Interobserver agreement in MRI assessment of severity of placenta accreta spectrum disorders

Abstract

Objective To evaluate the level of agreement in the prenatal magnetic resonance imaging (MRI) assessment of the presence and severity of placenta accreta spectrum (PAS) disorders between examiners with expertise in the diagnosis and management of these conditions. Methods This was a secondary analysis of a prospective study including women with placenta previa or low‐lying placenta and at least one prior Cesarean delivery or uterine surgery, who underwent MRI assessment at a regional referral center for PAS disorders in Italy, between 2007 and 2017. The MRI scans were retrieved from the hospital electronic database and assessed by four examiners, who are considered to be experts in the diagnosis and surgical management of PAS disorders. The examiners were blinded to the ultrasound diagnosis, histopathological findings and clinical data of the patients. Each examiner was asked to assess 20 features on the MRI scans, including the presence, depth and topography of placental invasion. Depth of invasion was defined as the degree of adhesion and invasion of the placenta into the myometrium and uterine serosa (placenta accreta, increta or percreta) and the histopathological examination of the removed uterus was considered the reference standard. Topography of the placental invasion was defined as the site of placental invasion within the uterus in relation to the posterior bladder wall (posterior upper bladder wall and uterine body, posterior lower bladder wall and lower uterine segment and cervix or no visible bladder invasion) and the site of invasion at surgery was considered the reference standard. The degree of interrater agreement (IRA) was evaluated by calculating both the percentage of observed agreement among raters and the Fleiss kappa (κ) value. Results Forty‐six women were included in the study. The median gestational age at MRI was 33.8 (interquartile range, 33.1–34.0) weeks. A final diagnosis of placenta accreta, increta and percreta was made in 15.2%, 17.4% and 50.0% patients, respectively. There was excellent agreement between the four examiners in the assessment of the overall presence of a PAS disorder (IRA, 92.1% (95% CI, 86.8–94.0%); κ, 0.90 (95% CI, 0.89–1.00)). However, there was significant heterogeneity in IRA when assessing the different MRI signs suggestive of a PAS disorder. There was excellent agreement between the examiners in the identification of the depth of placental invasion on MRI (IRA, 98.9% (95% CI, 96.8–100.0%); κ, 0.95 (95% CI, 0.89–1.00)). However, agreement in assessing the topography of placental invasion was only moderate (IRA, 72.8% (95% CI, 72.7–72.9%); κ, 0.56 (95% CI, 0.54–0.66)). More importantly, when assessing parametrial invasion, which is one of the most significant prognostic factors in women affected by PAS, the agreement was substantial and moderate in judging the presence of invasion in the coronal (IRA, 86.6% (95% CI, 86.5–86.7%); κ, 0.69 (95% CI, 0.59–0.71)) and axial (IRA, 78.6% (95% CI, 78.5–78.7%); κ, 0.56 (95% CI, 0.33–0.60)) planes, respectively. L...

Risk factors, histopathology and diagnostic accuracy in posterior placenta accreta spectrum disorders: systematic review and meta‐analysis

“…We have reported previously that both ultrasound and MRI have a high diagnostic accuracy for detecting PAS, with reported values of sensitivity and specificity of more than 90% in the overall population of women at risk for PAS [8][9][10][11] . In the present review, posterior PAS was missed on ultrasound in about half of the cases, while the detection rate by MRI was higher, with more than two-thirds of cases detected prenatally.…”

“…Both ultrasound and MRI have been shown to have an overall high diagnostic performance in detecting PAS [8][9][10] . However, these results are applicable mainly to women with anterior placenta previa, and it has yet to be determined whether the performance of prenatal imaging in detecting these anomalies is retained when placental invasion occurs in the posterior wall of the uterus 8,9,[11][12][13] .…”

Role of Ultrasound and MRI in Diagnosis of Severe Placenta Accreta Spectrum Disorder: An Intraindividual Assessment With Emphasis on Placental Bulge

“…The bulk of the US and MRI findings had fair or moderate interobserver agreement. Past studies have also shown suboptimal agreement for findings of PAS [24,25,28,42,43]. The limited interreader agreement reflects the often ambiguous nature of the assessment of imaging features for PAS, which requires experience and can be difficult in complex cases.…”

Prediction for Postpartum Hemorrhage of Placenta Previa Patients through MRI Using Self-Adaptive Edge Detection Algorithm

“…The clinical diagnosis of placenta previa often relies on clinical manifestations and ultrasound imaging. Although ultrasound is good for the diagnosis of placenta previa in pregnant women, it is easily affected by objective conditions such as overfilling of the bladder and fetal position [ 14 ]. In recent years, MRI has performed extremely well in obstetrics.…”