Stripped fetal vessel sign: a novel pathological feature of abnormal fetal vasculature in placenta accreta spectrum disorders with MRI correlates

Konstantinidou, Anastasia; Bourgioti, Charis; Fotopoulos, Stavros; Souka, Efi; Nikolaidou, Maria Evangelia; Zafeiropoulou, Konstantina; Moulopoulos, Lia A.

doi:10.1016/j.placenta.2019.07.005

“…Ueno et al suggested these vessels were of maternal origin arising from the underlying myometrium at the site of invasion and in ltrating the placenta [38]. However, other authors con rmed these abnormal vessels had a fetal origin and were from the cord or chorionic and /or subchorionic placental surface deep into the placenta [39,40]. The abnormal intraplacental vessels ( ≧ 3mm)…”

Section: Discussionmentioning

confidence: 99%

Can functional MRI help differentiate invasive placentas in patients with placenta previa?

Lu,

Li,

Li

et al. 2023

Preprint

0

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Introduction: To investigate if functional MRI can add additional diagnostic value in distinguishing invasive placentas in patients with placenta previa. Methods: A total of 53 patients with invasive placentas and 20 patients with noninvasive placentas were retrospectively enrolled. DWI parameters were measured by volumetric analysis and MRI images were reviewed,respectively. The differences of DWI parameters and MRI features were compared. The receiver operating characteristic (ROC) curve and logistic regression analysis were used to assess the ability of different diffusion parameters and MRI features for distinguishing invasive placentas. Results: Comparisons between patients with invasive and noninvasive placentas demonstrated D mean and D* min were significantly higher while ADC max and D max were significantly lower in patients with invasive placentas (p < 0.05). T2 dark bands, placental heterogeneity, abnormal intraplacental vascularity and placental bulge were associated with invasive placentas (p < 0.05). Multivariate analysis demonstrated that D max was an independent risk factor for invasive placentas. The AUC was 0.79 with sensitivity, specificity, and accuracy of 70%, 87%, and 78.5%, respectively. Discussion: D max helps distinguish invasive placentas in patients with placenta previa.

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“…The sensitivity and specificity of color Doppler imaging in the diagnosis of placenta previa accreta are reportedly 82.4% and 96.8%, respectively, with an 87.5% positive and a 95.3% negative predictive value [13]. A novel pathological feature of abnormal fetal vasculature in placenta accreta spectrum disorders (PASD) was described by Konstantinidou et al [14] in 2019. The histopathological examination of eleven PASD-hysterectomy specimens and subsequent review of the corresponding MRIs revealed the presence of large fetal vascular trunks extending deep towards the placental periphery, demonstrating deficient branching along their course ('stripped-fetal-vessel' sign).…”

Section: Discussionmentioning

confidence: 99%

Undiagnosed placenta previa percreta presenting as an obstetric emergency to the district hospital with inexperienced surgeons: Case report and review of the literature

Okuyan¹,

Bayramoğlu²,

Karakaya³

2019

Journal of Surgery and Medicine

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“…No less than two senior physicians read the images and made MRI imaging diagnoses, and in case of diagnostic disagreement, repeat reading was required until consensus was reached; MRI diagnostic criteria were divided into direct signs and indirect signs with reference to the relevant literature [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical Utility of the Prenatal Ultrasound Score of the Placenta Combined with Magnetic Resonance Imaging in Diagnosis of Placenta Accreta during the Second and Third Trimester of Pregnancy

Zhang

¹

,

Dong²

2022

Contrast Media & Molecular Imaging

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Objective. The aim is to explore the clinical utility of the prenatal ultrasound score of the placenta combined with magnetic resonance imaging (MRI) in diagnosis of placenta accreta during the second and third trimester of pregnancy. Materials and Methods. A total of 108 pregnant women with suspected placenta accreta treated in Wuhan Hankou Hospital and Yantaishan Hospital of Yantai from January 2019 to January 2022 were retrospectively analyzed, the enrolled pregnant women received MRI examination because of suspected results of ultrasonic diagnosis, and by taking pathologic findings as the gold standard, the diagnostic efficacy of the ultrasound score, MRI, and their combination to placenta accreta during the second and third trimester of pregnancy was analyzed, and the diagnostic sensitivity, specificity, the positive predictive value, and the negative predictive value of these diagnostic modalities were evaluated. Results. Among 108 patients with suspected placenta accreta, 75 with pathologically confirmed placenta accreta were included in the accreta group, and 33 without placenta accreta were included in the non-accreta group; no statistical between-group differences in the patients’ age, gestational weeks, educational degree, and other general data were observed ( P > 0.05 ), but the history of cesarean section, history of induced abortion, and incidence rate of placenta praevia were significantly higher in the accreta group than in the non-accreta group ( P < 0.05 ); the ultrasound score was significantly higher in the accreta group than in the non-accreta group ( P < 0.05 ); the incidence rates of signs of “placental heterogeneity” and “bulge of lower segment of the uterus and local thickening of the placenta” were obviously higher in the accreta group than in the non-accreta group ( P < 0.05 ); according to the comparison with pathologic findings, the accuracy rate, sensitivity, specificity, the positive predictive value, and the negative predictive value of combined diagnosis were significantly higher than those of single application of the ultrasound score and MRI diagnosis ( P < 0.05 ); and ROC analysis found that the area under the curve of combined diagnosis was obviously larger than that of the ultrasound score and MRI diagnosis ( P < 0.05 ). Conclusion. A combining prenatal ultrasound score of the placenta with MRI plays an important role in the diagnosis of placenta accreta during the second and third trimester of pregnancy, which can further improve the diagnostic accuracy rate of placenta accreta and provide significant guidance in preventing high-risk complications during the perinatal period.

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Stripped fetal vessel sign: a novel pathological feature of abnormal fetal vasculature in placenta accreta spectrum disorders with MRI correlates

Cited by 12 publications

References 7 publications

Can functional MRI help differentiate invasive placentas in patients with placenta previa?

Can functional MRI help differentiate invasive placentas in patients with placenta previa?

Undiagnosed placenta previa percreta presenting as an obstetric emergency to the district hospital with inexperienced surgeons: Case report and review of the literature

Clinical Utility of the Prenatal Ultrasound Score of the Placenta Combined with Magnetic Resonance Imaging in Diagnosis of Placenta Accreta during the Second and Third Trimester of Pregnancy

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