A comprehensive severity score for the morbidly adherent placenta: combining ultrasound and magnetic resonance imaging

Knight, Jordan; Lehnert, Stephen J.; Shanks, Anthony; Atasi, Lamia; Delaney, Lisa R.; Marine, Megan B.; Ibrahim, Sherrine; Brown, Brandon P.

doi:10.1007/s00247-018-4235-4

Cited by 23 publications

(23 citation statements)

References 25 publications

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“…Better sensitivity but a comparably lower specificity of either US or MRI techniques for the diagnosis of PAS, perhaps because once one feature of the diagnostic criteria was present, the diagnosis of PAS was considered, consequently the number of false positives was increased, and specificity of the test reduced. The most recent retrospective cohort study [35] exhibited that a comprehensive scoring system by combing US, MRI and clinical risk factors was superior to either modality when used alone, suggesting that a complementary approach by combing several characteristic markers from various clinical parameters into a structured and quantified system might improve the diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: a systematic review and meta-analysis

Hong

Lio

et al. 2022

Insights Imaging

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Objectives Accurate prenatal diagnosis of placenta accrete spectrum disorder (PAS) remains a challenge, and the reported diagnostic value of ultrasonography (US) and magnetic resonance imaging (MRI) varies widely. This study aims to systematically evaluate the diagnostic accuracy of US as compared with MRI in the detection of PAS within the identical patient population. Methods Medline, EMBASE, Google scholar and Cochrane library were searched. Pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the summary receiver operating characteristic (SROC) curve were calculated. Subgroup analysis was also performed to elucidate the heterogeneity of results. Results A total of 18 articles comprising 861 pregnancies were included in the study. The overall diagnostic accuracy of US for identification of PAS was as follows: sensitivity [0.90 (0.86–0.93)], specificity [0.83 (0.79–0.86)], DOR [39.5 (19.6–79.7)]. The overall diagnostic accuracy of MRI for identification of PAS was as follows: sensitivity [0.89 (0.85-0.92)], specificity [0.87 (0.83–0.89)], DOR [37.4 (17.0–82.3)]. The pooled sensitivity (p = 0.808) and specificity (p = 0.413) between US and MRI are not significantly different. SROC analysis revealed that there was no statistical difference (p = 0.552) in US and MRI for the overall predictive accuracy of PAS. Furthermore, in the subgroup analysis of between retrospective and prospective studies, between earlier and most recent studies, there was no statistical difference (p > 0.05) in diagnostic accuracy of US and MRI for the detection of PAS. Conclusions Both ultrasonography (US) and magnetic resonance imaging (MRI) showed comparable accuracy in the prenatal diagnosis of placenta accrete spectrum disorder (PAS). Routine employment of MRI with relatively high expense in the prenatal identification of PAS should not be recommended.

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Section: Discussionmentioning

confidence: 99%

Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: a systematic review and meta-analysis

Hong

Lio

et al. 2022

Insights Imaging

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“…For ultrasonic manifestations, placenta previa, vascular lacunae, obscure boundaries between the placenta and the myometrium, uterine serosa-posterior bladder wall interface, sub-placental hypervascularity were also frequently used as our PAS scoring system shows. [ 4 , 5 , 7 , 8 , 10 ] Other criteria like size and numbers of lacunae, myometrium thickness, disruption of the myometrium and cervix invaded were also applied and confirmed to be useful. [ 4 – 7 , 9 ] Our PAS scoring system including similar ultrasound descriptions with other studies.…”

