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Qualitative evaluation of MR images for assessing placenta accreta spectrum disorders in patients with placenta previa: A pilot validation study

Published:November 28, 2021DOI:https://doi.org/10.1016/j.ejrad.2021.110078

      Highlights

      • MRI is a reproducible tool for the detection of PAS in high-risk patients.
      • Dark bands, focal interruption of myometrial border, abnormal vascularity.
      • At least two abnormal MRI signs is a useful method to assess PAS.
      • Placental MRI for PAS evaluation requires imaging expertise and methodology.

      Abstract

      Purpose

      To validate a qualitative imaging method using magnetic resonance (MR) for predicting placental accreta spectrum (PAS) in patients with placenta previa (PP).

      Method

      Two MR imaging methods built in our previous experience was tested in an external comparable group of sixty-five patients with PP; these methods consisted of presence of at least one (Method 1) or two (Method 2) of the following abnormal MR imaging signs: intraplacental dark bands, focal interruption of myometrial border and abnormal placental vascularity. Three groups of radiologists with different level of expertise evaluated MR images: at least 5 years of experience in body imaging (Group 1); at least 10 (Group 2) or 20 (Group 3) years of experience in genito-urinary MR. While radiologists of Group 1 routinely evaluated MR images, those of Groups 2 and 3 used both Methods 1 and 2.

      Results

      A significant (p < 0.005) difference was found between the diagnostic accuracy values of imaging evaluation performed by Group 3 using Method 1 (63%) and Method 2 (89%); of note, the accuracy of Method 2 by Group 3 was also significantly (p < 0.005) higher compared to that of both Methods 1 (46%) and 2 (63%) by Group 2 as well as to that of the routine evaluation by Group 1 (60%).

      Conclusions

      The qualitative identification of at least two abnormal MR signs (Method 2) represents an accurate method for predicting PAS in patients with PP particularly when this method was used by more experienced radiologists; thus, imaging expertise and methodology is required for this purpose.

