Placenta accreta spectrum: value of placental bulge as a sign of myometrial invasion on MR imaging

Role of Ultrasound and MRI in Diagnosis of Severe Placenta Accreta Spectrum Disorder: An Intraindividual Assessment With Emphasis on Placental Bulge

“…In addition, on both modalities, the placental bulge sign was independently associated with severe PAS. Past studies have also observed the placental bulge to be a useful sign on MRI for detection of PAS, with reported sensitivity of 34%-88% and specificity of 92%-100% [24, 25,27,28]. In comparison, fewer studies have reported the performance of the placental bulge sign on US; in a systematic review of prenatal US for grading of PAS that included 53 series and 31 case reports, the placental bulge sign was reported in only three patients [34].…”

“…sign is associated with higher severity of PAS given that deeper villous invasion into the myometrium results in loss of muscle integrity, creating a focal area of myometrial-placental bulging beyond the normal uterine contour [23,24,[27][28][29]31]. We performed this study to evaluate the diagnostic performance and interobserver agreement of US and MRI features for diagnosis of severe PAS, with an emphasis on the placental bulge sign.…”

“…Various individual features on US or MRI have been investigated for diagnosing PAS, though challenges have been identified relating to the subjective nature of the findings, suboptimal inter-observer agreement, and dependency on reader experience [13,14,[21][22][23][24][25]. The "placental bulge" sign is a feature described on both US and MRI that has received particular attention [26][27][28][29][30]. The placental bulge…”

Texture analysis of dark intraplacental bands on T2WI in the evaluation of placenta accreta spectrum disorders: a feasibility study

“…All participants received T1-gradient sequence for detection of intraplacental hemorrhage and T2haste sequence to limit artifacts caused by fetal motion. The parameters for T1WI were: repetition time (TR) / echo time (TE), 169/4.76 msec; resolution matrix, 256×173; ip angle (FA), 70 0 ; slice thickness, 5mm and for T2WI they were: TR/TE, 1350/94 msec; resolution matrix, 256×205; FA, 170 0 ; slice thickness, 5mm [25].The eld-of-view (FOV) read of 400-480 mm and FOV phase of 75-100% were used. The MRI examinations of some participants also included T2-tru sequence in the coronal and sagittal planes without fat suppression using TR/TE of 3.87/1.68 msec and FA of 60°; T1-vibe in-phase and out-of-phase sequences in the transversal plane without fat suppression with TR/TE of 7.6/2.4 msec and FA of 10° [26].To maximize signal, a multi-channel surface coil was used whenever possible.…”

Utility of magnetic resonance imaging for placenta accreta spectrum (PAS) disorders

“…To the Editor, I read the recent paper by Jha et al on placental bulge sign of myometrial invasion on magnetic resonance (MR) imaging for placenta accreta spectrum (PAS) disorders [1]. The study has a unique quality in its methodology comparing imaging to histopathological findings.…”