MRI appearance of placenta percreta and placenta accreta

Maldjian, Catherine; Adam, Richard; Pelosi, Marco A.; Rudelli, R. D.; Maldjian, Joseph A.

doi:10.1016/s0730-725x(99)00035-1

Cited by 168 publications

(93 citation statements)

References 9 publications

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“…This is because placenta accreta originally has only deficiencies of the decidua without deep invasion into the myometrium by trophoblastic tissue and has no focal thinning of the myometrium (2)(3)(4)(5). A problem of DWI is that the myometrium during the third trimester is commonly thin.…”

Section: Discussionmentioning

confidence: 99%

“…PLACENTAL INVASION is defined as an abnormal adherence of the placenta to the uterine wall with a deficiency of the deciduas basalis (1)(2)(3)(4)(5). According to the degree of invasion of the chorionic villi, it is histologically classified into three types: placenta accreta in which the villi attach to the myometrium; placenta increta in which the villi invade the myometrium; and placenta percreta in which the villi invade the other organs through the uterine serosa (2)(3)(4)(5).…”

mentioning

confidence: 99%

“…According to the degree of invasion of the chorionic villi, it is histologically classified into three types: placenta accreta in which the villi attach to the myometrium; placenta increta in which the villi invade the myometrium; and placenta percreta in which the villi invade the other organs through the uterine serosa (2)(3)(4)(5). Due to the increase in cesarean deliveries, the incidence of placental invasion accompanied by placenta previa has increased dramatically (1,2).…”

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confidence: 99%

“…Magnetic resonance imaging (MRI) has recently been used as an additional diagnostic tool when the clinical suspicion of placental invasion is high and/or the US results are inconclusive, especially in the case of posterior wall attachment (1)(2)(3)(4)(5). A direct MRI finding of placental invasion is focal thinning of the myometrium caused by the invasion of the placenta (3). However, this is difficult to identify without gadolinium-enhancement because the contrast between the placenta and myometrium is weak on conventional MRI sequences (4).…”

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confidence: 99%

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Feasibility of diffusion‐weighted MRI for defining placental invasion

Morita

Ueno

Fujimura

et al. 2009

Magnetic Resonance Imaging

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The purpose of this clinical note is to describe the feasibility of using diffusion‐weighted imaging for diagnosing placental invasion with a case of placenta increta and six cases without it. Diffusion‐weighted imaging (DWI) at a b‐value of 1000 sec/mm2 can clearly define the border between the placenta and myometrium because only the placenta shows very high signal intensity. The corresponding image at a b‐value of 0 sec/mm2 shows the myometrium with high signal intensity compared with the surrounding fat. Therefore, fusion of the two images can be used additionally to visualize thickness of the myometrium. As a result, DWI can be used to visualize the focal thinning of the myometrium caused by placenta increta, which has been difficult to diagnose on conventional magnetic resonance imaging sequences without contrast enhancement. However, the use of DWI for placental invasion should be determined following careful consideration of its risks and benefits, as fetus safety has not been established. J. Magn. Reson. Imaging 2009;30:666–671. © 2009 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Feasibility of diffusion‐weighted MRI for defining placental invasion

Morita

Ueno

Fujimura

et al. 2009

Magnetic Resonance Imaging

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“…Entretanto, ainda não existem critérios para a RM 2,4 . A RM, nos últimos dez anos, se destaca como método de diagnóstico antenatal de malformações complexas e de patologias maternas na gestação, devido a não exposição à radiação ionizante e à boa resolução diagnóstica 5 . Já existem evidências na literatura de que a RM tem um papel importante no auxílio da detecção e complementa a avaliação da extensão do acretismo e do percretismo placentário; no entanto, estes estudos são limitados, pois as análises são retrospectivas e há grande variabilidade técnica 4,5 .…”

Section: Introductionunclassified

Valor da ressonância magnética no diagnóstico antenatal do acretismo placentário

Francisco¹,

Goldman²,

Faria³

et al. 2006

Rev. Bras. Ginecol. Obstet.

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RESUMOObjetivos: estabelecer os principais sinais de acretismo placentário na ressonância magnética (RM) em gestantes com suspeita clínica e avaliar a utilidade do método. Métodos: estudo prospectivo, transversal em 15 pacientes com suspeita de acretismo placentário. O período compreendido foi de março de 2003 a fevereiro de 2006. A idade gestacional variou de 20 a 31 semanas. Todas as pacientes realizaram RM com estudo dirigido para placenta e haviam sido submetidas à ultra-sonografi a (US) prévia ao exame. Todas as peças foram encaminhadas para estudo anátomo-patológico (AP). Os exames foram realizados nos equipamentos Magnetom Impact e Sonata Maestro Class Siemens ® , adquiridas as seqüências HASTE, TURBO FISP, nos planos axial, sagital e coronal e gradiente echo (GE ® ) pré-e pós-contraste dinâmico no melhor plano de aquisição. A análise das imagens foi realizada por dois radiologistas em consenso. Resultados: a idade gestacional média das pacientes foi de 24,3 semanas. Foram estudadas sete placentas prévias centro-totais (47%), seis placentas corporais anteriores (40%) e duas placentas corporais posteriores (13%). A US foi positiva em 80% dos casos e a RM em 53% dos casos. No entanto, a US apresentou concordância fraca com o AP pelo teste de kappa (11%), com sensibilidade de 75%, especifi cidade de 14%, valor preditivo positivo (VPP) de 50% e valor preditivo negativo (VPN) de 33%. Já a RM teve concordância excelente com o AP (0,86), com sensibilidade de 100%, especifi cidade de 86% , VPP de 89% e VPN de 100%. Conclusões: a RM é útil na identifi cação do acretismo placentário. Os principais sinais na RM do acretismo placentário são: o hipersinal transmural, a descontinuidade da parede miometrial nas seqüências rápidas e a identifi cação dos vasos invadindo o miométrio nas seqüências dinâmicas. PALAVRAS-CHAVE:Placenta acreta/diagnóstico; Imagem por ressonância magnética ABSTRACT Purpose: to establish the main signs of placental accretism in magnetic resonance imaging (MRI) in patients with clinical suspicion and to estimate the benefi t of this method. Methods: prospective transversal study with 15 patients suspected of placental accretism, referred between March 2003 and February 2006. Gestational age varied from 20 to 31 weeks. All patients underwent MRI to study the placenta and had previously done an ultrasonography. Material was sent to histological study. MRI was done on Magnetom Impact and Sonata Maestro Class Siemens ® , with acquired sequences HASTE, TURBO SPIN in axial, sagittal, coronal planes and echo gradient (GE ® ), pre-and post-dynamic contrast in the best plan for acquisition. Images were analyzed by a team of two radiologists. Results: mean gestational age was 24.3 weeks. We studied seven placenta previa (47%), six anterior placentas (40%) and two posterior placentas (13%). Ultrasonography was positive in 80% of the palcentas and MRI in 53%. However, echography had a low concordance with anatomic pathological studies by Kappa test (11%), revealing 75% of sensitivity, 14% of specifi city, 50%...

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