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

Bhawna Satija; Sanyal Kumar; Leena Wadhwa; Taru Gupta; Supreethi Kohli; Rajkumar Chandoke; Pratibha Gupta

doi:10.4103/0971-3026.169456

Indian Journal of Radiology and Imaging, Table of Contents

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

Abstract

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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

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References

References
1 Christopoulos P, Hassiakos D, Tsitoura A, Panoulis K, Papadias K, Vitoratos N. Obstetric hysterectomy: A review of cases over 16 years.J Obstet Gynaecol 2011;31:139-41.
2 Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al.; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107:1226-32.
3 Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: Twenty-year analysis. Am J Obstet Gynecol 2005;192:1458-61.
4 Hung TH, Shau WY, Hsieh CC, Chiu TH, Hsu JJ, Hsieh TT. Risk factors for placenta accreta. Obstet Gynecol 1999;93:545-50.
5 Usta IM, Hobeika EM, Musa AA, Gabriel GE, Nassar AH. Placenta previa-accreta: Risk factors and complications. Am J Obstet Gynecol 2005;193:1045-9.
6 Baughman WC, Corteville JE, Shah RR. Placenta accreta: Spectrum of US and MR imaging findings. Radiographics 2008;28:1905-16.
7 Blaicher W, Brugger PC, Mittermayer C, Schwindt J, Deutinger J, Bernaschek G, et al. Magnetic resonance imaging of the normal placenta. Eur J Radiol 2006;57:256-60.
8 Leyendecker JR, DuBose M, Hosseinzadeh K, Stone R, Gianini J, Childs DD, et al.MRI of pregnancy-related issues: Abnormal placentation. AJR Am J Roentgenol 2012;198:311-20.
9 Comstock CH. Antenatal diagnosis of placenta accrete; A review. Ultrasound Obstet Gynecol 2005;26:89-96.
10 Yang JI, Lim YK, Kim HS, Chang KH, Lee JP, Ryu HS. Sonographic findings of placental lacunae andthe prediction of adherent placenta in women withplacenta previatotalis and prior Cesarean section. Ultrasound Obstet Gynecol 2006;28:178-82.
11 Lax A, Prince MR, Mennitt KW, Schwebach JR, Budorick NE. The value of specific MRI features inthe evaluation of suspected placental invasion. Magn Reson Imaging 2007; 25:87-93.
12 Teo TH, Law YM, Tay KH, Tan BS, Cheah FK. Use of magnetic resonance imaging in evaluation placental invasion. ClinRadiol 2009;64:511-6.
13 Derman AY, Nikac V, Haberman S, Zelenko N, OpshaO, Flyer M.MRI of placenta accreta: A new imaging perspective. AJR Am J Roentgenol 2011;197:1514-21.
14 Levine D, Hulka CA, Ludmir J, Li W, Edelman RR. Placenta accreta: Evaluation with color Doppler US, power Doppler US, and MR imaging. Radiology 1997;205:773-6.
15 Dwyer BK, Belogolovkin V, Tran L, Rao A, Carroll I, Barth R, et al. Prenatal diagnosis ofplacenta accreta: Sonography or magnetic resonance imaging? J Ultrasound Med 2008;27:1275-81.
16 Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 2006;108:573-81.
17 Masselli G, Brunelli R, Casciani E, Polettini E, Piccioni MG, Anceschi M, et al. Magnetic resonance imaging in the evaluation of placental adhesive disorders: Correlation with color Doppler ultrasound. Eur Radiol 2008;18:1292-9.
18 Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG Jr, Froelich JW, et al.; ACR Blue Ribbon Panel on MR Safety. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 2007;188:1447-74.