MRI Features Predictive of Invasive Placenta With Extrauterine Spread in High-Risk Gravid Patients: A Prospective Evaluation

Bourgioti, Charis; Zafeiropoulou, Konstantina; Fotopoulos, Stavros; Nikolaidou, Maria Evangelia; Antoniou, Aris; Tzavara, Chara; Moulopoulos, Lia A.

doi:10.2214/ajr.17.19303

Cited by 45 publications

(36 citation statements)

References 37 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. 20,21,28 Since MRI is highly accurate in predicting the depth and topography of abnormal placentation, 6,29 it may help obstetricians choose the appropriate therapeutic approach and improve patient prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Each reader was asked to review the MRIs and record the presence of the following features, which, according to published literature, are highly indicative of abnormal placentation: myometrial thinning with disruption of the low T 2 signal of the outer myometrium, placental heterogeneity (any degree), intraplacental dark bands on T 2 W images, intraplacental hyperintense foci on T 1 W images, uterine bulge, prominent intraplacental vascularization, lumpy placental borders, placental protrusion within the cervical canal, placental mass within the parametrium, and signs of bladder invasion including loss of low T 2 signal of the bladder wall, intraluminal bladder mass, and elongation (tenting) of the bladder dome. The presence of an abnormal flow‐void vascular network abutting the uterine serosa or extending to the vesicouterine interface or parametrial fat, signs recently described as highly specific for extensive placental invasiveness, were also noted . Detailed definitions of the above MRI features are provided as Supplementary Material (S1).…”

Section: Methodsmentioning

confidence: 99%

“…The presence of an abnormal flow-void vascular network abutting the uterine serosa or extending to the vesicouterine interface or parametrial fat, signs recently described as highly specific for extensive placental invasiveness, were also noted. 20,21 Detailed definitions of the above MRI features are provided as Supplementary Material (S1).…”

Section: Image Interpretationmentioning

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: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Image Interpretationmentioning

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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“…Placenta increta is characterized by partial invasion of the myometrium by the placenta, whereas placenta percreta is characterized by full invasion of the myometrium, the placenta extending to or beyond the uterine serosa, in some cases extending to adjacent organs (3,4) . The major risk factors often associated with postpartum hemorrhage, emergency hysterectomy, maternal morbidity, and maternal mortality (1,5) . Ultrasound, combined with the color Doppler technique, is the main diagnostic tool for evaluating an abnormal placenta.…”

Section: Introductionmentioning

confidence: 99%

“…for placenta accreta are a previous cesarean section and placenta previa, less common risk factors including a history of conservative myomectomy, uterine artery embolization, curettage, or uterine rupture (1) , as well as advanced maternal age (5) .…”

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confidence: 99%

Placental adhesion disorder: magnetic resonance imaging features and a proposal for a structured report

et al. 2020

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Placental adhesion disorder encompasses the various types of abnormal placentation that occur when the chorionic villi penetrate the uterine wall. Placenta accreta has become more common, mainly because of the increasing rates of cesarean section. Although ultrasound is the first-line imaging modality for evaluation of the placenta, it plays a limited role in cases of posterior placenta accreta and inconclusive findings. In such cases, magnetic resonance imaging (MRI) is indicated, mainly because it is a more accurate means of identifying placental invasion of extrauterine structures in high-risk pregnant women. In this review article, we present the ten major and minor MRI features of placental adhesion disorder, as described in the international literature. In addition, we propose a template for structured reports of MRI examinations of the placenta. We have also devised a guided questionnaire in order to identify risk factors in patients scheduled to undergo such examinations, with the objective of facilitating the multidisciplinary treatment planning needed in order to minimize maternal morbidity and mortality.

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Prediction of placenta accreta spectrum with nomogram combining radiomic and clinical factors: A novel developed and validated integrative model

Chen

Kong

et al. 2023

Intl J Gynecology & Obste

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Objective: To develop and validate a clinicoradiomic nomogram based on sagittal T2WI images to predict placenta accreta spectrum (PAS). Methods: Between October 2016 and April 2022, women suspected of PAS by ultrasound were enrolled. After taking into account exclusion criteria, 132 women were retrospectively included in the study. The variance threshold SelectKBest and the least absolute shrinkage and selection operator were applied to select radiomic features, which was further used to calculate the Rad-score. Multivariable logistic regression was used to screen clinical factor. Results: Based on 13 radiomic features, five radiomic models were constructed. A clinical factor of intraplacental T2-hypointense bands was obtained by multivariate logistic regression. The area under the curve (AUC) value of the stochastic gradient descent (SGD) radiomic model was 0.82 in the training cohort and 0.78 in the test cohort. After adding clinical factors to the SGD radiomic model, the AUC value of the clinicoradiomic model was significantly increased from 0.82 and 0.78 to 0.84 in both the training and test cohorts. The nomogram of the clinicoradiomic model was constructed, which had good performance verified by calibration and a decision curve. Conclusion:The presented nomogram could be useful for predicting PAS.

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MRI Features Predictive of Invasive Placenta With Extrauterine Spread in High-Risk Gravid Patients: A Prospective Evaluation

Cited by 45 publications

References 37 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

Placental adhesion disorder: magnetic resonance imaging features and a proposal for a structured report

Prediction of placenta accreta spectrum with nomogram combining radiomic and clinical factors: A novel developed and validated integrative model

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