Novel MRI finding for diagnosis of invasive placenta praevia: evaluation of findings for 65 patients using clinical and histopathological correlations

Abstract

• Prenatal diagnosis for an invasive placenta is essential for perinatal planning. • Magnetic resonance imaging provides useful information for the diagnosis of invasive placenta. • The placental protrusion sign is a useful novel MRI finding for predicting invasive placenta.

Conventional MRI features for predicting the clinical outcome of patients with invasive placenta

“…Low signal intensity bands on T2-weighted imaging appear as areas with nodular or linear disposition, extending from the uterine-myometrial surface to placenta (16,17). They represent abnormally thickened fibrous tissue or areas of fibrin deposition because of repetitive intraplacental hemorrhage.…”

“…Placental cervical protrusion sign was also regarded as a useful novel MRI finding for predicting placenta invasion by Ueno et al (16), which is a known risk factor for the poor outcome of patients with placenta previa after CS. The potential reason for this might be related to the blood supply of the cervix.…”

“…1d) (15); the placental cervical protrusion sign, which indicates placenta tissue protrusion into the cervical canal ( Fig. 1e) (16); the tenting of the bladder and/or infiltration of the pelvic organ ( Fig. 1f ) (17).…”

“…on T2-weighted images, focal disruption of placental-myometrial interface, and placenta protrusion sign were listed as distinctive findings of placental invasion on MRI (15)(16)(17)(18). However, to the best of our knowledge, there has been no study correlating MRI features with maternal clinical outcome after UAE-assisted CS delivery until now.…”

The morbidly adherent placenta: when and what association of signs can improve MRI diagnosis? Our experience

“…In the antepartum period, magnetic resonance imaging (MRI) is requested to investigate placental disorders, particularly in difficult or ambiguous US examination cases. Specific diagnostic signs of abnormal placental implant on MRI pictures are reported in the literature (8)(9)(10). However, the final diagnosis of MAP is made based on the pathologic specimen obtained after hysterectomy, even if clinical signs such as the uterus continuing to bleed despite contraction could suggest MAP at cesarean section.…”