Comparisons of the diagnostic accuracy of the ultrasonic sign-score method and MRI for PA, PI and PP in high-risk gravid women: a retrospective study

Abstract

Background The diagnosis and management of placenta accrete spectrum (PAS) is a great challenge to obstetricians. Ultrasound (US) and magnetic resonance imaging (MRI) are two main methods to detect PAS. MRI has high resolution, but the examination fee is expensive. US machine and examination fee is cheap, but the resolution is relatively low. Balancing the cost and accuracy for PAS diagnosis is very important. Methods The ultrasonic sign-score method and MRI findings for 49 pregnant women at high risk of placental implantation were retrospectively analyzed. Inclusion criteria: (I) at high risk for PA as described in the Guidelines to Placenta Accreta Spectrum Disorders issued by the American College of Obstetricians and Gynecologists (ACOG) in 2018; (II) complete records of ultrasonic sign-scoring method and MRI data; (III) cesarean section; (IV) definite surgical and/or pathological findings. The results were validated by the gold-standard surgical or postoperative pathological findings, and the efficacy of the 2 imaging approaches in diagnosing placenta PAS was compared. Kappa test was used to analyze the consistency. Receiver operating characteristic (ROC) curves were used to compare the sensitivity and specificity. Results The mean maternal age was 32.6±4.4 years. The mean gestational week was 35.9±2.0 weeks. The mean gravidity was 3.3±1.1. The surgical or histopathological findings revealed PA in 26, placenta increta (PI) in 19 and placenta percreta (PP) in 4 of the 49 women. The diagnosis accuracy of PA, PI, and PP was higher using the ultrasonic sign-scoring method than MRI (75.51%, 73.47%, and 97.96% vs. 61.22%, 57.14% and 91.84%, respectively). The areas under the ROC curve for the sensitivity and specificity of the ultrasonic sign-scoring method and MRI in the diagnosis of PA, PI, and PP were 0.757 [95% confidence interval (CI): 0.613, 0.868], 0.725 (95% CI: 0.579, 0.843), 0.989 (95% CI: 0.907, 1.000), and 0.607 (95% CI: 0.457, 0.743), 0.544 (95% CI: 0.395, 0.687), 0.614 (95% CI: 0.464, 0.749), respectively. Conclusions Although the sensitivity and specificity were lower than 0.8, the ultrasonic sign-scoring method was still superior to MRI in the detection of PI and PP. US can be used to help identify high-risk gravid women.

Value of early pregnancy ultrasound combined with ultrasound score in the evaluation of placenta accreta in scar uterus: A retrospective cohort study

“…It was confirmed that the diagnostic value of the ultrasound scoring system was higher than that of conventional ultrasound examination, and the combination of the 2 can effectively improve the sensitivity and accuracy of disease diagnosis, reduce the risk of missed diagnosis and misdiagnosis, and ensure that patients receive targeted intervention as soon as possible. [ 18 ] Ye et al [ 19 ] showed that the ultrasound scoring system is a comprehensive system of typical abnormal signs of disease, which is scored according to its severity, and the degree of implantation is evaluated by different scores; compared with the subjective qualitative diagnosis of conventional ultrasound, it is more standardized and comprehensive, and can avoid the shortage that the operator chooses different ultrasonic signs and endows different importance with implantation judgment due to personal operation technology and clinical experience, which can effectively reduce misdiagnosis and missed diagnosis rates. The ultrasound scoring system can predict the type and degree of implantation to guide patients in terminating pregnancy and effectively make preoperative preparations.…”

“…Such as multidisciplinary collaborative management, reasonable selection of surgical methods, etc. [ 19 , 20 ] At the same time, Yang et al [ 21 ] pointed out that ultrasound examination can determine the BF status of the cavity BF in the placental parenchyma and the junction of uterine serosa and bladder; the ultrasound scoring system can confirm whether the subject has PA at the thinnest part of the uterine myometrium with the help of conventional ultrasound signs and other information. The combination of the two can realize complementary advantages and disadvantages and effectively improve the value of disease diagnosis and treatment evaluation.…”

“…The combination of the two can realize complementary advantages and disadvantages and effectively improve the value of disease diagnosis and treatment evaluation. Based on this, it is believed that in clinical practice, to avoid missed diagnosis or misdiagnosis to the greatest extent, conventional ultrasound and ultrasound scoring systems can be integrated to carry out inspection and evaluation for patients with early scar uterine PA. [19][20][21]…”