Placenta Accreta Spectrum (PAS) Disorder: Ultrasound versus Magnetic Resonance Imaging
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Population
2.2. Imaging Acquisition
2.3. Imaging Analysis
2.4. Definitive Diagnosis
2.5. Statistical Analysis
3. Results
3.1. Absence/Presence of PAS
3.2. Diagnosing Grade of PAS
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Palacios-Jaraquemada, J.M.; Basanta, N.; Fiorillo, A.; Labrousse, C.; Martínez, M. Neonatal outcome after conservative-reconstructive surgery for placenta accreta spectrum disorders. J. Matern. Fetal Neonatal Med. 2021, 1–3. [Google Scholar] [CrossRef] [PubMed]
- Silver, R.M.; Branch, D.W. Placenta Accreta Spectrum. N. Engl. J. Med. 2018, 378, 1529–1536. [Google Scholar] [CrossRef] [PubMed]
- Collins, S.L.; Ashcroft, A.; Braun, T.; Calda, P.; Langhoff-Roos, J.; Morel, O.; Stefanovic, V.; Tutschek, B.; Chantraine, F. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet. Gynecol. 2015, 47, 271–275. [Google Scholar] [CrossRef] [Green Version]
- Irving, F.C.; Hertig, A.T. A study of placenta accreta. Surg. Gynec. Obstet. 1937, 64, 178–200. [Google Scholar]
- Morgan, E.A.; Sidebottom, A.; Vacquier, M.; Wunderlich, W.; Loichinger, M. The effect of placental location in cases of placenta accreta spectrum. Am. J. Obstet. Gynecol. 2019, 221, 357.e1–357.e5. [Google Scholar] [CrossRef] [PubMed]
- Jauniaux, E.; Chantraine, F.; Silver, R.M.; Langhoff-Roos, J.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int. J. Gynecol. Obstet. 2018, 140, 265–273. [Google Scholar] [CrossRef] [Green Version]
- Fitzpatrick, K.E.; Sellers, S.; Spark, P.; Kurinczuk, J.J.; Brocklehurst, P.; Knight, M. The management and outcomes of placenta accreta, increta, and percreta in the UK: A population-based descriptive study. BJOG 2014, 121, 62–71. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bailit, J.L.; Grobman, W.A.; Rice, M.M.; Reddy, U.M.; Wapner, R.; Varner, M.; Leveno, K.J.; Iams, J.D.; Tita, A.; Saade, G.; et al. Morbidly Adherent Placenta Treatments and Outcomes. Obstet. Gynecol. 2015, 125, 683–689. [Google Scholar] [CrossRef] [PubMed]
- Thurn, L.; Lindqvist, P.; Jakobsson, M.; Colmorn, L.; Klungsoyr, K.; Bjarnadóttir, R.; Tapper, A.; Børdahl, P.; Gottvall, K.; Petersen, K.; et al. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: Results from a large population-based pregnancy cohort study in the Nordic countries. BJOG: Int. J. Obstet. Gynaecol. 2015, 123, 1348–1355. [Google Scholar] [CrossRef]
- Calì, G.; Timor-Trisch, I.E.; Palacios-Jaraquemada, J.; Monteaugudo, A.; Forlani, F.; Minneci, G.; Foti, F.; Buca, D.; Familiari, A.; Scambia, G.; et al. Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy. Int. J. Gynecol. Obstet. 2018, 140, 319–325. [Google Scholar] [CrossRef]
- Barzilay, E.; Brandt, B.; Gilboa, Y.; Kassif, E.; Achiron, R.; Raviv-Zilka, L.; Katorza, E. Comparative analysis of ultrasound and MRI in the diagnosis of placenta accreta spectrum. J. Matern. Fetal Neonatal Med. 2020, 1–4. [Google Scholar] [CrossRef]
- Jauniaux, E.; Ayres-de-Campos, D.; Langhoff-Roos, J.; Fox, K.A.; Collins, S. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int. J. Gynaecol. Obstet. 2019, 146, 20–24. [Google Scholar] [CrossRef] [Green Version]
- Hecht, J.L.; Baergen, R.; Ernst, L.M.; Katzman, P.J.; Jacques, S.M.; Jauniaux, E.; Khong, T.Y.; Metlay, L.A.; Poder, L.; Qureshi, F.; et al. Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: Recommendations from an expert panel. Mod. Pathol. 2020, 33, 2382–2396. [Google Scholar] [CrossRef]
