Use of ARFI elastography in the prediction of placental invasion anomaly via a new Virtual Touch Quantification Technique

Abstract

We aimed to evaluate the efficiency of placental elasticity in predicting a placental invasion anomaly with the Virtual Touch Quantification (VTQ) technique. Pregnant women in the third trimester with suspected placental invasion anomaly were enrolled into the research (n = 58). The placenta was evaluated and divided into three equal parts as foetal edge (inner 1/3 of placenta), maternal edge (outer 1/3 of placenta) and the central part (central 1/3 of placenta). Shear wave velocity (SWV) measurements were used in the elastographic evaluation of placentas by VTQ. We performed the measurements at the different regions of placenta for sampling the variety areas of the placenta. Acoustic Radiation Force Impulse (ARFI) Elastography scores were significantly higher in the group in which an invasion was detected during the surgery of patients with preoperative placental invasion suspicion. A significant difference in the measurements of the inner, central and outer third of the placenta between the groups was found (p < .001). In this study, we have shown higher SWV scores of placental measurements of the patients with preoperative suspected anomalies and an invasion detected during their surgery. These findings may reflect an event at the tissue elasticity level and we hope that the use of the VTQ technique may contribute to an early prediction of placental invasions before surgery in the future via new research. Impact statement What is already known on this subject? Placenta invasion anomalies (PIA's) are characterized by haemorrhages which can threat the mother's life. Placental invasion anomalies are among the most important causes of maternal mortality and morbidity. Early diagnosis is very important condition in reducing the mortality and morbidity. Gray scale ultrasonography (US) is mostly used in early diagnosis of PIA's. Acoustic radiation force impulse elastography (ARFI) is a new elastographic ultrasonography technic. We aimed to evaluate a new method in the early diagnosis of PIA's using ARFI technique. There is no study in the diagnosis of PIA's by ARFI in the literature to our knowledge. We think that this original study will contribute to the literature. What do the results of this study add? We showed the accuracy of ARFI in determination of PIA's. ARFI scores were significantly higher in the group in which invasion was detected during surgery of patients with preoperative placental invasion suspicion. What are the implications are of these findings for clinical practice and/or further research? Our findings may reflect an event at the tissue elasticity level and we hope that the use of VTQ technique may contribute to early predict of placental invasions before surgery in the future via new researches. Early diagnosis of placental invasion anomalies may reduce mortality and morbidity.

Subgroup analysis of accreta, increta and percreta cases using acoustic radiation force impulse elastography

“…Accordingly, our study determined that the majority of patients suspected to have API based on elastography values (46/54, 85.2%) were intraoperatively found to have API, and these findings were confirmed histopathologically. The high ARFI values our study determined in patients with API resemble those obtained by Cim and colleagues . Again, similar to our study, a study conducted by Davutoglu et al .…”

“…Particularly, post‐caesarean section (CS) abnormal uterine scars are thought to serve as a basis for defective decidualization and deep trophoblast invasion . Previous CS and placenta previa in patient history constitute major risk factors for the development of abnormal placental invasion (API) . This condition may lead to massive obstetric hemorrhage, multiple blood transfusions, multiorgan failure, a need for hysterectomy and even mortality .…”

Evaluation of a Healthy Pregnant Placenta with Shear Wave Elastography

“…In our study, the values obtained from the central placenta were higher than the periphery values, indicating the central region was harder, but this may be associated with the fact that the central region was thicker. A recent research study predicting the importance of SWE in placental invasion has revealed that elasticity scores are different among the fetal side, maternal side and central portion of placenta, and the elasticity score is higher in invasive placentas (26). In our measurements performed within the central region itself, consistent with previous studies, the higher velocity of the maternal side may be attributed to the neighborhood surrounding the myometrium, which is harder than the placenta The moderate and high-reliability values of SWE, with inter and intra-observer velocity measurements, are indicative of the fact that it is not a user-dependent test (14).…”

The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study

“…In recent years, due to increases in the caesarean section rate and uterine cavity operation rate, the incidence of PAS has increased, and the incidence of related postpartum haemorrhage has also increased [6]. Uncontrollable postpartum haemorrhage can occur when PAS is present in combination with placenta previa [7][8][9]. Caesarean section is the main treatment method for PAS, and haemorrhage control during the operation is key for successful treatment.…”