Assessment of Apparent diffusion coefficient and perfusion values of the placenta in intrauterine growth restriction by using 3Tesla Magnetic Resonance Imaging  (MRI) in an Indian population: A pilot study

Assessment of Apparent diffusion coefficient and perfusion values of the placenta in intrauterine growth restriction by using 3Tesla Magnetic Resonance Imaging (MRI) in an Indian population: A pilot study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Assessment of Apparent diffusion coefficient and perfusion values of the placenta in intrauterine growth restriction by using 3Tesla Magnetic Resonance Imaging (MRI) in an Indian population: A pilot study Priyanka Chandra Sekhar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5223184/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Intrauterine Growth Restriction (IUGR) is an estimated fetal weight below the 10th percentile for gestational age, often linked to placental insufficiency and abnormal fetoplacental oxygenation. IUGR affects approximately 24% of newborns globally, with a significant incidence in Asia. IUGR is a leading cause of perinatal morbidity and mortality. While sonography is commonly used, Magnetic Resonance Imaging (MRI) offers a radiation-free alternative that provides detailed morphological and functional insights into the placenta. This study aims to assess the Apparent Diffusion Coefficient (ADC) and perfusion values of the placenta in IUGR cases using 3T MRI. A prospective case-control study was conducted between April 2020 and March 2023, involving 60 pregnant women (30 with IUGR and 30 controls) with gestational ages ranging from 20 to 38 weeks. The study utilised a 3T MRI scanner to obtain T2-weighted and diffusion-weighted images and 3D pseudo-continuous arterial spin labelling (pCASL) sequences to measure placental perfusion. ADC and perfusion values were extracted and analysed using statistical methods to compare the IUGR and control groups.Significant differences were observed between the IUGR and control groups. The mean ADC value in IUGR cases was significantly lower (1.83 ± 0.103 × 10⁻³ mm²/s) compared to controls (2.02 ± 0.101 × 10⁻³ mm²/s), with a P-value of 0.001. Similarly, the mean perfusion value in IUGR cases (102.5 ± 18.7 ml/100g/min) was significantly lower than in controls (120.2 ± 23.7 ml/100g/min), with a P-value of 0.002. Receiver Operating Characteristic (ROC) curve analysis showed an AUC of 0.919 for ADC and 0.703 for perfusion, indicating the diagnostic potential of these parameters. This pilot study highlights significant reductions in ADC and perfusion values of the placenta in IUGR cases compared to controls, using 3T MRI. The findings suggest that 3T MRI could serve as an effective tool for early detection and management of IUGR, potentially improving perinatal outcomes. Further studies with larger sample sizes are recommended to validate these results. Health sciences/Health care Health sciences/Medical research Intrauterine Growth Restriction (IUGR) apparent diffusion coefficient (ADC) Pseudo continuous arterial spin labelling (pCASL) placental perfusion Figures Figure 1 Figure 2 Figure 3 Introduction Intrauterine growth restriction (IUGR) is defined as an estimated fetal weight below the 10th percentile for gestational age according to the American College of Obstetrics and Gynecology, and it is frequently associated with placental insufficiency and abnormal fetoplacental oxygenation ( 1 , 2 ). Fetuses with severe IUGR suffer chronic hypoxia and have a higher risk of preterm birth and acute perinatal distress. Late-onset IUGR infants are also at risk for altered outcomes, such as sub-optimal school performance, and attention and cognitive function disorders ( 3 ). Intrauterine Growth Restriction (IUGR) incidence rate is observed in about 24% of newborns worldwide. In Asia, IUGR accounts for nearly 75% of all affected infants. After prematurity, IUGR is the leading cause of perinatal morbidity and mortality ( 4 ) Sonography (US) and magnetic resonance imaging (MRI) are established modalities for assessing fetal anomalies ( 5 ). According to the American College of Radiology (ACR) and ACOG guidelines, MRI, performed with 3.0 T scanners or less, is not associated with any adverse effects on the fetus. However, it should be used prudently in any gestational age ( 6 , 7 ). Fetal MRI is complementary to the US in detecting morphologic and functional abnormalities in the fetus ( 8 ). MRI uses magnetic properties and radio frequency waves, carries no radiation, and is safe during pregnancy. Functional MRI (fMRI) techniques such as diffusion-weighted imaging (DWI) and Perfusion could provide specific functional information about the placenta. The term "perfusion" describes the blood flow at the capillary level and is measured in units ml/min/100 g. Arterial spin labelling (ASL) is a powerful MRI technique that does not require contrast agents because it uses the water molecules in arterial blood as an endogenous contrast agent, making it optimal for examining placental perfusion in pregnancy ( 9 ). DWI is the random Brownian motion of water molecules within a tissue voxel. The DWI is represented by a parameter called apparent diffusion coefficient (ADC) values ( 10 ). It is important to understand the normal and IUGR ADC and perfusion values of the placenta in an Indian population ( 11 ). Although studies have been conducted using a 1.5 Tesla MRI on this subject, the number of studies conducted with a 3 Tesla (3T) MRI is sparse ( 12 – 15 ). This study aimed to assess ADC and perfusion of the placenta in IUGR using 3T MRI. Methodology Study population: Prospective data were obtained from MRI studies conducted between April 2020 and March 2023. The study received approval from the institutional ethics committee (IEC) (NI/20/FEB/74/25) and informed consent was obtained. The case-control study included two groups of pregnant women IUGR and a control group. Each group consisted of 30 fetuses, a total of 60 participants. The gestational age of participants ranged from 20 to 38 weeks. The inclusion and exclusion criteria for both groups were: Inclusion criteria: IUGR Group Pregnant women diagnosed with intrauterine growth restriction (IUGR) based on clinical and sonographic criteria. Control Group Pregnant women with normal pregnancies, matched with gestational age were included. Exclusion criteria: Pregnancies with ( 1 ) severe anomalies ( 2 ) Poor image quality/artifacts ( 3 ) Contraindications to MRI like pacemakers, and claustrophobia were excluded. Follow up: The follow-up of these fetuses was obtained from the delivery notes and neonatologist examination notes in the hospital database. A telephone conversation with the parents provided further confirmation of the normalcy of the fetuses. MR Imaging: Our routine imaging protocol included T2- T2-weighted (T2W) SSFSE in 3T (single shot fast spin echo) and HASTE in 1.5T sequence obtained in three orthogonal planes to fetal brain or trunk (as per the indication) and T1-Weighted (T1W) FSPGR in 3T (Fast spoiled gradient echo) and FLASH in 1.5T sequence obtained in an axial plane. Diffusion-weighted imaging (DWI) was performed using single-shot spin-echo-planar imaging (EPI) in the axial plane to fetal head-trunk with an acquisition time of one minute and eighteen seconds. A 3D pCASL sequence was conducted in the axial plane to assess placental blood flow. The entire sequence took approximately 5 minutes to complete. Respiratory gating was used to reduce the effect of any motion artifacts. Post-processing of perfusion and diffusion of placenta: Post-processing of the data was performed on a workstation using Ready View software (AWS) for 3D ASL and DWI with automated generation of quantitative placental PBM (Pattern-based morphometry) maps and ADC maps. Perfusion: Multiple elliptical regions of interest ROIs (40 -60mm 2 ) were placed on the placental PBM (Pattern-based morphometry) maps overlaid on T2 weighted images for each slice.(Figure-1). All placentae were measured in the same way. The mean values of placental blood flow were extracted by averaging the data obtained from multiple ROIs. Diffusion: ADC values were measured in each slice of the placenta. On the axial plane, ROIs were positioned on the lateral portions and the central portion to measure the average ADC values (Figure-2). Statistical Analysis: The statistical analysis was performed using SPSS 19.0 (Armonk, NY: IBM Corp.) software. Descriptive Statistics were used to summarize the mean and standard deviation of ADC and perfusion values for both IUGR and control groups. Independent t-tests were used to compare ADC and perfusion values between IUGR and control groups. Receiver Operating Characteristic (ROC) curve analysis was performed to determine the diagnostic performance of ADC and perfusion values, including area under the curve (AUC), sensitivity, and specificity. Results The cohort study included two groups of pregnant women IUGR and a control group. Each group consisted of 30 fetuses, a total of 60 participants. The gestational age of participants ranged from 20 to 38 weeks were analysed. The ADC value of the placenta was significantly different between IUGR patients and controls. The mean ADC of the placenta in IUGR patients was (1.83 ± 0.10 × 10 − 3 mm²/s), while in controls it was (2.02 ± 0.10 × 10 − 3 mm²/s), with a P-value of 0.001 (Table 1 ). The perfusion value of the placenta differed significantly between IUGR patients and controls. The mean perfusion value in IUGR patients was (102.5 ± 18.7 ml/100g/min), compared to (120.2 ± 23.7 ml/100g/min) in controls, with a P-value of 0.002 (Table 1 ). Table 1 Mean and Standard Deviation of ADC and perfusion values of the Placenta along with F and P-value PARAMETERS N Mean ± Std. Deviation F-VALUE P-VALUE ADC (10 − 3 mm 2 /s) Controls 30 2.02 ± 0.101 51.708 0.000 Cases (IUGR) 30 1.83 ± 0.103 PERFUSION (ml/100g/min) Controls 30 120.2 ± 23.7 10.243 0.002 Cases (IUGR) 30 102.5 ± 18.7 Table 2 Showing results of the ROC curve along with sensitivity and specificity values PARAMETERS AUC CUT OFF SENSITIVITY SPECIFICITY ADC 0.919 1.832 96.7 53.3 PERFUSION 0.703 93.75 86.7 63.30 The ADC measurements yielded an AUC of 0.919, indicating excellent performance in distinguishing between normal and IUGR-complicated pregnancies. Using a cut-off value of 1.832, the ADC demonstrated a high sensitivity of 96.7%, signifying its strong capability to identify true positive cases of IUGR. However, the specificity was 53.3% (Table 2 ) (Figure − 3). Perfusion values provided an AUC of 0.703, reflecting a fair level of accuracy. With a cut-off value of 93.75, perfusion measurements exhibited a sensitivity of 86.7%, underscoring their reliability in