Magnetic resonance imaging versus color Doppler ultrasound for assessment of placenta accreta spectrum disorders: A prospective cohort study
DOI:
https://doi.org/10.37800/RM.1.2026.660Keywords:
Placenta accreta spectrum , magnetic resonance imaging , Color Doppler ultrasound, Prenatal diagnosis, Obstetric hemorrhageAbstract
Relevance: Placenta Accreta Spectrum (PAS) disorders are an important cause of severe postpartum hemorrhage and are associated with significant maternal morbidity. Timely and accurate antenatal diagnosis plays a key role in planning delivery and reducing complications. Ultrasound (US) is considered the primary imaging tool for evaluating suspected PAS.
This study was designed to evaluate and compare the diagnostic value of color Doppler ultrasound and magnetic resonance imaging in detecting placenta accreta spectrum (PAS) disorders.
Materials and Methods: This prospective cohort study was conducted at Ain Shams University Maternity Hospital in Cairo, Egypt, over two years from October 2021 to October 2023. Ninety pregnant women with suspected PAS were included. Imaging assessment for each patient was done using both color Doppler ultrasound (CDUS) and magnetic resonance imaging (MRI), which were later compared with surgical observations and histopathological examination.
Results: There was a statistically significant increase in the percentage of patients with placenta accreta with completely covered cervix, loss of retroplacental space, uterine bulge, invasion of myometrium and disruption of serosa bladder in patients with placenta accreta (92.5%, 47.5%, 62.5%, 92.5%, 12.5% and 20.0%, respectively) than patients without placenta accreta (76.0%, 24.0%, 14.0%, 34.0%, 0.0% and 4.0%, respectively). Also, the MRI comment shows that the percentage of placenta previa and focal accreta cases was higher in patients without placenta accreta (52.0% and 6.0%, respectively) than in those with placenta accreta (0.0% and 15.0%, respectively) (p < 0.001).
Conclusions: MRI is superior to CDUS for diagnosing placenta accreta spectrum disorders during the antenatal period, with significantly higher diagnostic accuracy. MRI should be considered, particularly when US findings are inconclusive or when there is a high risk of placenta accreta.
References
1. Jauniaux ER, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, Dornan S, Jurkovic D, Kayem G, Silver R, Sentilhes L. Placenta praevia and placenta accreta: diagnosis and management: green-top guideline no. 27a. Bjog. 2018 Dec 11;126(1):e1-48.
https://doi.org/10.1111/1471-0528.15306
2. Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015 Sep 1;126(3):654-68.
https://doi.org/10.1097/AOG.0000000000001005
3. Jenabi E, Salimi Z, Bashirian S, Khazaei S, Ayubi E. The risk factors associated with placenta previa: An umbrella review. Placenta. 2022 Jan 1;117:21-7.
https://doi.org/10.1016/j.placenta.2021.10.009
4. Einerson BD, Rodriguez CE, Kennedy AM, Woodward PJ, Donnelly MA, Silver RM. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am J Obstet Gynecol. 2018 Jun 1;218(6):618-e1.
https://doi.org/10.1016/j.ajog.2018.03.013
5. Ayati S, Pourali L, Pezeshkirad M, Toosi FS, Nekooei S, Shakeri MT, Golmohammadi MS. Accuracy of color Doppler ultrasonography and magnetic resonance imaging in diagnosis of placenta accreta: A survey of 82 cases. Int J Reprod BioMed. 2017 Apr 10;15(4):225.
https://pubmed.ncbi.nlm.nih.gov/28835939/
6. Jauniaux E, Jurkovic D, Hussein AM, Burton GJ. New insights into the etiopathology of placenta accreta spectrum. Am J Obstet Gynecol. 2022 Sep 1;227(3):384-91.
https://doi.org/10.1016/j.ajog.2022.02.038
7. Matsuzaki S, Takiuchi T, Kanagawa T, Matsuzaki S, Lee M, Maeda M, Endo M, Kimura T. Maternal and fetal outcomes after prior mid-trimester uterine rupture: a systematic review with our experience. Medicina. 2021 Nov 24;57(12):1294.
https://doi.org/10.3390/medicina57121294
8. Palacios-Jaraquemada JM, Fiorillo A, Hamer J, Martínez M, Bruno C. Placenta accreta spectrum: a hysterectomy can be prevented in almost 80% of cases using a resective-reconstructive technique. J Maternal Fetal Neonat Med. 2022 Jan 17;35(2):275-82.
https://doi.org/10.1080/14767058.2020.1716715
9. Ahmed HA, Ahmed AA, Ahmed KA, Sakr AI. Accuracy of MRI vs ultrasound in the diagnosis of placental adhesive disorder. Al-Azhar Assiut Med J. 2020 Jul 1;18(3):317-24.
https://doi.org/10.4103/AZMJ.AZMJ_67_20
10. Gupta P, Dutta U, Rana P, Singhal M, Gulati A, Kalra N, Soundararajan R, Kalage D, Chhabra M, Sharma V, Gupta V. Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography: an international expert consensus. Abdomin Radiol. 2022 Feb;47(2):554-65.
https://doi.org/10.1007/s00261-021-03360-w
11. Tanimura K, Shi Y, Imafuku H, Nakanishi T, Kanzawa M, Terai Y. Sudden fetal death with placental mesenchymal dysplasia complicated by placenta previa. J Obstet Gynaecol Res. 2021 Nov;47(11):4087-92.
