Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging?

Abstract

Objective: The purpose of this study was to compare the accuracy of transabdominal sonography and magnetic resonance imaging (MRI) for prenatal diagnosis of placenta accreta.

Methods: A historical cohort study was undertaken at 3 institutions identifying women at risk for placenta accreta who had undergone both sonography and MRI prenatally. Sonographic and MRI findings were compared with the final diagnosis as determined at delivery and by pathologic examination.

Results: Thirty-two patients who had both sonography and MRI prenatally to evaluate for placenta accreta were identified. Of these, 15 had confirmation of placenta accreta at delivery. Sonography correctly identified the presence of placenta accreta in 14 of 15 patients (93% sensitivity; 95% confidence interval [CI], 80%-100%) and the absence of placenta accreta in 12 of 17 patients (71% specificity; 95% CI, 49%-93%). Magnetic resonance imaging correctly identified the presence of placenta accreta in 12 of 15 patients (80% sensitivity; 95% CI, 60%-100%) and the absence of placenta accreta in 11 of 17 patients (65% specificity; 95% CI, 42%-88%). In 7 of 32 cases, sonography and MRI had discordant diagnoses: sonography was correct in 5 cases, and MRI was correct in 2. There was no statistical difference in sensitivity (P = .25) or specificity (P = .5) between sonography and MRI.

Conclusions: Both sonography and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. In the case of inconclusive findings with one imaging modality, the other modality may be useful for clarifying the diagnosis.

Figure 1

Concordant true-positive sonographic and MRI findings for diagnosis of placenta accreta in the same patient. A, Gray scale sonogram. Note the loss of the bladder wall-uterine interface and the bulge of the placenta into the bladder. B, Color Doppler sonogram. Note the presence of hypervascularity of the interface between the uterine serosa and the bladder wall. Placental lacunae are also present. C, T2-weighted MRI. Note the absence of the myometrium at the site of placental implantation, the nodular interface between the placenta and the uterus, and the dark intraplacental bands.

Figure 2

Discordant true-positive sonographic and false-negative MRI findings for diagnosis of placenta accreta in the same patient. A and B, Gray scale sonograms. Placenta previa is present. Note the placental lacunae and the poor definition of the placental-uterine interface. C, T2-weighted MRI. Note the relatively homogeneous placenta and the preservation of the placental-uterine interface.

Figure 3

Discordant false-positive sonographic and true-negative MRI findings for diagnosis of placenta accreta in the same patient. A, Gray scale sonograms. Note the presence of placental lacunae. B, Color Doppler sonogram. Note the presence of placental lacunae and hypervascularity of the interface between the uterine serosa and the bladder wall. C, T2-weighted MRI. Note the preserved myometrium at the site of placental implantation and the preserved tissue plane between the placenta and the bladder wall.