Priyanka Jha1, Liina Pōder2, Charis Bourgioti3, Nishat Bharwani4,5, Sara Lewis6, Amita Kamath6, Stephanie Nougaret7, Philippe Soyer8,9, Michael Weston10, Rosa P Castillo11, Aki Kido12, Rosemarie Forstner13, Gabriele Masselli14. 1. Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, BOX 0628, San Francisco, CA, 94143, USA. priyanka.jha@ucsf.edu. 2. Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, BOX 0628, San Francisco, CA, 94143, USA. 3. Division of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece. 4. Department of Radiology, Imperial College Healthcare NHS Trust, London, UK. 5. Department of Surgery & Cancer, Imperial College London, London, UK. 6. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 7. Department of Radiology, Montpellier Cancer Research Institute (IRCM), Montpellier, France. 8. Department of Radiology, Cochin Hospital AP-HP, Paris, 75014, France. 9. University of Paris, Descartes-Paris 5, Paris, 75006, France. 10. Department of Radiology, St James's University Hospital, Leeds, UK. 11. Department of Diagnostic Radiology, University of Miami, Miami, FL, USA. 12. Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan. 13. Department of Radiology, Paracelsus Medical University, Müllner Hauptstr, Salzburg, Austria. 14. Radiology Department, Umberto I Hospital, Sapienza University, Rome, Italy.
Abstract
OBJECTIVES: This study was conducted in order to establish the joint Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) guidelines on placenta accreta spectrum (PAS) disorders and propose strategies to standardize image acquisition, interpretation, and reporting for this condition with MRI. METHODS: The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to questions regarding the details of patient preparation, MRI protocol, image interpretation, and reporting were collected, analyzed, and classified as "recommended" versus "not recommended" (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts). RESULTS: Consensus regarding image acquisition, interpretation, and reporting was determined using the RAND-UCLA Appropriateness Method. The use of a tailored MRI protocol and standardized report was recommended. CONCLUSIONS: A standardized imaging protocol and reporting system ensures recognition of the salient features of PAS disorders. These consensus recommendations should be used as a guide for the evaluation of PAS disorders with MRI. KEY POINTS: • MRI is a powerful adjunct to ultrasound and provides valuable information on the topography and depth of placental invasion. • Consensus statement proposed a common lexicon to allow for uniformity in MRI acquisition, interpretation, and reporting of PAS disorders. • Seven MRI features, namely intraplacental dark T2 bands, uterine/placental bulge, loss of low T2 retroplacental line, myometrial thinning/disruption, bladder wall interruption, focal exophytic placental mass, and abnormal vasculature of the placental bed, reached consensus and are categorized as "recommended" for diagnosing PAS disorders.
OBJECTIVES: This study was conducted in order to establish the joint Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) guidelines on placenta accreta spectrum (PAS) disorders and propose strategies to standardize image acquisition, interpretation, and reporting for this condition with MRI. METHODS: The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to questions regarding the details of patient preparation, MRI protocol, image interpretation, and reporting were collected, analyzed, and classified as "recommended" versus "not recommended" (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts). RESULTS: Consensus regarding image acquisition, interpretation, and reporting was determined using the RAND-UCLA Appropriateness Method. The use of a tailored MRI protocol and standardized report was recommended. CONCLUSIONS: A standardized imaging protocol and reporting system ensures recognition of the salient features of PAS disorders. These consensus recommendations should be used as a guide for the evaluation of PAS disorders with MRI. KEY POINTS: • MRI is a powerful adjunct to ultrasound and provides valuable information on the topography and depth of placental invasion. • Consensus statement proposed a common lexicon to allow for uniformity in MRI acquisition, interpretation, and reporting of PAS disorders. • Seven MRI features, namely intraplacental dark T2 bands, uterine/placental bulge, loss of low T2 retroplacental line, myometrial thinning/disruption, bladder wall interruption, focal exophytic placental mass, and abnormal vasculature of the placental bed, reached consensus and are categorized as "recommended" for diagnosing PAS disorders.
Entities:
Keywords:
Consensus; Magnetic resonance imaging; Placenta accreta; Placenta diseases
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