Quantitative Ultrasound Parameters Based on the Backscattered Echo Power Signal as Biomarkers of Cervical Remodeling: A Longitudinal Study in the Pregnant Rhesus Macaque

Clinical prediction and especially prevention of abnormal birth timing, particularly pre-term, is poor. The cervix plays a key role in birth timing; it first serves as a rigid barrier to protect the developing fetus, then becomes the pathway to delivery of that fetus. Imaging biomarkers to define this remodeling process could provide insights to improve prediction of birth timing and elucidate novel targets for preventive therapies. Quantitative ultrasound (QUS) approaches that appear promising for this purpose include shear wave speed (SWS) estimation to quantify softness, as well as parameters based on backscattered power, such as the mean backscattered power difference (mBSPD) and specific attenuation coefficient (SAC), to quantify the organization of tissue microstructure. Invasive studies in rodents demonstrated that as pregnancy advances, cervical microstructure disorganizes as tissue softness and compliance increase. Our non-invasive studies in pregnant women and rhesus macaques suggested that QUS can detect these microstructural changes in vivo. Our previous study in the same cohort showed a progressive decline in SWS during pregnancy, consistent with increasing tissue softness, and we hypothesized that backscatter parameters would also decrease, consistent with increasing microstructural disorganization. In this study, we analyzed the mBSPD and SAC in the cervices of rhesus macaques (n = 18). We found that both mBSPD and SAC decreased throughout pregnancy (p < 0.001 for both parameters) and that the former appears to be a more reliable biomarker. In summary, biomarkers that can characterize tissue microstructural organization are promising for comprehensive characterization of cervical remodeling in pregnancy.