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Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders

  • Cecilia Cavalli , Claudia Maggi ORCID logo , Sebastiana Gambarini , Anna Fichera ORCID logo , Amerigo Santoro , Luigi Grazioli ORCID logo , Federico Prefumo ORCID logo EMAIL logo , Franco E. Odicino ORCID logo and Nicola Fratelli ORCID logo
Published/Copyright: December 3, 2021
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 50 Issue 3

Abstract

Objectives

We aimed to assess the performance of ultrasound (US) and magnetic resonance imaging (MRI) signs for antenatal detection of placenta accreta spectrum (PAS) disorders in women with placenta previa (placental edge ≤2 cm from the internal uterine orifice, ≥260/7 weeks’ gestation) with and without a history of previous Caesarean section.

Methods

Single center prospective observational study. US suspicion of PAS was raised in the presence of obliteration of the hypoechoic space between uterus and placenta, interruption of the hyperechoic uterine-bladder interface and/or turbulent placental lacunae on color Doppler. All MRI studies were blindly evaluated by a single operator. PAS was defined as clinically significant when histopathological diagnosis was associated with at least one of: intrauterine balloon placement, compressive uterine sutures, peripartum hysterectomy, uterine or hypogastric artery ligature, uterine artery embolization.

Results

A total of 39 women were included: 7/39 had clinically significant PAS. There were 6/18 cases of PAS with anterior placenta: hypoechoic space interruption and placental lacunae were the most sensitive sonographic signs (83%), while abnormal hyperechoic interface was the most specific (83%). On MRI, focal myometrial interruption and T2 intraplacental dark bands showed the best sensitivity (83%), bladder tenting had the best specificity (100%). 1/21 women with posterior placenta had PAS. There was substantial agreement between US and MRI in patients with anterior placenta (κ=0.78).

Conclusions

US and MRI agreement in antenatal diagnosis of clinically significant PAS was maximal in high-risk women. Placental lacunae on ultrasound scan and T2 intraplacental hypointense bands on MRI should trigger the suspicion of PAS.

Keywords: agreement; magnetic resonance imaging; placenta accreta spectrum; ultrasound
Corresponding author: Federico Prefumo, Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, ASST Spedali Civili, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy, Phone: +390303995340, Fax: +390303995034, E-mail:
Cecilia Cavalli and Claudia Maggi contributed equally to this work.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board approved the study.

References

1. Jauniaux, E, Collins, S, Burton, GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol 2018;218:75–87. https://doi.org/10.1016/j.ajog.2017.05.067.Search in Google Scholar PubMed

2. Carusi, D. Placenta accreta: epidemiology and risk factors. In: Silver, R, editor. Placenta accreta syndrome. Boca Raton, FL: CRC Press; 2017.10.1201/9781315117386-1Search in Google Scholar

3. Silver, RM, Landon, MB, Rouse, DJ, Leveno, KJ, Spong, CY, Thom, EA, et al.. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006;107:1226–32. https://doi.org/10.1097/01.aog.0000219750.79480.84.Search in Google Scholar PubMed

4. Chou, MM, Ho, ES, Lee, YH. Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound. Ultrasound Obstet Gynecol 2000;15:28–35. https://doi.org/10.1046/j.1469-0705.2000.00018.x.Search in Google Scholar PubMed

5. Dwyer, BK, Belogolovkin, V, Tran, L, Rao, A, Carroll, I, Barth, R, et al.. Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging? J Ultrasound Med 2008;27:1275–81. https://doi.org/10.7863/jum.2008.27.9.1275.Search in Google Scholar PubMed PubMed Central

6. D’Antonio, F, Iacovella, C, Bhide, A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013;42:509–17. https://doi.org/10.1002/uog.13194.Search in Google Scholar PubMed

7. Jauniaux, E, Bhide, A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2017;217:27–36. https://doi.org/10.1016/j.ajog.2017.02.050.Search in Google Scholar PubMed

