Andrea Delli Pizzi1, Alessandra Tavoletta2, Roberta Narciso2, Domenico Mastrodicasa3, Stefano Trebeschi4, Claudio Celentano5, Jacopo Mastracchio6, Roberta Cianci2, Barbara Seccia2, Luisa Marrone6, Marco Liberati6, Antonio Raffaele Cotroneo7,2, Massimo Caulo7,2, Raffaella Basilico2. 1. ITAB Institute of Advanced Biomedical Technologies, "G. d'Annunzio" University, Via Luigi Polacchi 11, 66100, Chieti, Italy. andreadellipizzi@gmail.com. 2. Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy. 3. Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA, 94305-5105, USA. 4. Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 5. Department of Medicine and Ageing Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy. 6. Department of Obstetrics and Gynaecology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy. 7. ITAB Institute of Advanced Biomedical Technologies, "G. d'Annunzio" University, Via Luigi Polacchi 11, 66100, Chieti, Italy.
Abstract
PURPOSE: To investigate the diagnostic accuracy of MRI for placenta accreta spectrum (PAS) and clinical outcome prediction in women with placenta previa, using a novel MRI-based predictive model. METHODS: Thirty-eight placental MRI exams performed on a 1.5T scanner were retrospectively reviewed by two radiologists in consensus. The presence of T2 dark bands, myometrial thinning, abnormal vascularity, uterine bulging, placental heterogeneity, placental protrusion sign, placental recess, and percretism signs was scored using a 5-point scale. Pathology and clinical intrapartum findings were the standard of reference for PAS, while intrapartum/peripartum bleeding and emergency hysterectomy defined the clinical outcome. Receiver-operating characteristic (ROC) analysis and discriminant function analysis were performed to test the predictive power of MRI findings for both PAS and clinical outcome prediction. RESULTS: Abnormal vascularity and percretism signs were the two most predictive MRI features of PAS. The area under the curve (AUC) of the predictive function was 0.833 (cutoff 0.39, 67% sensitivity, 100% specificity, p = 0.001). Percretism signs and myometrial thinning were the two most predictive MRI features of poor outcome. AUC of the predictive function was 0.971 (cutoff - 0.55, 100% sensitivity, 77% specificity, p < 0.001). CONCLUSION: The diagnostic accuracy of MRI, especially considering the combination of the most predictive MRI findings, is higher when the target of the prediction is the clinical outcome rather than the PAS.
PURPOSE: To investigate the diagnostic accuracy of MRI for placenta accreta spectrum (PAS) and clinical outcome prediction in women with placenta previa, using a novel MRI-based predictive model. METHODS: Thirty-eight placental MRI exams performed on a 1.5T scanner were retrospectively reviewed by two radiologists in consensus. The presence of T2 dark bands, myometrial thinning, abnormal vascularity, uterine bulging, placental heterogeneity, placental protrusion sign, placental recess, and percretism signs was scored using a 5-point scale. Pathology and clinical intrapartum findings were the standard of reference for PAS, while intrapartum/peripartum bleeding and emergency hysterectomy defined the clinical outcome. Receiver-operating characteristic (ROC) analysis and discriminant function analysis were performed to test the predictive power of MRI findings for both PAS and clinical outcome prediction. RESULTS: Abnormal vascularity and percretism signs were the two most predictive MRI features of PAS. The area under the curve (AUC) of the predictive function was 0.833 (cutoff 0.39, 67% sensitivity, 100% specificity, p = 0.001). Percretism signs and myometrial thinning were the two most predictive MRI features of poor outcome. AUC of the predictive function was 0.971 (cutoff - 0.55, 100% sensitivity, 77% specificity, p < 0.001). CONCLUSION: The diagnostic accuracy of MRI, especially considering the combination of the most predictive MRI findings, is higher when the target of the prediction is the clinical outcome rather than the PAS.