detecting IUGR cases. The specificity was 63.3% (Table 2 ) (Figure − 3). Discussion Our study aimed to assess the apparent diffusion coefficient (ADC) and perfusion values of the placenta in intrauterine growth restriction (IUGR) using 3T MRI in an Indian population. The findings indicated significant differences between the IUGR and control groups in ADC and perfusion values. The mean ADC value in IUGR cases was significantly lower (1.83 ± 0.103 x 10 − 3 mm 2 /s) compared to the controls (2.02 ± 0.101 x 10 − 3 mm 2 /s). This aligns with findings from Razek et al. ( 13 ), who observed lower ADC values in IUGR placentas using 1.5T MRI (1.35 ± 0.1 x 10⁻³ mm²/s for cases and 1.59 ± 0.1 x 10⁻³ mm²/s for controls). The slightly lower values in their study may be due to the lower resolution of 1.5T MRI and differences in population demographics. Our study, utilizing a 3T MRI, provides more precise imaging and may explain the higher ADC values observed. Similarly, our results are consistent with the study by Görkem et al. ( 8 ), which reported a mean ADC of 1.624 ± 0.181 x 10 − 3 mm²/s for IUGR patients, significantly lower than the control group's mean of 1.827 ± 0.191 x 10 − 3 mm²/s. Both studies highlight a notable reduction in ADC values in IUGR cases, indicating compromised placental function. Our study demonstrated an ADC AUC of 0.919, with a sensitivity of 96.7% and specificity of 53.3%. Razek et al. ( 13 ) reported an AUC of 0.87, with 86.7% sensitivity and 80% specificity using a cutoff of 1.45 × 10⁻³ mm²/s. While our study had higher sensitivity, Razek et al. showed better specificity. Görkem et al. ( 8 ) found ADC sensitivity of 72% and specificity of 84.6% with a cutoff of 1.727 × 10⁻³ mm²/s, achieving a higher positive predictive value (94.7%) and lower negative predictive value (44%). The mean perfusion value was significantly lower in IUGR cases (102.5 ± 18.7 ml/100g/min) than in controls (120.2 ± 23.7 ml/100g/min). Duncan et al. ( 13 ) observed that placental perfusion in IUGR cases (139 ml/100g/min) was lower than in controls (209 ml/100g/min) using a PASL technique at 0.5 T MRI, which aligns with the trend seen in our study. However, the absolute perfusion values reported by Duncan et al. ( 14 ) are higher than those in our study (102.5 ml/100g/min in IUGR and 120.2 ml/100g/min in controls). These differences in perfusion values could be attributed to several factors, including the MRI techniques and magnetic field strength. The use of PASL at a lower field strength might result in different absolute measurements of perfusion, but the relative reduction in perfusion in IUGR cases compared to controls is consistent across both studies. Perfusion values in our study had an AUC of 0.703, with sensitivity and specificity values of 86.7% and 63.3%, respectively, indicating a fair diagnostic accuracy. This contrasts with Sohlberg et al. ( 15 ), who reported slightly higher specificity for perfusion measurements but lower sensitivity, suggesting that our 3T MRI methodology might be more effective in detecting true IUGR cases, potentially due to the higher resolution and improved signal-to-noise ratio of 3T MRI. Limitations: This study has several limitations. First, our pilot study data involves a relatively small sample size. Second, though we used respiratory gating, there can still be movement due to maternal and fetal causes that are not compensated. We recommend further studies with a larger sample size using the same population and technique. Conclusion This pilot study used 3T MRI to assess the apparent diffusion coefficient (ADC) and perfusion values of the placenta in intrauterine growth restriction (IUGR) within an Indian population. Significant differences were found between IUGR and control pregnancies, with lower ADC and perfusion values observed in IUGR cases. These findings underscore the potential of 3T MRI as a tool for early detection and management of IUGR by providing more precise assessments of placental function, potentially leading to improved perinatal outcomes. Declarations Author Contribution Study conception and design: CPData collection: CPAnalysis and interpretation of results: CPDraft Manuscript preparation: CPCritical revision of the article:CPFinal approval of the version to be published: CP Acknowledgement NIL Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request”. References Nardozza, L. M. et al. Fetal growth restriction:current knowledge. Arch. Gynecol. Obstet. 295 , 1061–1077 (2017). Nawathe, A. & Lees, C. Early onset fetal growth restriction. Best Pract. Res. Clin. Obstet. Gynaecol. 38 , 24–37 (2017). Arthurs, O. J. et al. Alison M. Diffusion-weighted magnetic resonance imaging of the fetal brain in intrauterine growth restriction. Ultrasound Obstet. Gynecol. 50 (1), 79–87 (2017). Murki, S. & Sharma, D. Intrauterine growth retardation–a review article. J. Neonatal Biol. 3 (3), 1–1 (2014). Rathee, S., Joshi, P., Kelkar, A., Seth, N. & Fetal, M. R. I. A pictorial essay. Indian J. Radiol. Imaging . 26 (01), 52–62 (2016). ACR Committee on MR Safety et al. ACR guidance document on MR safe practices: Updates and critical information 2019. Magn. Reson. Imaging . 51 , 331–338 (2020). Gatta, G. et al. MRI in pregnancy and precision medicine: A review from literature. J. personalized Med. 12 (1), 9 (2021). Görkem, S. B., Coşkun, A., Eşlik, M., Kütük, M. S. & Öztürk, A. Diffusion-weighted imaging of placenta in intrauterine growth restriction with worsening Doppler US findings. Diagn. Interv Radiol. 