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

Familiari, Alessandra; Liberati, Marco; Lim, Philip S.; Pagani, G.; Calì, Giuseppe; Buca, D.; Manzoli, Lamberto; Flacco, Maria Elena; Scambia, Giovanni; D’Antonio, F.

doi:10.1111/aogs.13258

Cited by 116 publications

(80 citation statements)

References 39 publications

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“…Our results, in accordance with the literature, show excellent agreement between MRI and intraoperative/histological findings, regarding diagnosis of PAS, depth of placental invasion, and placental extrauterine spread to the bladder or parametrial tissues . Since MRI is highly accurate in predicting the depth and topography of abnormal placentation, it may help obstetricians choose the appropriate therapeutic approach and improve patient prognosis.…”

Section: Discussionsupporting

confidence: 89%

“…Few studies have focused on the predictive ability of specific imaging features for adverse events, such as hysterectomy or massive intraoperative hemorrhage during delivery, in patients with PAS . Prenatal identification of such morphological prognosticators may help physicians offer more careful counseling and implement individually tailored treatments, further improving the management of women affected with PAS …”

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confidence: 99%

“…[3][4][5] Color Doppler ultrasonography (CDUS) and magnetic resonance imaging (MRI) exhibit comparable diagnostic ability for early detection of PAS; reported sensitivity and specificity values for detecting invasive placenta reach 90.2% and 88.2% for MRI, and 85.7% and 88.6% for CDUS. 6,7 Even though CDUS is the frontline imaging modality for the evaluation of PAS disorders, MRI is used as a problem-solving tool for equivocal sonographic findings or suspicion of posterior/lateral placental extension. 8 Few studies have focused on the predictive ability of specific imaging features for adverse events, such as hysterectomy or massive intraoperative hemorrhage during delivery, in patients with PAS.…”

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confidence: 99%

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MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

Bourgioti

Zafeiropoulou

Fotopoulos

et al. 2018

Magnetic Resonance Imaging

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Background Placenta accreta spectrum (PAS) disorders may be associated with significant mortality and morbidity for both mother and fetus. Purpose/Hypothesis To identify MRI risk factors for poor peripartum outcome in gravid patients at risk for PAS. Study Type Prospective. Population One hundred gravid women (mean age: 34.9 years) at third trimester, with placenta previa. Field Strength/Sequence T2‐SSTSE (single‐shot turbo spin echo), T2‐TSE, T1‐TSEFS (TSE images with fat‐suppression) at 1.5T. Assessment Fifteen MRI features considered indicative of PAS were recorded by three radiologists and were tested for any association with the following adverse peripartum maternal and neonatal events: increased operation time, profound blood loss, hysterectomy, bladder repair, ICU admission, prematurity, low birthweight, and 5‐minute APGAR score <7. Statistical Tests Kappa (K) coefficients were computed as a measure of agreement between intraoperative information/histology and MRI results as well as for interobserver agreement; chi‐square and Fisher's exact tests were used to explore the association of the MRI signs with clinical complications. A score was calculated by adding all recorded MRI signs and its predictive ability was tested using receiver operating characteristic (ROC) analysis, against all complications, separately; odds ratios (ORs) for optimal cutoffs were determined with logistic regression analysis. Results There was excellent agreement (K >0.75, P < 0.001) between MRI and intraoperative findings for invasive placenta, bladder and parametrial involvement. Intraplacental T2 dark bands, myometrial disruption, uterine bulge, and hypervascularity at the utero‐placental interface or parametrium, showed significant association (P < 0.005) with poor clinical outcome for both mother and fetus. The MRI score showed significant predictive ability for each adverse maternal event (area under the curve [AUC]: 0.85–0.97, P < 0.001). The presence of ≥3 MRI signs was the cutoff point for a complicated delivery (OR: 19.08, 95% confidence interval [CI]: 6.05–60.13) and ≥6 MRI signs was the cutoff point for massive bleeding (OR: 90.93, 95% CI: 11.3–729.23), hysterectomy (OR: 72.5, 95% CI: 17.9–293.7), or extensive bladder repair (OR: 58.74, 95% CI: 7.35–469.32). The MRI score was not significant for predicting adverse neonatal events including preterm delivery (P = 0.558), low birthweight (P = 0.097), and 5‐minute Apgar score (P = 0.078). Data Conclusion Preoperative identification of specific MRI features may predict peripartum course in high‐risk patients for PAS. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:602–618.

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Section: Discussionsupporting

confidence: 89%

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confidence: 99%

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confidence: 99%

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MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

Bourgioti

Zafeiropoulou

Fotopoulos

et al. 2018

Magnetic Resonance Imaging

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“…Ultrasound is the primary tool to diagnose AIP in women at risk, such as those with placenta previa and a prior CS, whereas prenatal MRI is usually reserved for cases with inconclusive ultrasound assessment [11].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, diagnostic accuracy depends on the training and level of experience of the physician, irrespective of the imaging technique [1]. Ultrasound is the primary tool to diagnose AIP in women at risk, such as those with placenta previa and a prior cesarean section (CS), whereas prenatal MRI is usually reserved for cases with inconclusive ultrasound assessment [11]. In fact, ultrasound had an overall good diagnostic accuracy in identifying the depth of placental invasion with sensitivities of 90.6, 93.0, 89.5, and 81.2% for placenta accreta, increta, accreta/increta, and percreta respectively [12].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Ultrasound Predictors of Placenta Accreta in Pregnant Women with Antepartum Diagnosis of Placenta Previa: A Multicenter Study

Vita

Capobianco

Gerosolima

et al. 2018

Gynecol Obstet Invest

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Background/Aims: Abnormally invasive placenta (AIP) includes placenta accreta, increta, and percreta and represents major complications of pregnancy. This study was designed to assess the role of ultrasonography in the identification of AIP among pregnant women with antepartum diagnosis of placenta previa. Methods: A cross-sectional study was performed between May 2015 and April 2016 in 11 centers, including 242 women with antepartum diagnosis of placenta previa. Results: Ninety-eight out of 242 (40.49%) women had a histological diagnosis of placenta accreta. A higher number of caesarean deliveries (p = 0.001) and curettages (p = 0.027) and older age of the woman at the delivery (p = 0.031) were identified as risk factors for placenta accreta. The presence of irregularly shaped placental lacunae (vascular spaces) within the placenta (p = 0.008), protrusion of the placenta into the bladder (p < 0.0001), and turbulent blood flow through the lacunae on Doppler ultrasonography (p = 0.008) were predictors of placenta accreta. Conclusions: Women with a prior delivery by caesarean section have a high incidence of placenta accreta among women with antepartum diagnosis of placenta previa.

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Outcomes in emergency versus electively scheduled cases of placenta accreta spectrum disorder managed by cesarean‐hysterectomy within a multidisciplinary care team

Flores-Mendoza

Chandran

Hernández-Nieto

et al. 2022

Intl J Gynecology & Obste

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

Cited by 116 publications

References 39 publications

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

Clinical and Ultrasound Predictors of Placenta Accreta in Pregnant Women with Antepartum Diagnosis of Placenta Previa: A Multicenter Study

Outcomes in emergency versus electively scheduled cases of placenta accreta spectrum disorder managed by cesarean‐hysterectomy within a multidisciplinary care team

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