Section: Discussionmentioning

confidence: 99%

Comparison between placenta accreta scoring system, ultrasound staging, and clinical classification

et al. 2022

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Placenta accreta spectrum (PAS) is a series of disorders, which means that the placental trophoblast invades into the myometrium of the uterine wall. It is a serious obstetric complication which could be detected by ultrasound prenatally. In order to compare our placenta accreta scoring system with prenatal ultrasound staging system and International Federation of Gynecology and Obstetrics (FIGO) clinical classification, we did a retrospective study including 105 patients diagnosed with PAS disorders by operation or pathology at Peking University First Hospital, Beijing, China, between January, 2019 and December, 2020. Placenta accreta scoring system, prenatal ultrasound staging system and FIGO clinical classification were used on each patient. Basic information and clinical outcomes including gestational weeks, intraoperative hemorrhage, hysterectomy rate and blood transfusion were also counted. Both of placenta accreta scoring system, prenatal ultrasound staging system can give a rather clear prediction of placenta percreta, with their area under curve were 0.872 (95% confidential interval [CI]: 0.793–0.951) and 0.864 (95%CI: 0.779–0.949), P value were .000 compared with clinical classification. Beside for ultrasound staging system was designed for placenta previa patients, all those 3 criteria showed their relationships with preterm birth, hysterectomy rate and intraoperative bleeding. PAS scoring system also had the ability to predict a gestational week of delivery ≤34 weeks, intraoperative massive bleeding ≥2000 mL and hysterectomy at over 12 points. Our placenta accreta scoring system had good accordance with pre-operational ultrasound staging and FIGO clinical classification, with higher universality for patients without placenta previa.

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“…Knight et al [15] used a combined ultrasonography and MRI score to diagnose PA. They reported a sensitivity of 56% and specificity of 92% for identifying invasive placentation combining ultrasound and MRI findings.…”

Section: Discussionmentioning

confidence: 99%

Placenta accreta scoring system (PASS)—assessment of a simplified clinico-radiological scoring system for antenatal diagnosis of placenta accreta

Mahalingam

Rangasami

Premkumar

et al. 2021

Egypt J Radiol Nucl Med

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Background Placenta accreta spectrum (PAS) of disorders is an important cause of post-partum hemorrhage and resultant maternal morbidity and mortality. Imaging plays an indispensable role in antenatal diagnosis of PAS. However, diagnosis of PAS on both ultrasonography and magnetic resonance imaging (MRI) is reliant on recognition of multiple imaging signs each of which have a wide range of sensitivity and specificity. There is no single pathognomonic diagnostic feature. This results in interobserver variability. In our study, we aim to assess the accuracy of a combined clinico-radiological scoring system in predicting placenta accreta. Results This retrospective study included 60 MRI examinations done for suspected placenta accreta (PA). MRI findings were assessed by two radiologists in consensus. Clinical details of the patients were obtained from the hospital information system. Two clinical and six imaging criteria were assessed and a total score was calculated for each patient. Patients were stratified into three groups—low, moderate or high probability for placenta accreta based on the total score. The presence of any statistically significant difference in prevalence of PA among these groups was assessed. Intra-operative findings/histopathology were considered the gold standard. The prevalence of PA was 3% (1/33), 28.5% (2/7) and 90% (18/20) in the low-, moderate- and high-risk groups respectively. There was a statistically significant difference in the prevalence between the three groups (chi-square statistic = 41.54, p value < 0.0001). A score of greater than or equal to 6 provided sensitivity, specificity and accuracy of 85.71, 94.87 and 92.5% respectively in diagnosing placenta accreta. Conclusion PASS provides a simple, objective and accurate way to stratify patients into low, intermediate and high probability categories for PA.

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A comprehensive severity score for the morbidly adherent placenta: combining ultrasound and magnetic resonance imaging

Abstract: A combined scoring system using MRI and US may accurately identify patients at risk for morbidity associated with morbidly adherent placenta.

Cited by 23 publications

References 25 publications

Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: a systematic review and meta-analysis

Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: a systematic review and meta-analysis

Comparison between placenta accreta scoring system, ultrasound staging, and clinical classification

Placenta accreta scoring system (PASS)—assessment of a simplified clinico-radiological scoring system for antenatal diagnosis of placenta accreta

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