25 (4), 280 (2019 Jul). Harteveld, A. A. et al. Systematic evaluation of velocity selective arterial spin labeling settings for placental perfusion measurement. Magn. Reson. Med. 84 (4), 1828–1843 (2020). Han, R. et al. Assessment of apparent diffusion coefficient of normal fetal brain development from gestational age week 24 up to term age: a preliminary study. Fetal diagn. Ther. 37 (2), 102–107 (2015). Cannie, M. et al. A diffusion-weighted template for gestational age‐related apparent diffusion coefficient values in the developing fetal brain. Ultrasound Obstet. Gynecology: Official J. Int. Soc. Ultrasound Obstet. Gynecol. 30 (3), 318–324 (2007). Chandrasekhar, P., Rangasami, R., Andrew, C. & Paarthipan, N. Placental perfusion imaging on 3Tesla magnetic resonance imaging using pseudo-continuous arterial spin labelling: an initial experience. Egypt. J. Radiol. Nuclear Med. 54 (1), 170 (2023). Razek, A. A., Thabet, M. & Salam, E. A. Apparent diffusion coefficient of the placenta and fetal organs in intrauterine growth restriction. J. Comput. Assist. Tomogr. 43 (3), 507–512 (2019). Duncan, K. R. et al. The investigation of placental relaxation and estimation of placental perfusion using echo-planar magnetic resonance imaging. Placenta . 19 (7), 539–543 (1998). Sohlberg, S. et al. Placental perfusion in normal pregnancy and early and late preeclampsia: a magnetic resonance imaging study. Placenta . 35 (3), 202–206 (2014). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5223184","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":370361162,"identity":"ad91ea9f-71b4-4d71-94f6-a2fb49053900","order_by":0,"name":"Priyanka Chandra Sekhar","email":"data:image/png;base64,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","orcid":"","institution":"Sri Ramachandra Institute of Higher Education and Research","correspondingAuthor":true,"prefix":"","firstName":"Priyanka","middleName":"Chandra","lastName":"Sekhar","suffix":""}],"badges":[],"createdAt":"2024-10-08 08:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5223184/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5223184/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67620762,"identity":"337d5ae5-6806-4b92-a863-78e6aaaf5cbb","added_by":"auto","created_at":"2024-10-28 07:06:28","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":170994,"visible":true,"origin":"","legend":"\u003cp\u003eA 25-year-old female with 30 weeks of gestation was referred for placental magnetic resonance imaging (MRI) to evaluate intrauterine growth restriction (IUGR). The MRI revealed a placental blood flow value of 77 ml/min/100 g. (a) T2-weighted SSFSE sagittal image showing the placenta. (b) Placental Pattern-based Morphometry (PBM) map with the Region of Interest (ROI) marked on the placental image.\u003c/p\u003e","description":"","filename":"figure1.tif.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5223184/v1/da60dcee19dcf35dca50d1b8.jpg"},{"id":67620764,"identity":"a37be51d-e6f3-4435-abf6-2a7d0a5fa3d7","added_by":"auto","created_at":"2024-10-28 07:06:28","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":120810,"visible":true,"origin":"","legend":"\u003cp\u003eA 25-year-old female at 30 weeks of gestation was referred for placental magnetic resonance imaging (MRI) to evaluate intrauterine growth restriction (IUGR). The MRI revealed an ADC value of 1.734 (10⁻³ mm²/s). The ADC map shows the localization of the Region of Interest (ROI) within the placenta.\u003c/p\u003e","description":"","filename":"figure2.tif.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5223184/v1/6cf53b5aa66a8f855d6655bb.jpg"},{"id":67622312,"identity":"c0ee9511-8fa3-406b-b734-e1e18f33ae43","added_by":"auto","created_at":"2024-10-28 07:14:28","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":81743,"visible":true,"origin":"","legend":"\u003cp\u003eROC Curve for ADC and Perfusion of the Placenta in IUGR and Control Group\u003c/p\u003e","description":"","filename":"figure3.tif.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5223184/v1/9560398e4fe8cb6eed13504b.jpg"},{"id":79635153,"identity":"21c293a7-dde5-45bc-9494-c526bc2d45ae","added_by":"auto","created_at":"2025-04-01 04:16:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":877146,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5223184/v1/ecec8fa1-fdf0-476e-b10e-7b7e6abe83ce.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Apparent diffusion coefficient and perfusion values of the placenta in intrauterine growth restriction by using 3Tesla Magnetic Resonance Imaging (MRI) in an Indian population: A pilot study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntrauterine growth restriction (IUGR) is defined as an estimated fetal weight below the 10th percentile for gestational age according to the American College of Obstetrics and Gynecology, and it is frequently associated with placental insufficiency and abnormal fetoplacental oxygenation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Fetuses with severe IUGR suffer chronic hypoxia and have a higher risk of preterm birth and acute perinatal distress. Late-onset IUGR infants are also at risk for altered outcomes, such as sub-optimal school performance, and attention and cognitive function disorders (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIntrauterine Growth Restriction (IUGR) incidence rate is observed in about 24% of newborns worldwide. In Asia, IUGR accounts for nearly 75% of all affected infants. After prematurity, IUGR is the leading cause of perinatal morbidity and mortality (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSonography (US) and magnetic resonance imaging (MRI) are established modalities for assessing fetal anomalies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). According to the American College of Radiology (ACR) and ACOG guidelines, MRI, performed with 3.0 T scanners or less, is not associated with any adverse effects on the fetus. However, it should be used prudently in any gestational age (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Fetal MRI is complementary to the US in detecting morphologic and functional abnormalities in the fetus (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMRI uses magnetic properties and radio frequency waves, carries no radiation, and is safe during pregnancy. Functional MRI (fMRI) techniques such as diffusion-weighted imaging (DWI) and Perfusion could provide specific functional information about the placenta.\u003c/p\u003e \u003cp\u003eThe term \"perfusion\" describes the blood flow at the capillary level and is measured in units ml/min/100 g. Arterial spin labelling (ASL) is a powerful MRI technique that does not require contrast agents because it uses the water molecules in arterial blood as an endogenous contrast agent, making it optimal for examining placental perfusion in pregnancy (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). DWI is the random Brownian motion of water molecules within a tissue voxel. The DWI is represented by a parameter called apparent diffusion coefficient (ADC) values (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). It is important to understand the normal and IUGR ADC and perfusion values of the placenta in an Indian population (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Although studies have been conducted using a 1.5 Tesla MRI on this subject, the number of studies conducted with a 3 Tesla (3T) MRI is sparse (\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This study aimed to assess ADC and perfusion of the placenta in IUGR using 3T MRI.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population:\u003c/h2\u003e \u003cp\u003eProspective data were obtained from MRI studies conducted between April 2020 and March 2023. The study received approval from the institutional ethics committee (IEC) (NI/20/FEB/74/25) and informed consent was obtained.\u003c/p\u003e \u003cp\u003eThe case-control study included two groups of pregnant women IUGR and a control group. Each group consisted of 30 fetuses, a total of 60 participants. The gestational age of participants ranged from 20 to 38 weeks. The inclusion and exclusion criteria for both groups were:\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion criteria:\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eIUGR Group\u003c/strong\u003e \u003cp\u003ePregnant women diagnosed with intrauterine growth restriction (IUGR) based on clinical and sonographic criteria.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eControl Group\u003c/strong\u003e \u003cp\u003ePregnant women with normal pregnancies, matched with gestational age were included.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eExclusion criteria:\u003c/h3\u003e\n\u003cp\u003ePregnancies with (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) severe anomalies (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Poor image quality/artifacts (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Contraindications to MRI like pacemakers, and claustrophobia were excluded.\u003c/p\u003e\n\u003ch3\u003eFollow up:\u003c/h3\u003e\n\u003cp\u003eThe follow-up of these fetuses was obtained from the delivery notes and neonatologist examination notes in the hospital database. A telephone conversation with the parents provided further confirmation of the normalcy of the fetuses.\u003c/p\u003e\n\u003ch3\u003eMR Imaging:\u003c/h3\u003e\n\u003cp\u003eOur routine imaging protocol included T2- T2-weighted (T2W) SSFSE in 3T (single shot fast spin echo) and HASTE in 1.5T sequence obtained in three orthogonal planes to fetal brain or trunk (as per the indication) and T1-Weighted (T1W) FSPGR in 3T (Fast spoiled gradient echo) and FLASH in 1.5T sequence obtained in an axial plane. Diffusion-weighted imaging (DWI) was performed using single-shot spin-echo-planar imaging (EPI) in the axial plane to fetal head-trunk with an acquisition time of one minute and eighteen seconds. A 3D pCASL sequence was conducted in the axial plane to assess placental blood flow. The entire sequence took approximately 5 minutes to complete. Respiratory gating was used to reduce the effect of any motion artifacts.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePost-processing of perfusion and diffusion of placenta:\u003c/h2\u003e \u003cp\u003ePost-processing of the data was performed on a workstation using Ready View software (AWS) for 3D ASL and DWI with automated generation of quantitative placental PBM (Pattern-based morphometry) maps and ADC maps.