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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2015; 25(04): 464-470
DOI: 10.4103/0971-3026.169456
Obstetric Radiology

Utility of ultrasound and magnetic resonance imaging in prenatal diagnosis of placenta accreta: A prospective study

Bhawna Satija
Department of Radiodiagnosis, Delhi State Cancer Institute, New Delhi, India
,
Sanyal Kumar
Department of Radiodiagnosis, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India
,
Leena Wadhwa
Department of Obstretics and Gynaecology, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India
,
Taru Gupta
Department of Obstretics and Gynaecology, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India
,
Supreethi Kohli
Department of Radiodiagnosis, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India
,
Rajkumar Chandoke
Department of Pathology, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India
,
Pratibha Gupta
Department of Obstretics and Gynaecology, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Context: Placenta accreta is the abnormal adherence of the placenta to the uterine wall and the most common cause for emergency postpartum hysterectomy. Accurate prenatal diagnosis of affected pregnancies allows optimal obstetric management. Aims: To summarize our experience in the antenatal diagnosis of placenta accreta on imaging in a tertiary care setup. To compare the accuracy of ultrasound (USG) with color Doppler (CDUS) and magnetic resonance imaging (MRI) in prenatal diagnosis of placenta accreta. Settings and Design: Prospective study in a tertiary care setup. Materials and Methods: A prospective study was conducted on pregnant females with high clinical risk of placenta accreta. Antenatal diagnosis was established based on CDUS and MRI. The imaging findings were compared with final diagnosis at the time of delivery and/or pathologic examination. Statistical Analysis Used: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both CDUS and MRI. The sensitivity and specificity values of USG and MRI were compared by the McNemar test. Results: Thirty patients at risk of placenta accreta underwent both CDUS and MRI. Eight cases of placenta accreta were identified (3 vera, 4 increta, and 1 percreta). All patients had history of previous cesarean section. Placenta previa was present in seven out of eight patients. USG correctly identified the presence of placenta accreta in seven out of eight patients (87.5% sensitivity) and the absence of placenta accreta in 19 out of 22 patients (86.4% specificity). MRI correctly identified the presence of placenta accreta in 6 out of 8 patients (75.0% sensitivity) and absence of placenta accreta in 17 out of 22 patients (77.3% specificity). There were no statistical differences in sensitivity (P = 1.00) and specificity (P = 0.687) between USG and MRI. Conclusions: Both USG and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. Both modalities have complimentary role and in cases of inconclusive findings with one imaging modality, the other modality may be useful for obtaining the diagnosis. CDUS remains the first primary modality for antenatal diagnosis of placenta accreta, with MRI reserved for cases where USG is inconclusive.

Keywords

Accreta - color Doppler ultrasound - magnetic resonance imaging, placenta


Publication History

Article published online:
30 July 2021

© 2015. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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