Gabriele Masselli MD, Presenter: Nothing to Disclose

Maria Giulia Bernieri MD, Abstract Co-Author: Nothing to Disclose

Roberto Brunelli, Abstract Co-Author: Nothing to Disclose

Saadi Sollaku, Abstract Co-Author: Nothing to Disclose

Elisabetta Polettini, Abstract Co-Author: Nothing to Disclose

Gian Franco Gualdi MD, Abstract Co-Author: Nothing to Disclose

To determine whether the analysis of the apparent diffusion coefficient (ADC) maps of the subglandular area of the cervical canal helps to predict a forthcoming delivery when dealing with an asymptomatic patient presenting with a sonographic short cervix (SCX) below 15mm and with positive fetal fibronectin (FN) at 22-26 weeks of gestation.

The institutional review board approved this prospective, hypotheses-generating study and waived the informed consent requirement. Our study population comprised 30 pregnant women (mean age : 29 (20-39) with a mean gestational age at the diagnosis of 24 weeks (22-26) who underwent underwent pelvic MR on a 1.5-T scanner. Sagittal diffusion-weighted were obtained by using a single-shot spin-echo type echo-planar imaging sequence with fat suppression using two b values: 0, 800 s/mm2; ADC map was calculated for each patient. ADC subglandular, ADC stromal and Δ ADCs (ADC subglandular – ADC stromal) were calculated. Student t test for both unpaired and paired data and Bravais-Pearson linear correlation, as well as ROC curve analysis were performed using the MedCalc software.

8/30 patients ultimately delivered within 7 days after admission (impeding delivery group) while 22 patients delivered after at least 7 days after admission (between 7-63 days; mean 32 days) and entered the late delivery group. The subglandular ADC and Δ ADCs were significantly higher in patients with impending delivery than in patients with late delivery (p <0.0001 for both parameters). The ROC curve analysis classified the subglandular ADC as an extremely accurate parameter to predict impending delivery (AUC = 1.000, p <0.0001), with an overall sensitivity (95% CI: 63.1% - 100%) and a specificy (95% CI: 63.1% - 100%) of 100%.  The ADCs of cervical stromal did not help to differentiate the two groups.  

When considering a diagnosis of impending preterm delivery, ADC maps targeted to the subglandular area of the uterine cervix greatly increase the PPV granted by the combined findings of a short cervix and positive cervico-vaginal fibronectin.

The ADC maps of the subglandular area of the uterine cervix can predict impending preterm delivery. This result cannot be obtained with other techniques and can be particularly useful in the acute management of patients presenting with SCX and positive FN in the late second trimester of pregnancy.

Masselli, G, Bernieri, M, Brunelli, R, Sollaku, S, Polettini, E, Gualdi, G, Can Diffusion-weighted MR Images of the Uterine Cervix Predict Impending Preterm Delivery?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008468.html