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePerfusion:\u003c/h3\u003e\n\u003cp\u003eMultiple elliptical regions of interest ROIs (40 -60mm\u003csup\u003e2\u003c/sup\u003e) were placed on the placental PBM (Pattern-based morphometry) maps overlaid on T2 weighted images for each slice.(Figure-1). All placentae were measured in the same way. The mean values of placental blood flow were extracted by averaging the data obtained from multiple ROIs.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eDiffusion:\u003c/h3\u003e\n\u003cp\u003eADC values were measured in each slice of the placenta. On the axial plane, ROIs were positioned on the lateral portions and the central portion to measure the average ADC values (Figure-2).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eThe statistical analysis was performed using SPSS 19.0 (Armonk, NY: IBM Corp.) software. Descriptive Statistics were used to summarize the mean and standard deviation of ADC and perfusion values for both IUGR and control groups. Independent t-tests were used to compare ADC and perfusion values between IUGR and control groups. Receiver Operating Characteristic (ROC) curve analysis was performed to determine the diagnostic performance of ADC and perfusion values, including area under the curve (AUC), sensitivity, and specificity.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe cohort study included two groups of pregnant women IUGR and a control group. Each group consisted of 30 fetuses, a total of 60 participants. The gestational age of participants ranged from 20 to 38 weeks were analysed.\u003c/p\u003e \u003cp\u003eThe ADC value of the placenta was significantly different between IUGR patients and controls. The mean ADC of the placenta in IUGR patients was (1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10 \u0026times; 10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003e mm\u0026sup2;/s), while in controls it was (2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10 \u0026times; 10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003e mm\u0026sup2;/s), with a P-value of 0.001 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe perfusion value of the placenta differed significantly between IUGR patients and controls. The mean perfusion value in IUGR patients was (102.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7 ml/100g/min), compared to (120.2\u0026thinsp;\u0026plusmn;\u0026thinsp;23.7 ml/100g/min) in controls, with a P-value of 0.002 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean and Standard Deviation of ADC and perfusion values of the Placenta along with F and P-value\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePARAMETERS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Std. Deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF-VALUE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-VALUE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eADC\u003c/p\u003e \u003cp\u003e(10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003emm\u003csup\u003e2\u003c/sup\u003e/s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e51.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases (IUGR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePERFUSION\u003c/p\u003e \u003cp\u003e(ml/100g/min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e120.2\u0026thinsp;\u0026plusmn;\u0026thinsp;23.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e10.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases (IUGR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e102.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eShowing results of the ROC curve along with sensitivity and specificity values\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePARAMETERS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCUT OFF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSENSITIVITY\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSPECIFICITY\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePERFUSION\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe ADC measurements yielded an AUC of 0.919, indicating excellent performance in distinguishing between normal and IUGR-complicated pregnancies. Using a cut-off value of 1.832, the ADC demonstrated a high sensitivity of 96.7%, signifying its strong capability to identify true positive cases of IUGR. However, the specificity was 53.3% (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (Figure \u0026minus;\u0026thinsp;3).\u003c/p\u003e \u003cp\u003ePerfusion values provided an AUC of 0.703, reflecting a fair level of accuracy. With a cut-off value of 93.75, perfusion measurements exhibited a sensitivity of 86.7%, underscoring their reliability in detecting IUGR cases. The specificity was 63.3% (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (Figure \u0026minus;\u0026thinsp;3).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study aimed to assess the apparent diffusion coefficient (ADC) and perfusion values of the placenta in intrauterine growth restriction (IUGR) using 3T MRI in an Indian population. The findings indicated significant differences between the IUGR and control groups in ADC and perfusion values.