclampsia Á Strain Á Real-time elastography Introduction Sonoelastography which evolved as a natural extension of conventional ultrasonography has recently been used for evaluation of tissue elasticity, and was integrated into clinical practice like Doppler imaging. One method of elastography also called as Strain elastography (SE) or real-time sonoelastography, calculates the relative hardness of tissue by measuring mechanically induced deformation (strain) of the structures to estimate the elasticity of the targeted area and the surrounding tissues [1, 2]. Elasticity measurements of soft tissues are useful in the differential diagnosis of neoplasms, inflammation, fibrosis, and normal tissue. Real-time sonoelastography is used for benign and malignant masses of the breast, thyroid, pros- tate, and kidney as well as for the assessment of liver fibrosis [3–8]. Endoscopic elastography is a method for the characterization of pancreatic lesions, lymph nodes, and gastrointestinal wall layers especially in the anorectal region [9, 10]. Applications for this technique in gynecol- ogy and obstetrics have recently been documented [11, 12]. The consequences of placental dysfunction such as preeclampsia (PE), intrauterine growth retardation, and fetal demise are major causes of fetomaternal morbidity and mortality [13]. Early-onset PE developing before 34 weeks is commonly associated with fetal growth restriction, and adverse outcomes [14, 15]. The C. Cimsit (&) Á I. N. Akpinar Department of Radiology, Marmara University Training and Research Hospital, Istanbul, Pendik, Turkey e-mail: canancimsit@gmail.com T. Yoldemir Department of Obstetrics and Gynaecology, Marmara University Training and Research Hospital, Istanbul, Pendik, Turkey 123 Arch Gynecol Obstet DOI 10.1007/s00404-014-3479-y