8. Collins, SL, Ashcroft, A, Braun, T, Calda, P, Langhoff-Roos, J, Morel, O, et al.. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol 2016;47:271–5. https://doi.org/10.1002/uog.14952.Search in Google Scholar PubMed

9. D’Antonio, F, Iacovella, C, Palacios-Jaraquemada, J, Bruno, CH, Manzoli, L, Bhide, A. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2014;44:8–16. https://doi.org/10.1002/uog.13327.Search in Google Scholar PubMed

10. Meng, X, Xie, L, Song, W. Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: a systematic review and meta-analysis. Ultrasound Med Biol 2013;39:1958–65. https://doi.org/10.1016/j.ultrasmedbio.2013.05.017.Search in Google Scholar PubMed

11. Rahaim, NS, Whitby, EH. The MRI features of placental adhesion disorder and their diagnostic significance: systematic review. Clin Radiol 2015;70:917–25. https://doi.org/10.1016/j.crad.2015.04.010.Search in Google Scholar

12. Reddy, UM, Abuhamad, AZ, Levine, D, Saade, GR. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2014;123:1070–82. https://doi.org/10.1097/aog.0000000000000245.Search in Google Scholar

13. Jauniaux, E, Alfirevic, Z, Bhide, AG, Belfort, MA, Burton, GJ, Collins, SL, et al.. Placenta praevia and placenta accreta: diagnosis and management: Green-top Guideline No. 27a. BJOG 2019;126:e1–48. https://doi.org/10.1111/1471-0528.15306.Search in Google Scholar

14. Valentini, AL, Gui, B, Ninivaggi, V, Miccò, M, Giuliani, M, Russo, L, et al.. The morbidly adherent placenta: when and what association of signs can improve MRI diagnosis? Our experience. Diagn Interv Radiol 2017;23:180–6. https://doi.org/10.5152/dir.2017.16275.Search in Google Scholar

15. Alamo, L, Anaye, A, Rey, J, Denys, A, Bongartz, G, Terraz, S, et al.. Detection of suspected placental invasion by MRI: do the results depend on observer’ experience? Eur J Radiol 2013;82:e51–7. https://doi.org/10.1016/j.ejrad.2012.08.022.Search in Google Scholar

16. Familiari, A, Liberati, M, Lim, P, Pagani, G, Cali, G, Buca, D, et al.. Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018;97:507–20. https://doi.org/10.1111/aogs.13258.Search in Google Scholar

17. Baughman, WC, Corteville, JE, Shah, RR. Placenta accreta: spectrum of US and MR imaging findings. Radiographics 2008;28:1905–16. https://doi.org/10.1148/rg.287085060.Search in Google Scholar

18. Bhide, A, Sebire, N, Abuhamad, A, Acharya, G, Silver, R. Morbidly adherent placenta: the need for standardization. Ultrasound Obstet Gynecol 2017;49:559–63. https://doi.org/10.1002/uog.17417.Search in Google Scholar

19. Khong, TY, Werger, AC. Myometrial fibers in the placental basal plate can confirm but do not necessarily indicate clinical placenta accreta. Am J Clin Pathol 2001;116:703–8. https://doi.org/10.1309/m9bf-6jhh-vf2u-2b8t.Search in Google Scholar

20. Biggerstaff, BJ. Comparing diagnostic tests: a simple graphic using likelihood ratios. Stat Med 2000;19:649–63. https://doi.org/10.1002/(sici)1097-0258(20000315)19:5<649::aid-sim371>3.0.co;2-h.10.1002/(SICI)1097-0258(20000315)19:5<649::AID-SIM371>3.0.CO;2-HSearch in Google Scholar

21. Fitzpatrick, KE, Sellers, S, Spark, P, Kurinczuk, JJ, Brocklehurst, P, Knight, M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One 2012;7:e52893. https://doi.org/10.1371/journal.pone.0052893.Search in Google Scholar PubMed PubMed Central