https://doi.org/10.1111/jog.14991
12. 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 Jan 15;104:31-9.
https://doi.org/10.1016/j.placenta.2020.11.004
13. Borg HM, Ossman AM, Salem HA, El-Hemedi M, El-Shafie K, Alarabawya RA. Color Doppler ultrasound in diagnosis of placenta accreta. Evidence-Based Women’s Health J. 2018 Aug 1;8(3):215-22.
https://doi.org/10.21608/ebwhj.2018.15471
14. Rezk MA, Shawky M. Grey-scale and colour Doppler ultrasound versus magnetic resonance imaging for the prenatal diagnosis of placenta accreta. J Matern Fetal Neonat Med. 2016; 29(2):218-23.
https://doi.org/10.3109/14767058.2014.993604
15. Riteau AS, Tassin M, Chambon G, Le Vaillant C, de Laveaucoupet J, Quéré MP, Joubert M, Prevot S, Philippe HJ, Benachi A. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. PLoS One. 2014 Apr 14;9(4):e94866.
https://doi.org/10.1371/journal.pone.0094866
16. Shweel MA, El Ameen NF, Ibrahiem MA, Kotib A. Placenta accreta in women with prior uterine surgery: Diagnostic accuracy of Doppler ultrasonography and MRI. Egypt J Radiol Nuclear Med. 2012 Sep 1;43(3):473-80.
https://doi.org/10.1016/j.ejrnm.2012.05.004
17. Elhawary TM, Dabees NL, Youssef MA. Diagnostic value of ultrasonography and magnetic resonance imaging in pregnant women at risk for placenta accreta. J Matern Fetal Neonat Med. 2013;26(14):1443-9.
https://doi.org/10.3109/14767058.2013.784740
18. Zapien-Terrones BC, Naves-Sánchez J, Sosa-Bustamante GP, González AP, Paque-Bautista C, Luna-Anguiano JL, Peralta-Cortázar C. Diagnóstico prenatal de acretismo placentario por ultrasonido y su asociación histopatológica. Rev Méd Inst Mex Seguro Soc. 2023;61(Suppl 2):S96. Spanish.
https://pubmed.ncbi.nlm.nih.gov/38011191/
19. El Wakeel A, Azab S, Rahman HA. Role of ultrasound, Doppler, and MRI in the diagnosis of placenta accreta. Menoufia Med J. 2018 Jul 1;31(3):1023.
https://doi.org/10.4103/mmj.mmj_80_17
20. Badr AA, El-Maghraby IM. Placenta accreta index as a predictor of placental invasion in cases of placenta previa. J Med Sci Res. 2022;5(3):9.
https://doi.org/10.4103/jmisr.jmisr_9_21
21. Farquhar CM, Li Z, Lensen S, McLintock C, Pollock W, Peek MJ, Ellwood D, Knight M, Homer CS, Vaughan G, Wang A. Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case–control study. BMJ Open. 2017 Oct 1;7(10):e017713.
https://doi.org/10.1136/bmjopen-2017-017713
22. Marsoosi V, Ghotbizadeh F, Hashemi N, Molaei B. Development of a scoring system for prediction of placenta accreta and determine the accuracy of its results. J Matern Fetal Neonatal Med. 2020 Jun 2;33(11):1824-30.
https://doi.org/10.1080/14767058.2018.1531119
23. Kılıçcı Ç, Eken MK, İlhan G, Çöğendez E, Şanverdi İ, Keskin M, Abide ÇY, Karateke A. Evaluation of risk factors, incidence, perinatal and maternal outcome of placenta previa cases with and without placenta accreta spectrum. Duzce Med J. 2018;19(3):75-80.
https://dergipark.org.tr/en/pub/dtfd/article/418955
24. De Gennaro E, Orsaria M, Driul L. Placenta accreta in the first trimester: A case report. Clin Case Rep. 2021 Sep;9(9):e04615.
https://doi.org/10.1002/ccr3.4615.
25. Hamisa M, Mashaly E, Fathy S, Tawfeek A. Role of Doppler US and MRI in diagnosis of placenta accreta. Alexandria J Med. 2015 Sep 15;51(3):225-30.
https://doi.org/10.1016/j.ajme.2014.09.002
26. Jaisankar P, Kumar MV, Gowtham RR, Vinoth T. Accuracy of ultrasound and magnetic resonance imaging in predicting placenta accreta: A retrospective study. Curr Med Iss. 2023 Apr 1;21(2):83-7.
https://doi.org/10.4103/cmi.cmi_85_22
27. Mohammadi A, Bouzari Z, Hajian-Tilaki K, Nabahati M, Mehraeen R. Role of scaling combination of risk factors in clinical and imaging findings during pregnancy in predicting placenta accreta spectrum. Caspian J Intern Med. 2022;13(1):10.
https://doi.org/10.22088/cjim.13.1.10
28. Shteynman L, Monanian G, Torres G, Sabetta G, Li DM, Jin Z, Angelo T, Daoud BE, Factor M. Pathophysiology and Management of Placenta Accreta Spectrum. J Dev Biol. 2025 Dec 10;13(4):45.
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