- D’Antonio, F.; Palacios-Jaraquemada, J.; Timor-Trisch, I.; Cali, G. Placenta accreta spectrum disorders: Prenatal diagnosis still lacks clinical correlation. Acta Obstet. Gynecol. Scand. 2018, 97, 773–775. [Google Scholar] [CrossRef] [Green Version]
- 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, 274–280. [Google Scholar] [CrossRef] [PubMed]
- Collins, S.L.; Alemdar, B.; van Beekhuizen, H.J.; Bertholdt, C.; Braun, T.; Calda, P.; Delorme, P.; Duvekot, J.J.; Gronbeck, L.; Kayem, G.; et al. Evidence-based guidelines for the management of abnormally invasive placenta: Recommendations from the International Society for Abnormally Invasive Placenta. Am. J. Obstet. Gynecol. 2019, 220, 511–526. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kapoor, H.; Hanaoka, M.; Dawkins, A.; Khurana, A. Review of MRI imaging for placenta accreta spectrum: Pathophysiologic insights, imaging signs, and recent developments. Placenta 2021, 104, 31–39. [Google Scholar] [CrossRef]
- D’Antonio, F.; Iacovella, C.; Bhide, A. Prenatal identification of invasive placentation using ultrasound: Systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2013, 42, 509–517. [Google Scholar] [CrossRef] [PubMed]
- Jauniaux, E.; Bhide, A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: A systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2017, 217, 27–36. [Google Scholar] [CrossRef] [Green Version]
- Jauniaux, E.; Alfirevic, Z.; Bhide, A.G.; Belfort, M.A.; Burton, G.J.; Collins, S.; Dornan, S.; Jurkovic, D.; Kayem, G.; Kingdom, J.; et al. Placenta Praevia and Placenta Accreta: Diagnosis and Management. BJOG: Int. J. Obstet. Gynaecol. 2018, 126, e1–e48. [Google Scholar] [CrossRef] [Green Version]
- Del Negro, V.; Aleksa, N.; Galli, C.; Ciminello, E.; Derme, M.; Vena, F.; Muzii, L.; Piccioni, M.G. Ultrasonographic Diagnosis of Placenta Accreta Spectrum (PAS) Disorder: Ideation of an Ultrasonographic Score and Correlation with Surgical and Neonatal Outcomes. Diagnostics 2020, 11, 23. [Google Scholar] [CrossRef] [PubMed]
- Jha, P.; Pōder, L.; Bourgioti, C.; Bharwani, N.; Lewis, S.; Kamath, A.; Nougaret, S.; Soyer, P.; Weston, M.; Castillo, R.P.; et al. 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, 2604–2615. [Google Scholar] [CrossRef] [PubMed]
- Levine, D.; Hulka, C.A.; Ludmir, J.; Li, W.; Edelman, R.R. Placenta accreta: Evaluation with color Doppler US, power Doppler US, and MR imaging. Radiology 1997, 205, 773–776. [Google Scholar] [CrossRef]
- Lim, P.S.; Greenberg, M.; Edelson, M.I.; Bell, K.A.; Edmonds, P.R.; Mackey, A.M. Utility of Ultrasound and MRI in Prenatal Diagnosis of Placenta Accreta: A Pilot Study. AJR Am. J. Roentgenol. 2011, 197, 1506–1513. [Google Scholar] [CrossRef] [PubMed]
- Lopes, E.S.; Feitosa, F.E.D.L.; Brazil, A.V.; de Castro, J.D.V.; da Costa, J.I.F.; Júnior, E.A.; Peixoto, A.B.; Carvalho, F.H.C. Assessment of Sensitivity and Specificity of Ultrasound and Magnetic Resonance Imaging in the Diagnosis of Placenta Accreta. Avaliação da sensibilidade e especificidade da ultrassonografia e ressonância magnética no diagnóstico da placenta acreta. Rev. Bras Ginecol. Obstet. 2019, 41, 17–23. [Google Scholar] [CrossRef] [Green Version]
- Xia, H.; Ke, S.-C.; Qian, R.-R.; Lin, J.-G.; Li, Y.; Zhang, X. Comparison between abdominal ultrasound and nuclear magnetic resonance imaging detection of placenta accreta in the second and third trimester of pregnancy. Medicine 2020, 99, e17908. [Google Scholar] [CrossRef]
