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

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.