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. 2014 Apr 14;9(4):e94866.
doi: 10.1371/journal.pone.0094866. eCollection 2014.

Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta

Anne-Sophie Riteau  1 , Mikael Tassin  2 , Guillemette Chambon  2 , Claudine Le Vaillant  3 , Jocelyne de Laveaucoupet  4 , Marie-Pierre Quéré  5 , Madeleine Joubert  6 , Sophie Prevot  7 , Henri-Jean Philippe  3 , Alexandra Benachi  2
Affiliations

Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta

Anne-Sophie Riteau et al. PLoS One. .

Abstract

Purpose: To evaluate the accuracy of ultrasonography and magnetic resonance imaging (MRI) in the diagnosis of placenta accreta and to define the most relevant specific ultrasound and MRI features that may predict placental invasion.

Material and methods: This study was approved by the institutional review board of the French College of Obstetricians and Gynecologists. We retrospectively reviewed the medical records of all patients referred for suspected placenta accreta to two university hospitals from 01/2001 to 05/2012. Our study population included 42 pregnant women who had been investigated by both ultrasonography and MRI. Ultrasound images and MRI were blindly reassessed for each case by 2 raters in order to score features that predict abnormal placental invasion.

Results: Sensitivity in the diagnosis of placenta accreta was 100% with ultrasound and 76.9% for MRI (P = 0.03). Specificity was 37.5% with ultrasonography and 50% for MRI (P = 0.6). The features of greatest sensitivity on ultrasonography were intraplacental lacunae and loss of the normal retroplacental clear space. Increased vascularization in the uterine serosa-bladder wall interface and vascularization perpendicular to the uterine wall had the best positive predictive value (92%). At MRI, uterine bulging had the best positive predictive value (85%) and its combination with the presence of dark intraplacental bands on T2-weighted images improved the predictive value to 90%.

Conclusion: Ultrasound imaging is the mainstay of screening for placenta accreta. MRI appears to be complementary to ultrasonography, especially when there are few ultrasound signs.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Loss of the normal retroplacental clear space on ultrasonography.
Figure 2
Figure 2. Uterine bulging and disruption of the hyperechogenic uterine serosa-bladder wall interface on ultrasonography.
Figure 3
Figure 3. Uterine bulging into the bladder on MRI.
Figure 4
Figure 4. A–B - Dark intraplacental bands on T2-weighted images on MRI.
Figure 5
Figure 5. Concordance between ultrasound and MRI.
Figure 6
Figure 6. Sensitivity and specificity of ultrasound features.
Figure 7
Figure 7. Sensitivity and specificity of MRI features.
Figure 8
Figure 8. A–B - Intraplacental vascularization perpendicular to the myometrium and hypervascularization on ultrasound.
See this image and copyright information in PMC

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