Xin Chen1, Ruiqin Shan2, Lianxin Zhao3, Qingxu Song4, Changting Zuo5, Xinjuan Zhang1, Shanshan Wang1, Honglu Shi1, Fei Gao1, Tianyi Qian6, Guangbin Wang7, Catherine Limperopoulos8,9. 1. Department of MR, Shandong Medical Imaging Research Institute, Shandong University, 324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China. 2. Department of Obstetrics, Jinan Maternity and Child Care Hospital, 2 Jianguoxiaojingsan Road, Jinan, 250001, People's Republic of China. 3. Department of Radiology, Qilu Hospital of Shandong University, 107, Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China. 4. Department of Radiation Oncology, Qilu Hospital of Shandong University, 107, Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China. 5. Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, 107, Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China. 6. Siemens Healthcare, MR Collaborations NE Asia, Beijing, 100000, People's Republic of China. 7. Department of MR, Shandong Medical Imaging Research Institute, Shandong University, 324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China. wgb7932596@hotmail.com. 8. Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC, 20010, USA. 9. Department of Radiology, George Washington University School of Medicine, Washington, DC, 20052, USA.
Abstract
OBJECTIVES: To characterise MRI features of invasive placenta previa and to identify specific features for differentiating placenta percreta (PP) from placenta accreta (PA). METHODS: Forty-five women with PP and 93 women with PA who underwent 1.5T placental MRI were included. Two radiologists independently evaluated the MRI features of invasive placenta previa, including our novel type of placental bulge (i.e. placental bulge type-II, characterized by placental bulge with distorted uterine outline). Pearson's chi-squared or Fisher's two-sided exact test was performed to compare the MRI features between PP and PA. Logistic stepwise regression analysis and the area under the receiver operating characteristic curve (AUC) were performed to select the optimal features for differentiating PP from PA. RESULTS: Significant differences were found in nine MRI features between women with PP and those with PA (P <0.05). Placental bulge type-II and uterine serosal hypervascularity were independently associated with PP (odds ratio = 48.618, P < 0.001; odds ratio = 4.165, P = 0.018 respectively), and the combination of the two MRI features to distinguish PP from PA yielded an AUC of 0.92 for its predictive performance. CONCLUSION: Placental bulge type-II and uterine serosal hypervascularity are useful MRI features for differentiating PP from PA. KEY POINTS: • Placental bulge type-II demonstrated the strongest independent association with PP. • Uterine serosal hypervascularity is a useful feature for differentiating PP from PA. • MRI features associated with abnormal vessels increase the risk of massive haemorrhage.
OBJECTIVES: To characterise MRI features of invasive placenta previa and to identify specific features for differentiating placenta percreta (PP) from placenta accreta (PA). METHODS: Forty-five women with PP and 93 women with PA who underwent 1.5T placental MRI were included. Two radiologists independently evaluated the MRI features of invasive placenta previa, including our novel type of placental bulge (i.e. placental bulge type-II, characterized by placental bulge with distorted uterine outline). Pearson's chi-squared or Fisher's two-sided exact test was performed to compare the MRI features between PP and PA. Logistic stepwise regression analysis and the area under the receiver operating characteristic curve (AUC) were performed to select the optimal features for differentiating PP from PA. RESULTS: Significant differences were found in nine MRI features between women with PP and those with PA (P <0.05). Placental bulge type-II and uterine serosal hypervascularity were independently associated with PP (odds ratio = 48.618, P < 0.001; odds ratio = 4.165, P = 0.018 respectively), and the combination of the two MRI features to distinguish PP from PA yielded an AUC of 0.92 for its predictive performance. CONCLUSION: Placental bulge type-II and uterine serosal hypervascularity are useful MRI features for differentiating PP from PA. KEY POINTS: • Placental bulge type-II demonstrated the strongest independent association with PP. • Uterine serosal hypervascularity is a useful feature for differentiating PP from PA. • MRI features associated with abnormal vessels increase the risk of massive haemorrhage.
Authors: John R Leyendecker; Melinda DuBose; Keyanoosh Hosseinzadeh; Ryan Stone; John Gianini; David D Childs; Anthony N Snow; Heather Mertz Journal: AJR Am J Roentgenol Date: 2012-02 Impact factor: 3.959
Authors: F D'Antonio; C Iacovella; J Palacios-Jaraquemada; C H Bruno; L Manzoli; A Bhide Journal: Ultrasound Obstet Gynecol Date: 2014-06-02 Impact factor: 7.299
Authors: Carri R Warshak; Gladys A Ramos; Ramez Eskander; Kurt Benirschke; Cheryl C Saenz; Thomas F Kelly; Thomas R Moore; Robert Resnik Journal: Obstet Gynecol Date: 2010-01 Impact factor: 7.661