\u003c/p\u003e \u003cp\u003eThe mean ADC value in IUGR cases was significantly lower (1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.103 x 10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003e mm\u003csup\u003e2\u003c/sup\u003e/s) compared to the controls (2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.101 x 10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003e mm\u003csup\u003e2\u003c/sup\u003e/s). This aligns with findings from Razek et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), who observed lower ADC values in IUGR placentas using 1.5T MRI (1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1 x 10⁻\u0026sup3; mm\u0026sup2;/s for cases and 1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1 x 10⁻\u0026sup3; mm\u0026sup2;/s for controls). The slightly lower values in their study may be due to the lower resolution of 1.5T MRI and differences in population demographics. Our study, utilizing a 3T MRI, provides more precise imaging and may explain the higher ADC values observed.\u003c/p\u003e \u003cp\u003eSimilarly, our results are consistent with the study by G\u0026ouml;rkem et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), which reported a mean ADC of 1.624\u0026thinsp;\u0026plusmn;\u0026thinsp;0.181 x 10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003e mm\u0026sup2;/s for IUGR patients, significantly lower than the control group's mean of 1.827\u0026thinsp;\u0026plusmn;\u0026thinsp;0.191 x 10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003e mm\u0026sup2;/s. Both studies highlight a notable reduction in ADC values in IUGR cases, indicating compromised placental function.\u003c/p\u003e \u003cp\u003eOur study demonstrated an ADC AUC of 0.919, with a sensitivity of 96.7% and specificity of 53.3%. Razek et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) reported an AUC of 0.87, with 86.7% sensitivity and 80% specificity using a cutoff of 1.45 \u0026times; 10⁻\u0026sup3; mm\u0026sup2;/s. While our study had higher sensitivity, Razek et al. showed better specificity. G\u0026ouml;rkem et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) found ADC sensitivity of 72% and specificity of 84.6% with a cutoff of 1.727 \u0026times; 10⁻\u0026sup3; mm\u0026sup2;/s, achieving a higher positive predictive value (94.7%) and lower negative predictive value (44%).\u003c/p\u003e \u003cp\u003eThe mean perfusion value was significantly lower in IUGR cases (102.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7 ml/100g/min) than in controls (120.2\u0026thinsp;\u0026plusmn;\u0026thinsp;23.7 ml/100g/min). Duncan et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) observed that placental perfusion in IUGR cases (139 ml/100g/min) was lower than in controls (209 ml/100g/min) using a PASL technique at 0.5 T MRI, which aligns with the trend seen in our study.\u003c/p\u003e \u003cp\u003eHowever, the absolute perfusion values reported by Duncan et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) are higher than those in our study (102.5 ml/100g/min in IUGR and 120.2 ml/100g/min in controls). These differences in perfusion values could be attributed to several factors, including the MRI techniques and magnetic field strength. The use of PASL at a lower field strength might result in different absolute measurements of perfusion, but the relative reduction in perfusion in IUGR cases compared to controls is consistent across both studies.\u003c/p\u003e \u003cp\u003ePerfusion values in our study had an AUC of 0.703, with sensitivity and specificity values of 86.7% and 63.3%, respectively, indicating a fair diagnostic accuracy. This contrasts with Sohlberg et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), who reported slightly higher specificity for perfusion measurements but lower sensitivity, suggesting that our 3T MRI methodology might be more effective in detecting true IUGR cases, potentially due to the higher resolution and improved signal-to-noise ratio of 3T MRI.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, our pilot study data involves a relatively small sample size. Second, though we used respiratory gating, there can still be movement due to maternal and fetal causes that are not compensated.\u003c/p\u003e \u003cp\u003eWe recommend further studies with a larger sample size using the same population and technique.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis pilot study used 3T MRI to assess the apparent diffusion coefficient (ADC) and perfusion values of the placenta in intrauterine growth restriction (IUGR) within an Indian population. Significant differences were found between IUGR and control pregnancies, with lower ADC and perfusion values observed in IUGR cases. These findings underscore the potential of 3T MRI as a tool for early detection and management of IUGR by providing more precise assessments of placental function, potentially leading to improved perinatal outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eStudy conception and design: CPData collection: CPAnalysis and interpretation of results: CPDraft Manuscript preparation: CPCritical revision of the article:CPFinal approval of the version to be published: CP\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eNIL\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request\u0026rdquo;.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNardozza, L. M. et al. Fetal growth restriction:current knowledge. \u003cem\u003eArch. Gynecol. Obstet.\u003c/em\u003e \u003cb\u003e295\u003c/b\u003e, 1061\u0026ndash;1077 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNawathe, A. \u0026amp; Lees, C. Early onset fetal growth restriction. \u003cem\u003eBest Pract. Res. Clin. Obstet. Gynaecol.