- Berkley, E.M.; Abuhamad, A.Z. Prenatal Diagnosis of Placenta Accreta: Is sonography all we need? J. Ultrasound Med. 2013, 32, 1345–1350. [Google Scholar] [CrossRef]
- 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, 35, 1445–1456. [Google Scholar] [CrossRef]
- Allen, B.C.; Leyendecker, J.R. Placental Evaluation with Magnetic Resonance. Radiol. Clin. N. Am. 2013, 51, 955–966. [Google Scholar] [CrossRef]
- Chou, M.M.; Tseng, J.J.; Ho, E.S.C. The application of three-dimensional color power Doppler ultrasound in the depiction of abnormal uteroplacental angioarchitecture in placenta previa percreta. Ultrasound Obstet. Gynecol. 2002, 19, 625–627. [Google Scholar] [CrossRef]
- Rezk, M.; Shawky, M. Grey-scale and colour Doppler ultrasound versus magnetic resonance imaging for the prenatal diagnosis of placenta accreta. J. Matern. Fetal Neonatal Med. 2014, 29, 218–223. [Google Scholar] [CrossRef] [PubMed]
- Ayati, S.; Pourali, L.; Pezeshkirad, M.; Toosi, F.S.; Nekooei, S.; Shakeri, M.T.; Golmohammadi, M.S. Accuracy of color Doppler ultrasonography and magnetic resonance imaging in diagnosis of placenta accreta: A survey of 82 cases. Int. J. Reprod. Biomed. 2017, 15, 225–230. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kumar, I.; Verma, A.; Ojha, R.; Shukla, R.C.; Jain, M.; Srivastava, A. Invasive placental disorders: A prospective US and MRI comparative analysis. Acta Radiol. 2016, 58, 121–128. [Google Scholar] [CrossRef]
- Riteau, A.-S.; Tassin, M.; Chambon, G.; Le Vaillant, C.; De Laveaucoupet, J.; Quere, M.-P.; Joubert, M.; Prevot, S.; Philippe, H.-J.; Benachi, A. Accuracy of Ultrasonography and Magnetic Resonance Imaging in the Diagnosis of Placenta Accreta. PLoS ONE 2014, 9, e94866. [Google Scholar] [CrossRef]
- Meng, X.; Xie, L.; Song, W. Comparing the Diagnostic Value of Ultrasound and Magnetic Resonance Imaging for Placenta Accreta: A Systematic Review and Meta-analysis. Ultrasound Med. Biol. 2013, 39, 1958–1965. [Google Scholar] [CrossRef]
- Jaraquemada, J.M.P.; Bruno, C.H. Magnetic resonance imaging in 300 cases of placenta accreta: Surgical correlation of new findings. Acta Obstet. Gynecol. Scand. 2005, 84, 716–724. [Google Scholar] [CrossRef] [PubMed]
- Baughman, W.C.; Corteville, J.E.; Shah, R.R. Placenta Accreta: Spectrum of US and MR Imaging Findings. RadioGraphics 2008, 28, 1905–1916. [Google Scholar] [CrossRef] [Green Version]
- D’Antonio, F.; Iacovella, C.; Palacios-Jaraquemada, J.; Bruno, C.H.; Manzoli, L.; Bhide, A. Prenatal identification of invasive placentation using magnetic resonance imaging: Systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2014, 44, 8–16. [Google Scholar] [CrossRef]
Characteristics and Risk Factors | No PAS | Accreta | Increta | Percreta | p-Value |
---|---|---|---|---|---|
Number of patients (%) | 79 (75) | 14 (13) | 7 (6.7%) | 4 (3.8%) | |
Mean age (SD) 1 | 37 (5.5) | 38 (5.6) | 40 (7.5) | 38 (8) | 0.73 |
No previous cesarean (%) | 48 (60.8) | 2 (14.3) | 1 (14.3) | 0 | <0.001 |
1 previous cesarean (%) | 24 (30.4) | 7 (50) | 2 (28.6) | 0 | <0.001 |
2 previous cesareans (%) | 5 (6.3) | 3 (21.4) | 1 (14.3) | 3 (75) | <0.001 |
>2 previous cesareans (%) | 2 (2.5) | 2 (14.3) | 3 (42.8) | 1 (25) | <0.001 |
Major placenta previa (%) | 45 (60) | 11 (78.6) | 7 (100) | 4 (100) | 0.02 |
