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

Abstract

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Predicting Placenta Accreta Spectrum Disorders in a Cohort of Pregnant Patients in the North-East Region of Romania—Diagnostic Accuracy of Ultrasound and Magnetic Resonance Imaging

“…In a different study, Gulati et al found that Doppler US could be used as an important tool for the detection of bridging vessels, which had a high specificity (93.5%) for PAS [ 33 ], which was comparable to our study (Sp-92.3%). On the other hand, in our study, placental bulging presented a very low sensitivity (30.7%) and a maximum specificity, while other authors reported good sensitivity (91.7%) and poorer specificity (76.9%) [ 34 ].…”

Debunking 20th century myths and legends about the diagnosis of placenta accreta spectrum

“…The main MRI features of accreta placentation include abnormal uterine bulging, dark intraplacental bands on T2-weighted imaging, heterogeneous signal intensity within the placenta and disruption of the uteroplacental zone [40][41][42][43][44][45][46][47][48] . Recent data suggest that the finding of a placental budge on MRI has the highest sensitivity for the diagnosis of severe PAS 43 . However, as a placental bulge is a hernia of placental tissue through a dehiscence of the uterine wall and is independent of accreta placentation (Table 1), this sign is unlikely to add much to the prenatal diagnosis of PAS.…”

“…The main MRI features of accreta placentation include abnormal uterine bulging, dark intraplacental bands on T2-weighted imaging, heterogeneous signal intensity within the placenta and disruption of the uteroplacental zone [40][41][42][43][44][45][46][47][48] . Recent data suggest that the finding of a placental budge on MRI has the highest sensitivity for the diagnosis of severe PAS 43 .…”

Ultrasonography of the Explanted Uterus in Placenta Accreta Spectrum

“…Despite a growing body of evidence to the contrary, the description of PAS as an invasive placental disorder persists and predominates in the current literature and most recent medical society guidelines on this topic. [28][29][30][31][32][33][34][35][36] Even with a recent move away from the use of traditional histopathologic criteria for diagnostic grade (accreta, increta, percreta), current pathologic 22 and clinical 21 grading schemes rely on invasion as a central component of characterizing disease progression. This, in part, has resulted in an inability to sufficiently predict disease severity 37 and morbidity with antenatal imaging.…”