\u003c/em\u003e \u003cb\u003e38\u003c/b\u003e, 24\u0026ndash;37 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArthurs, O. J. et al. Alison M. Diffusion-weighted magnetic resonance imaging of the fetal brain in intrauterine growth restriction. \u003cem\u003eUltrasound Obstet. Gynecol.\u003c/em\u003e \u003cb\u003e50\u003c/b\u003e (1), 79\u0026ndash;87 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurki, S. \u0026amp; Sharma, D. Intrauterine growth retardation\u0026ndash;a review article. \u003cem\u003eJ. Neonatal Biol.\u003c/em\u003e \u003cb\u003e3\u003c/b\u003e (3), 1\u0026ndash;1 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRathee, S., Joshi, P., Kelkar, A., Seth, N. \u0026amp; Fetal, M. R. I. A pictorial essay. \u003cem\u003eIndian J. Radiol. Imaging\u003c/em\u003e. \u003cb\u003e26\u003c/b\u003e (01), 52\u0026ndash;62 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eACR Committee on MR Safety et al. ACR guidance document on MR safe practices: Updates and critical information 2019. \u003cem\u003eMagn. Reson. Imaging\u003c/em\u003e. \u003cb\u003e51\u003c/b\u003e, 331\u0026ndash;338 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGatta, G. et al. MRI in pregnancy and precision medicine: A review from literature. \u003cem\u003eJ. personalized Med.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (1), 9 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG\u0026ouml;rkem, S. 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Placental perfusion in normal pregnancy and early and late preeclampsia: a magnetic resonance imaging study. \u003cem\u003ePlacenta\u003c/em\u003e. \u003cb\u003e35\u003c/b\u003e (3), 202\u0026ndash;206 (2014).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intrauterine Growth Restriction (IUGR), apparent diffusion coefficient (ADC), Pseudo continuous arterial spin labelling (pCASL), placental perfusion","lastPublishedDoi":"10.21203/rs.3.rs-5223184/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5223184/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction:\u003c/p\u003e \u003cp\u003eIntrauterine Growth Restriction (IUGR) is an estimated fetal weight below the 10th percentile for gestational age, often linked to placental insufficiency and abnormal fetoplacental oxygenation. IUGR affects approximately 24% of newborns globally, with a significant incidence in Asia. IUGR is a leading cause of perinatal morbidity and mortality. While sonography is commonly used, Magnetic Resonance Imaging (MRI) offers a radiation-free alternative that provides detailed morphological and functional insights into the placenta. This study aims to assess the Apparent Diffusion Coefficient (ADC) and perfusion values of the placenta in IUGR cases using 3T MRI. A prospective case-control study was conducted between April 2020 and March 2023, involving 60 pregnant women (30 with IUGR and 30 controls) with gestational ages ranging from 20 to 38 weeks. The study utilised a 3T MRI scanner to obtain T2-weighted and diffusion-weighted images and 3D pseudo-continuous arterial spin labelling (pCASL) sequences to measure placental perfusion. ADC and perfusion values were extracted and analysed using statistical methods to compare the IUGR and control groups.Significant differences were observed between the IUGR and control groups. The mean ADC value in IUGR cases was significantly lower (1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.103 \u0026times; 10⁻\u0026sup3; mm\u0026sup2;/s) compared to controls (2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.101 \u0026times; 10⁻\u0026sup3; mm\u0026sup2;/s), with a P-value of 0.001. Similarly, the mean perfusion value in IUGR cases (102.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7 ml/100g/min) was significantly lower than in controls (120.2\u0026thinsp;\u0026plusmn;\u0026thinsp;23.7 ml/100g/min), with a P-value of 0.002. Receiver Operating Characteristic (ROC) curve analysis showed an AUC of 0.919 for ADC and 0.703 for perfusion, indicating the diagnostic potential of these parameters. This pilot study highlights significant reductions in ADC and perfusion values of the placenta in IUGR cases compared to controls, using 3T MRI. The findings suggest that 3T MRI could serve as an effective tool for early detection and management of IUGR, potentially improving perinatal outcomes. Further studies with larger sample sizes are recommended to validate these results.\u003c/p\u003e","manuscriptTitle":"Assessment of Apparent diffusion coefficient and perfusion values of the placenta in intrauterine growth restriction by using 3Tesla Magnetic Resonance Imaging (MRI) in an Indian population: A pilot study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-28 07:06:23","doi":"10.21203/rs.3.rs-5223184/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2fc0b794-7183-4c66-91a6-9eaf23894d36","owner":[],"postedDate":"October 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":39419536,"name":"Health sciences/Health care"},{"id":39419537,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-04-01T04:08:34+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-28 07:06:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5223184","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5223184","identity":"rs-5223184","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}