22. Bailit, JL, Grobman, WA, Rice, MM, Reddy, UM, Wapner, RJ, Varner, MW, et al.. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 2015;125:683–9. https://doi.org/10.1097/aog.0000000000000680.Search in Google Scholar

23. Bowman, ZS, Eller, AG, Kennedy, AM, Richards, DS, Winter, TC, Woodward, PJ, et al.. Accuracy of ultrasound for the prediction of placenta accreta. Am J Obstet Gynecol 2014;211:177.e171–7. https://doi.org/10.1016/j.ajog.2014.03.029.Search in Google Scholar PubMed

24. Jacques, SM, Qureshi, F, Trent, VS, Ramirez, NC. Placenta accreta: mild cases diagnosed by placental examination. Int J Gynecol Pathol 1996;15:28–33. https://doi.org/10.1097/00004347-199601000-00005.Search in Google Scholar PubMed

25. Pagani, G, Cali, G, Acharya, G, Trisch, IT, Palacios-Jaraquemada, J, Familiari, A, et al.. Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018;97:25–37. https://doi.org/10.1111/aogs.13238.Search in Google Scholar PubMed

26. Comstock, CH, Love, JJ, Bronsteen, RA, Lee, W, Vettraino, IM, Huang, RR, et al.. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Am J Obstet Gynecol 2004;190:1135–40. https://doi.org/10.1016/j.ajog.2003.11.024.Search in Google Scholar PubMed

27. Riteau, AS, Tassin, M, Chambon, G, Le Vaillant, C, de Laveaucoupet, J, Quéré, MP, et al.. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. PLoS One 2014;9:e94866. https://doi.org/10.1371/journal.pone.0094866.Search in Google Scholar PubMed PubMed Central

28. Einerson, BD, Rodriguez, CE, Kennedy, AM, Woodward, PJ, Donnelly, MA, Silver, RM. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am J Obstet Gynecol 2018;218:618.e611–7. https://doi.org/10.1016/j.ajog.2018.03.013.Search in Google Scholar PubMed

29. Jauniaux, E, Chantraine, F, Silver, RM, Langhoff-Roos, J. FIGO placenta accreta diagnosis and management expert consensus panel. Int J Gynaecol Obstet 2018;140:265–73. https://doi.org/10.1002/ijgo.12407.Search in Google Scholar PubMed

30. Cali, G, Forlani, F, Lees, C, Timor-Tritsch, I, Palacios-Jaraquemada, J, Dall’Asta, A, et al.. Prenatal ultrasound staging system for placenta accreta spectrum disorders. Ultrasound Obstet Gynecol 2019;53:752–60. https://doi.org/10.1002/uog.20246.Search in Google Scholar PubMed

31. Noda, Y, Kanematsu, M, Goshima, S, Kondo, H, Watanabe, H, Kawada, H, et al.. Prenatal MR imaging diagnosis of placental invasion. Abdom Imag 2015;40:1273–8. https://doi.org/10.1007/s00261-014-0281-z.Search in Google Scholar PubMed

32. Hecht, JL, Baergen, R, Ernst, LM, Katzman, PJ, Jacques, SM, Jauniaux, E, et al.. Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel. Mod Pathol 2020;33:2382–96. https://doi.org/10.1038/s41379-020-0569-1.Search in Google Scholar PubMed

Received: 2021-07-04
Accepted: 2021-11-14
Published Online: 2021-12-03
Published in Print: 2022-03-28

