title: Are Second Trimester Apparent Diffusion Coefficient Values of the Short Uterine Cervix Associated with Impending Preterm Delivery?
abstract: Purpose To prospectively determine whether the apparent diffusion coefficient (ADC) of the cervix is associated with preterm delivery in asymptomatic patients with a sonographic cervical length of 15 mm or less and positive fetal fibronectin test results between 23 and 28 weeks of gestation. Materials and Methods The institutional review board approved this prospective hypotheses-generating study. A total of 30 pregnant women (mean gestational age, 26 weeks) with a sonographic short cervix (≤15 mm) underwent pelvic 1.5-T magnetic resonance (MR) imaging. Oblique sagittal diffusion-weighted images were obtained with b values of 0, 400, and 800 sec/mm(2). ADC values at MR imaging of the subglandular and stromal cervix and the difference between both were correlated to the interval to delivery. Receiver operating characteristic curve analysis was performed to obtain sensitivity and specificity of ADC values in association with delivery within 7 days. Results Eight (27%) of 30 patients delivered within 6 or 7 days after MR imaging (impending delivery group), and 22 (73%) of 30 patients delivered between 18 and 89 days after imaging (mean, 55 days) (late delivery group). Mean subglandular ADC and mean ADC difference were higher (P < .001) in patients with impending delivery than in those with late delivery ([2406.3 ± 166.0] × 10(-6) mm(2)/sec vs [1708.9 ± 108.1] × 10(-6) mm(2)/sec and [657.3 ± 129.9] × 10(-6) mm(2)/sec vs [69.2 ± 70.2] × 10(-6) mm(2)/sec, respectively). Subglandular ADC inversely correlated with the interval between MR imaging and delivery (r = -0.75). Receiver operating characteristic curve analysis of subglandular ADC revealed 100% sensitivity (95% confidence interval: 63.1, 100) and 100% specificity (95% confidence interval: 84.6, 100) in association with impending delivery with a 1921 × 10(-6) mm(2)/sec threshold. Stromal ADC and sonographic cervical length showed no difference between groups (P = .072 and P = .511, respectively). Conclusion Cervical subglandular ADC at MR imaging is associated with impending preterm birth in patients with a short sonographic cervix. (©) RSNA, 2016.
authors.affiliation: From the Department of Radiology (G.M., F.L., G.G.), Department of Gynecology, Obstetrics and Urology (G.P., R.B.), and Department of Internal Medicine and Medical Specialities (M.D.T.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; and Department of Radiology, Clinique des Grangettes, Geneva, Switzerland (K.K.).
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masselli
authors.affiliation: From the Department of Radiology (G.M., F.L., G.G.), Department of Gynecology, Obstetrics and Urology (G.P., R.B.), and Department of Internal Medicine and Medical Specialities (M.D.T.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; and Department of Radiology, Clinique des Grangettes, Geneva, Switzerland (K.K.).
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Perrone
authors.affiliation: From the Department of Radiology (G.M., F.L., G.G.), Department of Gynecology, Obstetrics and Urology (G.P., R.B.), and Department of Internal Medicine and Medical Specialities (M.D.T.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; and Department of Radiology, Clinique des Grangettes, Geneva, Switzerland (K.K.).
authors.forename: Karen
authors.initials: K
authors.lastname: Kinkel
authors.affiliation: From the Department of Radiology (G.M., F.L., G.G.), Department of Gynecology, Obstetrics and Urology (G.P., R.B.), and Department of Internal Medicine and Medical Specialities (M.D.T.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; and Department of Radiology, Clinique des Grangettes, Geneva, Switzerland (K.K.).
authors.forename: Marco
authors.initials: M
authors.lastname: Di Tola
authors.affiliation: From the Department of Radiology (G.M., F.L., G.G.), Department of Gynecology, Obstetrics and Urology (G.P., R.B.), and Department of Internal Medicine and Medical Specialities (M.D.T.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; and Department of Radiology, Clinique des Grangettes, Geneva, Switzerland (K.K.).
authors.forename: Francesca
authors.initials: F
authors.lastname: Laghi
authors.affiliation: From the Department of Radiology (G.M., F.L., G.G.), Department of Gynecology, Obstetrics and Urology (G.P., R.B.), and Department of Internal Medicine and Medical Specialities (M.D.T.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; and Department of Radiology, Clinique des Grangettes, Geneva, Switzerland (K.K.).
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Gualdi
authors.affiliation: From the Department of Radiology (G.M., F.L., G.G.), Department of Gynecology, Obstetrics and Urology (G.P., R.B.), and Department of Internal Medicine and Medical Specialities (M.D.T.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; and Department of Radiology, Clinique des Grangettes, Geneva, Switzerland (K.K.).
authors.forename: Roberto
authors.initials: R
authors.lastname: Brunelli
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D047928:Premature Birth; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity