The Egyptian Journal of Radiology and Nuclear Medicine (Jan 2025)

Noninvasive in vivo assessment of placental insufficiency using pCASL: a prospective case–control study

  • Ghada Awad,
  • Alaa Mohamed Reda,
  • Rasha Lotfy Younis,
  • Manal Mostafa Hassan,
  • Rania Essam Eldin Mohamed Ali

DOI
https://doi.org/10.1186/s43055-025-01418-z
Journal volume & issue
Vol. 56, no. 1
pp. 1 – 12

Abstract

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Abstract Background Arterial spin labeling is a noninvasive imaging modality that does not use contrast for evaluation of placental perfusion in the placental pathological conditions. Our study enrolled 30 pregnant females with different risk factors for developing IUGR and other 30 females with the same age group having normal pregnancy. The two groups were evaluated by free breathing arterial spin labeling magnetic resonance imaging. Image findings of pseudo-continuous arterial spin labeling were compared to color duplex Doppler ultrasound of umbilical and middle cerebral arteries. Aim The aim of the present study was to evaluate the role of pseudo-continuous arterial spin labeling in measurement of placental perfusion with quantitative analysis of regional placental blood flow. Methods This prospective case–control study enrolled 30 pregnant females who had different causes of placental insufficiency, and another healthy group of matched ages, all were evaluated by 2D and color duplex Doppler ultrasound, conventional non-contrast magnetic resonance imaging and MRI perfusion using arterial spin labeling technique. The study was carried out from October 2021 to October 2023. Results Significant relation was found between placental perfusion values and umbilical and middle cerebral artery resistive indices as indicator for placental insufficiency with sensitivity and specificity 77.8%, 80%, respectively, for umbilical artery resistive index and 90%, 83.3%, respectively, for middle cerebral artery resistive index. While the diagnostic value of ASL perfusion was as follows, it had sensitivity = 90%, specificity = 83.3%, PPV = 84.4%, NPV = 89.3% and accuracy = 86.7%. Conclusions ASL-MRI is an excellent noninvasive in vivo MRI technique for evaluation of placental perfusion and quantitative analysis of regional placental blood flow in cases of placental insufficiency. This study supported the value of the new noninvasive MRI techniques in the elaboration of placental pathology.

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