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Corner of Academy
  3. Cost of providing cell-free DNA screening for Down syndrome in Finland using different strategies
  4. Adverse perinatal outcomes following the prenatal diagnosis of isolated single umbilical artery in singleton pregnancies: a systematic review and meta-analysis
  5. Original Articles – Obstetrics
  6. Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls
  7. The postpartum period during the COVID-19 pandemic: investigating Turkish women’s postpartum support and postpartum-specific anxiety
  8. First-line noninvasive management of cytomegalovirus primary infection in pregnancy
  9. Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders
  10. Improved management of placenta accreta spectrum disorders: experience from a single institution
  11. A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  12. The impact of preimplantation genetic testing for aneuploidy on prenatal screening
  13. Original Articles – Fetus
  14. Myocardial deformation analysis in late-onset small-for-gestational-age and growth-restricted fetuses using two-dimensional speckle tracking echocardiography: a prospective cohort study
  15. HDlive Flow Silhouette with spatiotemporal image correlation for assessment of fetal cardiac structures at 12 to 14 + 6 weeks of gestation
  16. Umbilical artery pulsatility index and half-peak systolic velocity in second- and third-trimester fetuses with trisomy 18 and 13
  17. Original Articles – Neonates
  18. Pulmonary hypertension in infants with bronchopulmonary dysplasia: risk factors, mortality and duration of hospitalisation
  19. Outcomes from birth to 6 months of publicly insured infants born to mothers with severe acute respiratory syndrome coronavirus 2 infection in the United States
  20. Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy – an 11-year single-center experience
  21. High frequency band limits in spectral analysis of heart rate variability in preterm infants
  22. Bacterial DNA detection in very preterm infants assessed for risk of early onset sepsis
  23. Short Communication
  24. Healthcare workers’ attitudes about vaccination of pregnant women and those wishing to become pregnant
  25. Letter to the Editors
  26. Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  27. Re: Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  28. SARS-CoV-2 behavior, through the eyes of a perinatologist?
  29. Re: SARS-CoV-2 behavior, through the eyes of a perinatologist?
https://doi.org/10.1515/jpm-2021-0334
Keywords for this article
agreement; magnetic resonance imaging; placenta accreta spectrum; ultrasound

Articles in the same Issue

  1. Frontmatter
  2. Corner of Academy
  3. Cost of providing cell-free DNA screening for Down syndrome in Finland using different strategies
  4. Adverse perinatal outcomes following the prenatal diagnosis of isolated single umbilical artery in singleton pregnancies: a systematic review and meta-analysis
  5. Original Articles – Obstetrics
  6. Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls
  7. The postpartum period during the COVID-19 pandemic: investigating Turkish women’s postpartum support and postpartum-specific anxiety
  8. First-line noninvasive management of cytomegalovirus primary infection in pregnancy
  9. Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders
  10. Improved management of placenta accreta spectrum disorders: experience from a single institution
  11. A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  12. The impact of preimplantation genetic testing for aneuploidy on prenatal screening
  13. Original Articles – Fetus
  14. Myocardial deformation analysis in late-onset small-for-gestational-age and growth-restricted fetuses using two-dimensional speckle tracking echocardiography: a prospective cohort study
  15. HDlive Flow Silhouette with spatiotemporal image correlation for assessment of fetal cardiac structures at 12 to 14 + 6 weeks of gestation
  16. Umbilical artery pulsatility index and half-peak systolic velocity in second- and third-trimester fetuses with trisomy 18 and 13
  17. Original Articles – Neonates
  18. Pulmonary hypertension in infants with bronchopulmonary dysplasia: risk factors, mortality and duration of hospitalisation
  19. Outcomes from birth to 6 months of publicly insured infants born to mothers with severe acute respiratory syndrome coronavirus 2 infection in the United States
  20. Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy – an 11-year single-center experience
  21. High frequency band limits in spectral analysis of heart rate variability in preterm infants
  22. Bacterial DNA detection in very preterm infants assessed for risk of early onset sepsis
  23. Short Communication
  24. Healthcare workers’ attitudes about vaccination of pregnant women and those wishing to become pregnant
  25. Letter to the Editors
  26. Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  27. Re: Comment on Abdel Wahab et al.: A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200 mg for prevention of preterm labor in twin gestations
  28. SARS-CoV-2 behavior, through the eyes of a perinatologist?
  29. Re: SARS-CoV-2 behavior, through the eyes of a perinatologist?
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