Diffusion-weighted MR imaging of the placenta in fetuses with placental insufficiency

Bonel, Harald Marcel; Stolz, Bernhard; Diedrichsen, Lars; Frei Bonel, Kathrin Anne; Saar, Bettina; Tutschek, Boris; Raio, Luigi; Surbek, Daniel; Srivastav, Sudesh; Nelle, Mathias; Slotboom, Johannes; Wiest, Roland (2010). Diffusion-weighted MR imaging of the placenta in fetuses with placental insufficiency. Radiology, 257(3), pp. 810-819. Oak Brook, Ill.: Radiological Society of North America RSNA 10.1148/radiol.10092283

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PURPOSE: To evaluate diffusion-weighted magnetic resonance (MR) imaging of the human placenta in fetuses with and fetuses without intrauterine growth restriction (IUGR) who were suspected of having placental insufficiency. MATERIALS AND METHODS: The study was approved by the local ethics committee, and written informed consent was obtained. The authors retrospectively evaluated 1.5-T fetal MR images from 102 singleton pregnancies (mean gestation ± standard deviation, 29 weeks ± 5; range, 21-41 weeks). Morphologic and diffusion-weighted MR imaging were performed. A region of interest analysis of the apparent diffusion coefficient (ADC) of the placenta was independently performed by two observers who were blinded to clinical data and outcome. Placental insufficiency was diagnosed if flattening of the growth curve was detected at obstetric ultrasonography (US), if the birth weight was in the 10th percentile or less, or if fetal weight estimated with US was below the 10th percentile. Abnormal findings at Doppler US of the umbilical artery and histopathologic examination of specimens from the placenta were recorded. The ADCs in fetuses with placental insufficiency were compared with those in fetuses of the same gestational age without placental insufficiency and tested for normal distribution. The t tests and Pearson correlation coefficients were used to compare these results at 5% levels of significance. RESULTS: Thirty-three of the 102 pregnancies were ultimately categorized as having an insufficient placenta. MR imaging depicted morphologic changes (eg, infarction or bleeding) in 27 fetuses. Placental dysfunction was suspected in 33 fetuses at diffusion-weighted imaging (mean ADC, 146.4 sec/mm(2) ± 10.63 for fetuses with placental insufficiency vs 177.1 sec/mm(2) ± 18.90 for fetuses without placental insufficiency; P < .01, with one false-positive case). The use of diffusion-weighted imaging in addition to US increased sensitivity for the detection of placental insufficiency from 73% to 100%, increased accuracy from 91% to 99%, and preserved specificity at 99%. CONCLUSION: Placental dysfunction associated with growth restriction is associated with restricted diffusion and reduced ADC. A decreased ADC used as an early marker of placental damage might be indicative of pregnancy complications such as IUGR.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Gynaecology

UniBE Contributor:

Bonel, Harald Marcel; Stolz, Bernhard; Diedrichsen, Lars; Frei Bonel, Kathrin Anne; Saar, Bettina; Tutschek, Boris; Raio, Luigi; Surbek, Daniel; Nelle, Mathias; Slotboom, Johannes and Wiest, Roland

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0033-8419

Publisher:

Radiological Society of North America RSNA

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:11

Last Modified:

06 Dec 2014 14:22

Publisher DOI:

10.1148/radiol.10092283

PubMed ID:

21084415

Web of Science ID:

000284469300026

BORIS DOI:

10.7892/boris.1950

URI:

https://boris.unibe.ch/id/eprint/1950 (FactScience: 204048)

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