E-ISSN 1305-3612
Fetal Imaging - Original Article
Diffusion weighted imaging of placenta in ıntrauterine growth restriction with worsening doppler findings
1 Division of Pediatric Radiology, Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey  
2 Department of Obstetrics and Gynaecology, Erciyes University School of Medicine, Kayseri, Turkey  
3 Department of Biostatistics, Erciyes University School of Medicine, Kayseri, Turkey  
Diagn Interv Radiol ; : -

Abstract

PURPOSE: To compare the placental diffusion difference between intrauterine growth restriction (IUGR) patients with worsening doppler findings and control group with normal Doppler findings by using diffusion weighted imaging (DWI).

 

METHODS: We performed a prospective study to compare the placental diffusion difference in sixty-three patients (gestational week between 28-34 weeks) whom consisted of IUGR patients (n=50) (mean gestational week: 30w3d±16.2d) with worsening doppler findings and patients with normal doppler findings (n=13) (mean gestational week: 29w4d ±12.3d) by using DWI (b=0-1000 s/mm2). We subgrouped IUGR patients into three groups (group 1-3) according to the reference values of the umbilical artery pulsatility index (PI) chart. Placenta apparent diffusion coefficient (ADC) calculations were performed by freehand ROI draws (min=8.04 cm2-max=200 cm2).

 

RESULTS: Placental ADC values in IUGR patients (mean=1.624±0.181, range 1.35-1.96×10−3 mm2/s) were significantly reduced compared to the control group (mean=1.827±0.191, range 1.35-2.84 × 10−3 mm2/s) (P = 0.001). For adjusted ROI area calculation, ADC values were significantly lower in group 3, 2 and 1 respectively compared to the control group (P < 0.05); and there was no significant difference between group 1 and group 2 (P > 0.05). Preeclampsia significantly reduced the placental diffusion compared to patients without preeclampsia (P = 0.003). Gestational aging did not significantly affect ADC values in control patients (r=0.08, P = 0.561). The sensitivity, specificity, negative and positive predictive values of ADC to detect IUGR were 72%, 84.6%, 44%, and 94.7% with a cut-off value of 1.727× 10−3 mm2/s, respectively.

 

CONCLUSION: The diagnostic estimation of placental ADC values to predict severity of IUGR is comparable to that of umbilical artery PI. Considering that at the very early onset of IUGR, placental diffusion diminishes, ADC as a marker for IUGR in lieu of umbilical artery PI has the potential to determine the threshold for decreased placental diffusion. Therefore, DWI should be added to the routine fetal MRI to show diffusion changes in placenta.

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