The value of specific MRI features in the evaluation of suspected placental invasion.
OBJECTIVE
The objective of this study was to determine imaging features that may help predict the presence of placenta accreta, placenta increta or placenta percreta on prenatal MRI scanning.


METHODS
A retrospective review of the prenatal MR scans of 10 patients with a diagnosis of placenta accreta, placenta increta or placenta percreta made by pathologic and clinical reports and of 10 patients without placental invasion was performed. Two expert MRI readers were blinded to the patients' true diagnosis and were asked to score a total of 17 MRI features of the placenta and adjacent structures. The interrater reliability was assessed using kappa statistics. The features with a moderate kappa statistic or better (kappa > .40) were then compared with the true diagnosis for each observer.


RESULTS
Seven of the scored features had an interobserver reliability of kappa > .40: placenta previa (kappa = .83); abnormal uterine bulging (kappa = .48); intraplacental hemorrhage (kappa = .51); heterogeneity of signal intensity on T2-weighted (T2W) imaging (kappa = .61); the presence of dark intraplacental bands on T2W imaging (kappa = .53); increased placental thickness (kappa = .69); and visualization of the myometrium beneath the placenta on T2W imaging (kappa = .44). Using Fisher's two-sided exact test, there was a statistically significant difference between the proportion of patients with placental invasion and those without placental invasion for three of the features: abnormal uterine bulging (Rater 1, P = .005; Rater 2, P = .011); heterogeneity of T2W imaging signal intensity (Rater 1, P = .006; Rater 2, P = .010); and presence of dark intraplacental bands on T2W imaging (Rater 1, P = .003; Rater 2, P = .033).


CONCLUSIONS
MRI can be a useful adjunct to ultrasound in diagnosing placenta accreta prenatally. Three features that are seen on MRI in patients with placental invasion appear to be useful for diagnosis: uterine bulging; heterogeneous signal intensity within the placenta; and the presence of dark intraplacental bands on T2W imaging.
Lax
Allison
A
Department of Radiology, Columbia University Medical Center, New York, NY 10032, USA. all2010@med.cornell.edu
Prince
Martin R
MR
Mennitt
Kevin W
KW
Schwebach
J Reid
JR
Budorick
Nancy E
NE
D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D010920:Placenta / Q000000981:diagnostic imaging / Q000473:pathology; D010921:Placenta Accreta / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D010923:Placenta Previa / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D014463:Ultrasonography