      Keywords

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      References

      1. Obstetric Care Consensus No. 7, Obstet. Gynecol. 132 (2018) e259–e275. https://doi.org/10.1097/AOG.0000000000002983.

        • Jauniaux E.
        • Bhide A.
        • Kennedy A.
        • Woodward P.
        • Hubinont C.
        • Collins S.
        FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening.
        Int. J. Gynecol. Obstet. 2018; 140: 274-280https://doi.org/10.1002/ijgo.12408
        • Zaghal A.A.
        • Hussain H.K.
        • Berjawi G.A.
        MRI evaluation of the placenta from normal variants to abnormalities of implantation and malignancies.
        J. Magn. Reson. Imaging. 2019; 50: 1702-1717https://doi.org/10.1002/jmri.v50.610.1002/jmri.26764
        • Woodward P.J.
        • Kennedy A.
        • Einerson B.D.
        Is There a Role for MRI in the Management of Placenta Accreta Spectrum?.
        Curr. Obstet. Gynecol. Rep. 2019; 8: 64-70https://doi.org/10.1007/s13669-019-00266-9
        • Jha P.
        • Pōder L.
        • Bourgioti C.
        • Bharwani N.
        • Lewis S.
        • Kamath A.
        • Nougaret S.
        • Soyer P.
        • Weston M.
        • Castillo R.P.
        • Kido A.
        • Forstner R.
        • Masselli G.
        Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders.
        Eur. Radiol. 2020; 30: 2604-2615https://doi.org/10.1007/s00330-019-06617-7
        • Rahaim N.S.A.
        • Whitby E.H.
        The MRI features of placental adhesion disorder and their diagnostic significance: systematic review.
        Clin. Radiol. 2015; 70: 917-925https://doi.org/10.1016/j.crad.2015.04.010
        • Alamo L.
        • Anaye A.
        • Rey J.
        • Denys A.
        • Bongartz G.
        • Terraz S.
        • Artemisia S.
        • Meuli R.
        • Schmidt S.
        Detection of suspected placental invasion by MRI: Do the results depend on observer’ experience?.
        Eur. J. Radiol. 2013; 82: e51-e57https://doi.org/10.1016/j.ejrad.2012.08.022
        • Ueno Y.
        • Maeda T.
        • Tanaka U.
        • Tanimura K.
        • Kitajima K.
        • Suenaga Y.
        • Takahashi S.
        • Yamada H.
        • Sugimura K.
        Evaluation of interobserver variability and diagnostic performance of developed MRI-based radiological scoring system for invasive placenta previa.
        J. Magn. Reson. Imaging. 2016; 44: 573-583https://doi.org/10.1002/jmri.v44.310.1002/jmri.25184
        • Ghezzi C.L.A.
        • Silva C.K.
        • Casagrande A.S.
        • Westphalen S.S.
        • Salazar C.C.
        • Vettorazzi J.
        Diagnostic performance of radiologists with different levels of experience in the interpretation of MRI of the placenta accreta spectrum disorder.
        Br. J. Radiol. 2021; : 20210827https://doi.org/10.1259/bjr.20210827
        • Noda Y.
        • Kanematsu M.
        • Goshima S.
        • Kondo H.
        • Watanabe H.
        • Kawada H.
        • Kawai N.
        • Tanahashi Y.
        • Furui T.
        • Morishige K.-I.
        • Bae K.T.
        Prenatal MR imaging diagnosis of placental invasion.
        Abdom. Imaging. 2015; 40: 1273-1278https://doi.org/10.1007/s00261-014-0281-z
        • Valentini A.L.
        • Gui B.
        • Ninivaggi V.
        • Miccò M.
        • Giuliani M.
        • Russo L.
        • Marini M.G.
        • Tintoni M.
        • Cavaliere A.F.
        • Bonomo L.
        The morbidly adherent placenta: When and what association of signs can improve MRI diagnosis? our experience.
        Diagnostic Interv. Radiol. 2017; 23: 180-186https://doi.org/10.5152/dir10.5152/dir.201710.5152/dir.2017.16275
        • Balcacer P.
        • Pahade J.
        • Spektor M.
        • Staib L.
        • Copel J.A.
        • McCarthy S.
        Magnetic resonance imaging and sonography in the diagnosis of placental invasion.
        J. Ultrasound Med. 2016; https://doi.org/10.7863/ultra.15.07040
        • Maurea S.
        • Romeo V.
        • Mainenti P.P.
        • Ginocchio M.I.
        • Frauenfelder G.
        • Verde F.
        • Liuzzi R.
        • D’Armiento M.
        • Sarno L.
        • Morlando M.
        • Petretta M.
        • Martinelli P.
        • Brunetti A.
        Diagnostic accuracy of magnetic resonance imaging in assessing placental adhesion disorder in patients with placenta previa: Correlation with histological findings.
