MRI of placenta percreta: differentiation from other entities of placental adhesive disorder

Abstract

MRI is recommended for the evaluation of placenta percreta, with the most specific signs including the invasion of placental tissue outside the uterus on B-FFE sequences, and consideration of the degree of placental signal heterogeneity. The size of the T2 dark band alone, or bizarre disorganized intra-placental vessels, did not correlate with the severity of invasion.

Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta‐analysis

“…Nine studies explored the diagnostic performance of MR in detecting the severity of placental invasion based on histopathology (). MRI had an overall good diagnostic accuracy in identifying the depth of placental invasion, with a sensitivity of 94.4% (95% CI 15.8–99.9), 100% (95% CI 75.3–100), 95.0% (95% CI 86.0–99.0) and 86.5% (95% CI 74.2–94.4) for placenta accreta, increta, accreta/increta and percreta, respectively; the corresponding figures for specificity were 98.8% (95% CI 70.7–100), 97.3 (95% CI 93.3–99.3), 96.0 (95% CI 92.3–98.3), 96.8 (95% CI 93.5–98.7).…”

“…Eight studies explored the strength of association and the predictive accuracy of the presence of uterine bulging in recognizing the depth of placental invasion . Uterine bulging was associated with a higher risk of increta and percreta, with an OR of 6.1 and 6.3, respectively, but not of placenta accreta.…”

“…A total of 984 articles were identified. After screening the abstracts, 50 full text articles were assessed with respect to their eligibility for inclusion (Supporting Information Table S2) and 16 studies were included in the systematic review (Table 1, Figure 2) (15,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). These 20 studies included 1080 pregnancies at risk for AIP, mainly because of the ultrasound suspicion of such anomalies, thus representing a population already screened for the occurrence of these disorders.…”

“…Most of the studies were of high quality, and there was a low risk of bias and low concern regarding the applicability of the studies. Nine studies explored the diagnostic performance of MR in detecting the severity of placental invasion based on histopathology (28,29,31,(33)(34)(35)(37)(38)(39) Table 2.…”

“…Seven studies explored the strength of association between intra-placental dark bands and the severity of placental invasion (25)(26)(27)29,(35)(36)(37). The presence of dark bands was independently associated with placenta accreta, increta and percreta (Supporting Information of the depth of placental invasion was 8.5, 9.3 and 6.7 for placenta accreta, increta and percreta.…”