Placental ADC and perfusion in IUGR: insights from 3 T MRI in an Indian cohort

Abstract Introduction Intrauterine growth restriction (IUGR) is a significant contributor to perinatal morbidity and mortality, frequently associated with placental insufficiency. While ultrasonography remains the primary imaging modality, advanced magnetic resonance imaging (MRI) techniques offer valuable physiological insights into placental function. This study aimed to assess placental ADC and perfusion values using 3 T MRI in pregnancies complicated by IUGR and compare them with healthy controls. These MRI-derived metrics may support early diagnosis and monitoring of placental insufficiency, improving management of high-risk pregnancies. Methodology A prospective case–control study was conducted on 60 pregnant women between 20 and 38 weeks of gestation, comprising 30 IUGR cases and 30 controls. All participants underwent 3 T MRI, which included anatomical, diffusion-weighted, and arterial spin labeling (ASL) perfusion imaging sequences. Quantitative analysis of ADC and perfusion values was performed. Statistical comparisons were made using an independent t-test, and inter-observer agreement was evaluated using the intraclass correlation coefficient (ICC). Results Mean placental ADC values were significantly lower in the IUGR group (1.83 ± 0.10 × 10⁻ 3 mm 2 /s) compared to controls (2.02 ± 0.10 × 10⁻ 3 mm 2 /s; p = 0.001). Similarly, placental perfusion was reduced in IUGR pregnancies (102.5 ± 18.7 ml/100 g/min) versus controls (120.2 ± 23.7 ml/100 g/min; p = 0.002). The ICC value was 0.8, indicating excellent inter-observer reliability. Conclusion ADC and perfusion parameters derived from 3 T MRI differ significantly between IUGR and normal pregnancies, reflecting placental microstructural and vascular compromise. Functional placental imaging using 3 T MRI may serve as a valuable adjunct to ultrasound for early detection, monitoring, and risk stratification in high-risk pregnancies.