Comparison between abdominal ultrasound and nuclear magnetic resonance imaging detection of placenta accreta in the second and third trimester of pregnancy

Abstract

This study is to determine accuracy of abdominal ultrasound and nuclear magnetic resonance imaging (MRI) for placenta accreta in the second and third trimester of pregnancy and to define the most relevant features of abdominal ultrasound and MRI for placenta accreta prediction. Between September 2012 and September 2018, 245 high risk of placenta accreta in the second trimester of pregnancy were prenatal diagnosed by abdominal ultrasound and MRI and they were followed up until the end of pregnancy. Forty-six patients at the second trimester of pregnancy and 40 patients at the third trimester of pregnancy were confirmed as placenta accreta. For the second and third trimester of pregnancy, the sensitivity (Se), specificity (Sp), positive and negative predictive value (PPV and NPV) of abdominal ultrasound were 95.65% versus 97.50%, 91.78% versus 90.70%, 88% versus 83%, and 97% versus 99%, respectively, while the Se, Sp, PPV, and NPV of MRI were 89.13% versus 92.50%, 87.67% versus 8721%, 82% versus 77%, and 93% versus 96%, respectively. Five features having significant statistical differences between normal placentation women and placenta accreta patients in second or third trimester of pregnancy, including loss of the normal retroplacental clear space, thinning or disappearance of the myometrium, increased vascularization at the uterine serosa-bladder wall interface, and vascularization perpendicular to the uterine wall on abdominal ultrasound, and uterine bulging and dark intraplacental bands on MRI. Abdominal ultrasound and MRI for placenta accreta in the second and third trimester of pregnancy could provide meaningful imaging evidences.

Diagnosis of placenta accreta spectrum in high‐risk women using ultrasonography or magnetic resonance imaging: systematic review and meta‐analysis

“…Two studies reported the use of contrast medium 26,28 . Xia et al 28 conducted separate evaluations of two populations of women in different trimesters; six studies included participants in the third trimester [26][27][28][29]35,36 .…”

“…Finally, it is unfortunate that we were unable to retrieve from most studies the following important patient selection details: (1) whether patients were included consecutively (i.e. whether all patients referred to the study center underwent ultrasound and MRI examinations or whether the assessments were offered only to selected subsets of women) and (2) risk factors for PAS, which were not disclosed clearly by four studies [26][27][28]32 .…”

“…Elhawary (2013) 30 Hashem (2016) 37 Kumar (2017) 38 Lim (2011) 24 Abdel Magied (2018) 34 Nawab (2017) 32 Xia (2020a) 28 Ayati (2017) 39 Lin (2017) 25 Rezk (2016) 36 Guo (2021) 40 Riteau (2014) 26 Xia (2020b) 28 Algebally (2014) 31 Budorick (2017) 27 Mansour (2011) 29 Tables S2 and S3 for ultrasound and MRI, respectively.…”

Clinical diagnostic value and analysis of MRI combined with ultrasound in prenatal pernicious placenta previa with placenta accreta

“…Some studies have also shown that missed diagnosis that occurs when MRI or ultrasound are used in isolation may be related to changes in bladder filling due to inflammation, the thickness of abdominal fat layer, and placenta position (22)(23)(24). Xia et al (25) found that combined ultrasound and MRI had higher sensitivity for placenta accreta diagnosis in the second trimester of pregnancy than ultrasound or MRI alone. This study also revealed that the combined ultrasound and MRI had significantly higher specificity and accuracy for the placenta accreta diagnosis either modality alone, reducing the risk of missed diagnosis and it implications.…”

Sonographic Detection of Placenta Percreta With Associated Placenta Previa and Succenturiate Lobe

“…11 While sonography is often the preferred single imaging modality for evaluating for PAS, the accuracy for diagnosing it remains higher when both sonography and MRI are conducted together (97.5%). 2,13…”