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(Radiology. 1999;213:681-689.)
© RSNA, 1999

Obstetric Imaging

Prediction of Perinatal Outcome in Fetuses Suspected to Have Intrauterine Growth Restriction: Doppler US Study of Fetal Cerebral, Renal, and Umbilical Arteries1

Katherine W. Fong, MB, BS, FRCPC, Arne Ohlsson, MD, MSc, FRCPC, Mary E. Hannah, MDCM, MSc, FRCSC, Sorina Grisaru, MD, John Kingdom, MD, FRCSC, MRCP (UK), MRCOG, Howard Cohen, MDCM, FRCSC, Marylou Ryan, RDMS, Rory Windrim, MB, BCh, FRCSC, Gary Foster, PhD and Kofi Amankwah, MD, FRCSC

1 From the Depts of Medical Imaging (K.W.F.) and Obstetrics and Gynecology (M.E.H., H.C., M.R., K.A.), Women's College Campus, Sunnybrook and Women's College Health Sciences Center, 76 Grenville St, Toronto, Canada M5S 1B2; Depts of Pediatrics (A.O.) and Obstetrics and Gynecology (S.G., J.K., R.W.), Mt Sinai Hospital, Toronto; and Maternal, Infant, and Reproductive Health Research Unit at Center for Research in Women's Health, University of Toronto (A.O., M.E.H., G.F.). From the 1998 RSNA scientific assembly. Received Dec 8, 1998; revision requested Feb 15, 1999; revision received Mar 17; accepted Apr 11. K.W.F. supported in part by a 1994 RSNA Seed Grant. Address reprint requests to K.W.F. (e-mail: katherine.fong@swchsc.on.ca).

PURPOSE: To determine and compare the diagnostic performance of fetal middle cerebral (MCA), renal (RA), and umbilical (UA) arterial Doppler ultrasonography (US) for prediction of adverse perinatal outcome in suspected intrauterine growth restriction (IUGR).

MATERIALS AND METHODS: Two hundred ninety-three small–for–gestational age fetuses (24–39 weeks at recruitment and US-estimated weight or abdominal circumference below 10th percentile) were prospectively examined with Doppler US of the UA, MCA, and RA. Clinicians were blinded to MCA and RA Doppler measurements.

RESULTS: Seventy-six fetuses (25.9%) had at least one major or minor adverse perinatal outcome. Major outcomes included stillbirth, neonatal death, neurologic complication, and necrotizing enterocolitis. The MCA pulsatility index (PI), compared with the UA PI and RA PI, was more sensitive (72.4% vs 44.7% and 8.3%) but less specific (58.1% vs 86.6% and 92.6%) in predicting adverse outcome. The UA PI had the highest positive likelihood ratio (ratio, 3.3); the MCA PI had the lowest negative likelihood ratio (ratio, 0.48). When gestational age at the first Doppler US examination was less than 32 weeks, the MCA PI had a sensitivity of 95.5% and negative predictive value of 97.7% for major adverse outcome (negative likelihood ratio, 0.10).

CONCLUSION: In suspected IUGR, while an abnormal UA PI is a better predictor of adverse perinatal outcome than an abnormal MCA or RA PI, a normal MCA PI may help to identify fetuses without major adverse perinatal outcome, especially before 32 weeks gestational age.

Index terms: Arteries, middle cerebral, 174.12984 • Arteries, umbilical, 989.12984 • Arteries, US, 174.12984, 961.12984, 989.12984 • Fetus, US, 856.128, 856.12984, 856.871 • Pregnancy, 856.1311, 856.871 • Renal arteries, US, 961.12984




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