Diagnostic Accuracy of Ratio of Transverse Cerebellar Diameter to Abdominal Circumference (TCD/AC) for Detection of Asymmetrical Intrauterine Growth Retardation

Sumera  Bacha; Um E Kalsoom; Riffat  Murtaza; Farkhanda  Jabeen; Maliha  Baseer; Hira  Khan

doi:10.29054/apmc/2023.1264

Sumera Bacha Consultant Radiologist, Department of Radiology, Holy Family Hospital, Rawalpindi Pakistan
Um E Kalsoom Assistant Professor, Department of Radiology, Rawalpindi medical University, Rawalpindi Pakistan
Riffat Murtaza Senior Medical Officer, Divisional head Quarter, Mirpur Azad Kashmir Pakistan
Farkhanda Jabeen Consultant Radiologist, Federal Govt. poly Clinic Islamabad, Islamabad, Pakistan
Maliha Baseer Associate Radiologist, Federal Government Poly Clinic Islamabad, Pakistan
Hira Khan Consultant Radiologist, Department of Radiology, Islamabad Diagnostic Centre, Pakistan

DOI: https://doi.org/10.29054/apmc/2023.1264

Keywords: IUGR, TCD/AC, Ultrasound

Abstract

Background: Intrauterine growth restriction (IUGR) is defined as a fetus whose estimated weight is below the 10^th percentile for its gestational age. Literature has reported that TCD/AC ratio is more sensitive and specific in diagnosis of IUGR as compared to other parameters. This may be helpful in early prediction of IUGR and cases can be managed on early stages and neonatal/perinatal deaths can be prevented. Objective: To determine the diagnostic accuracy of transverse cerebellar diameter/abdominal circumference (TCD/AC) ratio for detection of intrauterine growth retardation (IUGR) taking postnatal diagnosis of IUGR as gold standard. Study Design: Descriptive cross-sectional study. Settings: Six months (Augst 2017 to February 2018). Duration: Department of Radiology, Holy Family Hospital, Rawalpindi Pakistan. Methods: Female patients between age 20 to 40 years and with gestational age >28 weeks and clinically suspected for IUGR were selected for study. Patients underwent ultrasound scan. TCD measurement was obtained by placing the electronic calipers at the outer-to-outer margins of the cerebellum. The AC was measured from a trans axial view of the abdomen at the level of the junction of the umbilical vein with the left portal vein. The measurements were made along the outer perimeter of the abdomen. TCD/AC ratios were calculated. TCD/AC ratio > 0.154 was considered as positive and ≤ 0.154 was considered negative. After TCD/AC measurement, the patients were followed-up till delivery and assessed for IUGR. All the information was collected via self-designed study proforma. SPSS version 26 was used for statistical analysis. Results: In this study involving 135 female patients with clinical suspicion of intrauterine growth restriction (IUGR), the average age was 30.3 years, and the mean gestational age was 32.8 weeks. Ultrasound findings indicated that 62.2% of the patients showed positive signs of IUGR. Postnatally, IUGR was confirmed in 63.7% of cases. Study's results revealed a sensitivity of 83.7%, indicating the ratio of correctly identified cases of IUGR, and a specificity of 75.5%. Additionally, the positive predictive value (PPV) 85.7% and the overall diagnostic accuracy was 80.7%. Conclusion: Ultrasonography measurements of TCD/AC ratios allows non- invasive detection of IUGR in second and third trimester of pregnancy with good accuracy.