London: Magnetic Resonance Imaging (MRI) of the cervix is more accurate than ultrasound at predicting if some women will have a preterm birth, a new study has found.
Early dilation of the cervix, a neck of tissue connecting the uterus with the vagina, during pregnancy can lead to premature delivery, researchers from Sapienza University in Italy said.
Women in their second trimester of pregnancy with a cervix measuring 15 millimetres or less, as seen on ultrasound, are considered to be at higher risk of preterm birth, they said. However, ultrasound has limitations as a predictor of preterm birth, as it does not provide important information on changes in cervical tissue in the antepartum phase just before childbirth.
Researchers used an MRI technique called diffusion-weighted imaging (DWI) to examine pregnant women who had been referred for suspected foetal or placental abnormality.
DWI shows differences in the mobility of water molecules in tissue and the results can be used to create apparent diffusion coefficient (ADC) maps that provide a measure of local cell density, researchers said.
DWI has been increasingly used for abdominal and pelvic diseases, but has not been tested for the evaluation of the uterine cervix in pregnant patients, they said. Each of the 30 pregnant women in the study had a sonographically short cervix and a positive foetal fibronectin test between 23 and 28 weeks of gestation.
Foetal fibronectin is a glue-like protein that helps hold the foetal sac to the uterine lining, and the presence of it before week 35 of gestation may indicate a higher risk of preterm birth.
Of the 30 women, eight, or 27 per cent, delivered within a week of the MRI examination. The other 22 delivered an average of 55 days later. Researchers compared differences in ADC values at MRI between two areas of the cervix - the inner, subglandular zone and the outer, stromal area. While stromal ADC and sonographic cervical length showed no difference between both groups, the subglandular ADC was higher in patients with impending delivery, suggesting an
increased mobility of water molecules in that area consistent with cervical ripening.
"Our results indicate that a high ADC value recorded at the level of the subglandular area of the cervix is associated with the imminent delivery of asymptomatic patients with a short cervix," said Gabriele Masselli from Sapienza
University.
"In detail, the subglandular ADC was inversely correlated to the time interval between MRI and delivery and therefore emerged as a powerful imaging biomarker in evaluating patients with impending delivery," said Masselli. The findings were published in the journal Radiology.
