Diagnostic performance of radiologists with different levels of experience in the interpretation of MRI of the placenta accreta spectrum disorder

Abstract

Objectives: There have been no investigations on the association between previous abdominopelvic MRI experience without placental MRI experience and diagnostic accuracy of placenta accreta spectrum (PAS). To evaluate the diagnostic performance of radiologists with different experience levels in interpreting PAS-related MRI findings. Methods: This retrospective study included 60 women who underwent MRI for placental assessment between 2016 and 2020. MR images were reviewed by four radiologists who were blinded to the clinical outcomes and had different experience levels in interpreting PAS-related MRI findings. The radiologists’ diagnostic performance was evaluated according to the pathologic and surgical outcomes. Simple κ statistics were calculated to determine agreement among the radiologists. Results: Of 60 women, 46 were diagnosed with PAS. The maternal age mean ± SD was 33.0 years ± 5.0 for the PAS absent group and 36.0 ± 4.3 for the PAS present group (p = 0.013). Overall, the most experienced radiologist had the highest sensitivity (100%, 95% confidence interval (CI): 92.3–100%) and NPV (100%, 95% CI: 63.1–100%) in PAS diagnoses. However, the PPV and specificity were independent of experience. The most experienced radiologist had the highest diagnostic accuracy in PAS (90%, 95% CI: 79.5–96.2%) and placenta percreta (95%, 95% CI: 86.1–99.0%). There was a strong association between definitive PAS diagnoses and the highest experience level. The κ values for the interobserver agreement regarding PAS diagnoses were 0.67 for the most experienced radiologist (p < 0.001) and 0.38, 0.40, and 0.43 for the other radiologists (p = 0.001) and regarding placenta percreta diagnoses were 0.87 for the senior radiologist (p < 0.001) and 0.63, 0.57, and 0.62 for the other radiologists (p < 0.001). Conclusion: Previous experience in interpreting PAS-related MRI findings plays a significant role in accurately interpreting such imaging findings. Previous abdominopelvic MRI experience without specific placental MRI experience did not improve diagnostic performance. Advances in knowledge: We believe that our study makes a significant contribution to the literature and that this paper will be of interest to the readership of your journal because to the best of our knowledge, this study is the first in which the correlation between previous experience in abdominopelvic MRI with no specific experience in PAS-related MRI and diagnostic accuracy of radiologists has been explored. Our results could aid in setting up specialized multidisciplinary teams to assist women with PAS disorders.

Magnetic resonance imaging and previous cesarean section in placenta accrete spectrum disorder: Predictor model

“…The authors have also evaluated the interobserver variability of MRI analyses of experienced and less experienced radiologists, knowing that the previous experience of the radiologist improves the diagnostic performance, as shown by Ghezzi et al. [34] The authors found a substantial agreement for the intraplacental T2 dark band and a moderate agreement for abnormal vascularity, similarly to previous reports. [ 19 , 21 , 22 , 28 , 35 , 36 ] The heterogeneity sign also had moderate agreement even though the authors understand that this finding is very influenced by subjective evaluation as resembled on previous studies,[ 22 , 28 ] and it is known that normal placenta can show some heterogeneity.…”

A Deep Learning Pipeline Using Prior Knowledge for Automatic Evaluation of Placenta Accreta Spectrum Disorders With MRI

“…However, several meta-analysis studies have concluded that for MRI-based detection of placenta accreta, increta, and percreta, the sensitivity and the specificity of radiologists are in the range of [66%, 100%] and [71%, 76.9%], respectively. 11,12 Our radiologists failed to achieve the highest reported diagnostic performance, which may be due to the fact that the interpretation of PAS is highly dependent on expertise, which varies across radiologists and institutions, even in tertiary centers. Therefore, using the DL tool to minimize the difference of medical level in different regions and to homogenize the diagnosis and treatment level can effectively improve the accuracy of PAS diagnosis in primary hospitals, provide timely referral, and reduce the maternal mortality rate.…”

“…9,11 However, the diagnostic performance before invasive surgical procedures is highly dependent on radiologists' expertise. 11,12 Some specific MRI features have been identified in the evaluation of PAS. 13 A previous study has shown that MRI resulted in a change in diagnosis that could alter clinical management of PAS disorders in more than one third of cases.…”

“…In certain circumstances, magnetic resonance imaging (MRI) can overcome many of the technical limitations related to the US diagnosis of PAS, especially when placental extension into either the bladder, posterior uterus, cervix, and/or parametrium is suspected, 9 and it is now well‐established that MRI has an important role in diagnosis of PAS, 10 having high sensitivity and specificity. The sensitivity and specificity of MRI diagnosis of PAS range from 87% to 100% and from 97% to 99%, respectively, for experienced radiologists 9,11 . However, the diagnostic performance before invasive surgical procedures is highly dependent on radiologists' expertise 11,12 .…”

Maternal Smoking and the Risk of Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis

“…After delivery, the placenta usually separates spontaneously, and any difficulty in separating the placenta or the need for placental abruption is considered a clinical criterion for the PAS. Another clinical criterion is uncontrollable bleeding from the placenta after delivery or cesarean section [ 4 ]. Prenatal diagnosis of PAS is usually made by ultrasound [ 5 , 6 ].…”