Abdel Razek Ahmed Abdel Khalek, Thabet Mahmoud, Salam Eman Abdel
From the Departments of Diagnostic Radiology and Obstetrics and Gynecology, Mansoura Faculty of Medicine, Mansoura. Egypt.
J Comput Assist Tomogr. 2019 May/Jun;43(3):507-512. doi: 10.1097/RCT.0000000000000844.
This study aimed to assess apparent diffusion coefficient (ADC) of the placenta and fetal organs in intrauterine growth restriction (IUGR).
A prospective study of 30 consecutive pregnant women (aged 21-38 years with mean age of 31.5 years and a mean gestational week of 35 ± 2.3) with IUGR and 15 age-matched pregnant women was conducted. All patients and controls underwent diffusion-weighted magnetic resonance imaging. The ADCs of the placenta and fetal brain, kidney, and lung were calculated and correlated with neonates needing intensive care unit (ICU) admission.
There was a significant difference in ADC of the placenta and fetal brain, lung, and kidney (P = 0.001, 0.001, 0.04, and 0.04, respectively) between the patients and the controls. The cutoff ADCs of the placenta and fetal brain, lung, and kidney used to detect IUGR were 1.45, 1.15, 1.80, and 1.40 × 10 mm/s, respectively, with areas under the curve (AUCs) of 0.865, 0.858, 0.812, and 0.650, respectively, and accuracy values of 75%, 72.5%, 72.5%, and 70%, respectively. Combined ADC of the placenta and fetal organs used to detect IUGR revealed an AUC of 1.00 and an accuracy of 100%. There was a significant difference in ADC of the placenta and fetal brain, lung, and kidney between neonates needing admission and those not needing ICU admission (P = 0.001, 0.001, 0.002, and 0.002, respectively). The cutoff ADCs of the placenta and fetal brain, lung, and kidney used to define neonates needing ICU were 1.35, 1.25, 1.95, and 1.15 × 10 mm/s with AUCs of 0.955, 0.880, 0.884, and 0.793, respectively, and accuracy values of 86.7%, 46.7%, 76.7%, and 70%, respectively. Combined placental and fetal brain ADC used to define neonates needing ICU revealed an AUC of 0.968 and an accuracy of 93.3%.
Combined ADC of the placenta and fetal organs can detect IUGR, and combined ADC of the placenta and fetal brain can define fetuses needing ICU.
本研究旨在评估宫内生长受限(IUGR)时胎盘及胎儿器官的表观扩散系数(ADC)。
对30例连续的IUGR孕妇(年龄21 - 38岁,平均年龄31.5岁,平均孕周35 ± 2.3周)和15例年龄匹配的孕妇进行前瞻性研究。所有患者及对照均接受扩散加权磁共振成像检查。计算胎盘及胎儿脑、肾、肺的ADC,并将其与需要入住重症监护病房(ICU)的新生儿进行相关性分析。
患者与对照之间胎盘及胎儿脑、肺、肾的ADC存在显著差异(分别为P = 0.001、0.001、0.04和0.04)。用于检测IUGR的胎盘及胎儿脑、肺、肾的ADC临界值分别为1.45、1.15、1.80和1.40×10⁻³mm²/s,曲线下面积(AUC)分别为0.865、0.858、0.812和0.650,准确率分别为75%、72.5%、72.5%和70%。用于检测IUGR的胎盘及胎儿器官联合ADC的AUC为1.00,准确率为100%。需要入住ICU的新生儿与不需要入住ICU的新生儿之间,胎盘及胎儿脑、肺、肾的ADC存在显著差异(分别为P = 0.001、0.001、0.002和0.002)。用于定义需要ICU的新生儿的胎盘及胎儿脑、肺、肾的ADC临界值分别为1.35、1.25、1.95和1.15×10⁻³mm²/s,AUC分别为0.955、0.880、0.884和0.793,准确率分别为86.7%、46.7%、76.7%和70%。用于定义需要ICU的新生儿的胎盘及胎儿脑联合ADC的AUC为0.968,准确率为93.3%。
胎盘及胎儿器官联合ADC可检测IUGR,胎盘及胎儿脑联合ADC可确定需要ICU的胎儿。