Minor placenta previa (%) | 34 (43) | 3 (21.4) | 0 | 0 | 0.02 |
Previous courettage (%) | 25 (31.6) | 4 (28.6) | 1 (14.3) | 2 (50) | 0.64 |
No previous courettage (%) | 54 (68.4) | 10 (71.4) | 6 (85.7) | 2 (50) | 0.64 |
Variable | Coefficient | SD 1 | p Value |
---|---|---|---|
Intercept | −3.95 | 0.87 | <0.001 |
Previous CS 2 | 1.20 | 0.33 | <0.001 |
Previous courettage | −0.08 | 0.041 | 0.83 |
Previous myomectomy | 2.87 | 1.38 | 0.03 |
Major placenta previa | 1.9 | 0.82 | 0.02 |
US Diagnosis | MRI Diagnosis | ||||
---|---|---|---|---|---|
Histological/ Surgical diagnosis | No PAS | PAS | No PAS | PAS | |
NO PAS (%) | 70 (88.6) | 9 (11.4) | 70 (88.6) | 9 (11.4) | |
PAS (%) | 2 (8) | 23 (92) | 3 (12) | 22 (88) |
US | MRI | |
---|---|---|
Accuracy | 0.89 | 0.88 |
Sensitivity | 0.92 | 0.88 |
Specificity | 0.89 | 0.89 |
PPV 1 | 0.72 | 0.71 |
NPV 2 | 0.97 | 0.95 |
US Diagnosis | MRI Diagnosis | ||||||||
---|---|---|---|---|---|---|---|---|---|
Histological/ Surgical diagnosis | No PAS | Accreta | Increta | Percreta | No PAS | Accreta | Increta | Percreta | |
No PAS (%) | 70 (88.6) | 9 (11.4) | 0 | 0 | 70 (88.6) | 9 (11.4) | 0 | 0 | |
Accreta (%) | 2 (14.3) | 12 (85.7) | 0 | 0 | 2 (14.3) | 10 (71.4) | 2 (14.3) | 0 | |
Increta (%) | 0 | 3 (42.8) | 2 (28.6) | 2 (28.6) | 1 (14.3) | 4 (57.1) | 0 | 2 (28.6) | |
Percreta (%) | 0 | 0 | 0 | 4 (100) | 0 | 1 (25) | 0 | 3 (75) |
Anterior | Posterior | Total | ||
---|---|---|---|---|
US: PAS/no-PAS distinction | Error (%) | 5 (5.8) | 6 (33.3) | 11 (10.6) |
Correct (%) | 81 (92.2) | 12 (66.7) | 93 (89.4) | |
Total | 86 | 18 | 104 | |
Accuracy for anterior placenta | Accuracy for posterior placenta | Difference significance (chi-squared test) | ||
0.94 | 0.67 | p = 0.0024 | ||
MRI: PAS/no-PAS distinction | Error (%) | 6 (7) | 6 (33.3) | 12 (11.5) |
Correct (%) | 80 (93) | 12 (66.7) | 92 (88.5) | |
Total | 86 | 18 | 104 | |
Accuracy for anterior placenta | Accuracy for posterior placenta | Difference significance (chi-squared test) | ||
0.93 | 0.67 | p = 0.0055 |
Anterior | Posterior | Total | ||
---|---|---|---|---|
US | Error (%) | 9 (10.5) | 7 (38.9) | 16 (15.4) |
Correct (%) | 77 (89.5) | 11 (61.1) | 88 (84.6) | |
Total | 86 | 18 | 104 | |
Accuracy for anterior placenta | Accuracy for posterior placenta | Difference significance (chi-squared test) | ||
0.89 | 0.61 | p = 0.0074 | ||
MRI | Error (%) | 13 (15.1) | 8 (44.4) | 21 (20.2) |
Correct (%) | 73 (84.9) | 10 (55.6) | 83 (79.8) | |
Total | 86 | 18 | 104 | |
Accuracy for anterior placenta | Accuracy for posterior placenta | Difference significance (chi-squared test) | ||
0.85 | 0.55 | p = 0.0126 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Faralli, I.; Del Negro, V.; Chinè, A.; Aleksa, N.; Ciminello, E.; Piccioni, M.G. Placenta Accreta Spectrum (PAS) Disorder: Ultrasound versus Magnetic Resonance Imaging. Diagnostics 2022, 12, 2769. https://doi.org/10.3390/diagnostics12112769
Faralli I, Del Negro V, Chinè A, Aleksa N, Ciminello E, Piccioni MG. Placenta Accreta Spectrum (PAS) Disorder: Ultrasound versus Magnetic Resonance Imaging. Diagnostics. 2022; 12(11):2769. https://doi.org/10.3390/diagnostics12112769
Chicago/Turabian StyleFaralli, Ida, Valentina Del Negro, Alessandra Chinè, Natalia Aleksa, Enrico Ciminello, and Maria Grazia Piccioni. 2022. "Placenta Accreta Spectrum (PAS) Disorder: Ultrasound versus Magnetic Resonance Imaging" Diagnostics 12, no. 11: 2769. https://doi.org/10.3390/diagnostics12112769