        Eur. J. Radiol. 2018; 106: 77-84https://doi.org/10.1016/j.ejrad.2018.07.014
        • Romeo V.
        • Sarno L.
        • Volpe A.
        • Ginocchio M.I.
        • Esposito R.
        • Mainenti P.P.
        • Petretta M.
        • Liuzzi R.
        • D’Armiento M.
        • Martinelli P.
        • Brunetti A.
        • Maurea S.
        US and MR imaging findings to detect placental adhesion spectrum (PAS) in patients with placenta previa: a comparative systematic study.
        Abdom. Radiol. 2019; 44: 3398-3407https://doi.org/10.1007/s00261-019-02185-y
        • Li Q.
        • Zhou H.
        • Zhou K.
        • He J.
        • Shi Z.
        • Wang Z.
        • Dai Y.
        • Hu Y.
        Development and validation of a magnetic resonance imaging-based nomogram for predicting invasive forms of placental accreta spectrum disorders.
        J. Obstet. Gynaecol. Res. 2021; 47: 3488-3497https://doi.org/10.1111/jog.v47.1010.1111/jog.14982
        • Chu C.
        • Liu M.
        • Zhang Y.
        • Yu L.
        • Wang D.
        • Gao C.
        • Li W.
        Quantifying magnetic resonance imaging features to classify placenta accreta spectrum (PAS) in high-risk gravid patients.
        Clin. Imaging. 2021; 80: 50-57https://doi.org/10.1016/j.clinimag.2021.04.025
        • Romeo V.
        • Verde F.
        • Sarno L.
        • Migliorini S.
        • Petretta M.
        • Mainenti P.P.
        • D’Armiento M.
        • Guida M.
        • Brunetti A.
        • Maurea S.
        Prediction of placenta accreta spectrum in patients with placenta previa using clinical risk factors, ultrasound and magnetic resonance imaging findings.
        Radiol. Medica. 2021; 126: 1216-1225https://doi.org/10.1007/s11547-021-01348-6
        • Siauve N.
        How and why should the radiologist look at the placenta?.
        Eur. Radiol. 2019; 29: 6149-6151https://doi.org/10.1007/s00330-019-06373-8
        • Romeo V.
        • Maurea S.
        The new era of advanced placental tissue characterization using MRI texture analysis: Clinical implications.
        EBioMedicine. 2020; 51: 102588https://doi.org/10.1016/j.ebiom.2019.11.049
        • Romeo V.
        • Ricciardi C.
        • Cuocolo R.
        • Stanzione A.
        • Verde F.
        • Sarno L.
        • Improta G.
        • Mainenti P.P.
        • D’Armiento M.
        • Brunetti A.
        • Maurea S.
        Machine learning analysis of MRI-derived texture features to predict placenta accreta spectrum in patients with placenta previa.
        Magn. Reson. Imaging. 2019; 64: 71-76https://doi.org/10.1016/j.mri.2019.05.017
        • Sun H.
        • Qu H.
        • Chen L.u.
        • Wang W.
        • Liao Y.i.
        • Zou L.
        • Zhou Z.
        • Wang X.
        • Zhou S.
        Identification of suspicious invasive placentation based on clinical MRI data using textural features and automated machine learning.
        Eur. Radiol. 2019; 29: 6152-6162https://doi.org/10.1007/s00330-019-06372-9
        • Do Q.N.
        • Lewis M.A.
        • Xi Y.
        • Madhuranthakam A.J.
        • Happe S.K.
        • Dashe J.S.
        • Lenkinski R.E.
        • Khan A.
        • Twickler D.M.
        MRI of the Placenta Accreta Spectrum (PAS) Disorder: Radiomics Analysis Correlates With Surgical and Pathological Outcome.
        J. Magn. Reson. Imaging. 2020; 51: 936-946https://doi.org/10.1002/jmri.v51.310.1002/jmri.26883
        • Chen E.
        • Mar W.A.
        • Horowitz J.M.
        • Allen A.
        • Jha P.
        • Cantrell D.R.
        • Cai K.
        Texture analysis of placental MRI: can it aid in the prenatal diagnosis of placenta accreta spectrum?.
        Abdom. Radiol. (New York). 2019; 44: 3175-3184https://doi.org/10.1007/s00261-019-02104-1
        • Xuan R.
        • Li T.
        • Wang Y.
        • Xu J.
        • Jin W.
        Prenatal prediction and typing of placental invasion using MRI deep and radiomic features.
        Biomed. Eng. Online. 2021; 20: 56https://doi.org/10.1186/s12938-021-00893-5
        • Nelson L.W.
        • Richardson D.
        • Chavan N.R.
        • Kapoor H.
        • Stanley Z.D.
        • Gulati V.
        • Winfrey O.K.
        • Khurana A.
        Correlation of placental MR imaging signs and pathologic diagnosis of placenta accreta spectrum: Retrospective single center case series.
        Eur. J. Obstet. Gynecol. Reprod. Biol. 2021; 262: 239-247https://doi.org/10.1016/j.ejogrb.2021.05.031