title: Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta.
abstract: OBJECTIVE
  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.
  
  
  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%.
  
  
  CONCLUSIONS
  Ultrasound imaging is the mainstay of screening for placenta accreta. MRI appears to be complementary to ultrasonography, especially when there are few ultrasound signs.
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, APHP, Clamart, France; Department of Obstetrics and Gynecology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, Nantes, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Riteau
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, APHP, Clamart, France.
authors.forename: Mikael
authors.initials: M
authors.lastname: Tassin
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, APHP, Clamart, France.
authors.forename: Guillemette
authors.initials: G
authors.lastname: Chambon
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, Nantes, France.
authors.forename: Claudine
authors.initials: C
authors.lastname: Le Vaillant
authors.affiliation: Department of Radiology, Hôpital Antoine Béclère, APHP, Clamart, France.
authors.forename: Jocelyne
authors.initials: J
authors.lastname: de Laveaucoupet
authors.affiliation: Department of Radiology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, Nantes, France.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Quéré
authors.affiliation: Department of Pathology, Hôpital Mère Enfant, Centre Hospitalier Universitaire Nantes, France.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Joubert
authors.affiliation: Department of Pathology, Hôpital Antoine Béclère, APHP, Clamart, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Prevot
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, Nantes, France.
authors.forename: Henri-Jean
authors.initials: HJ
authors.lastname: Philippe
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, APHP, Clamart, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Benachi
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010920:Placenta / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D010921:Placenta Accreta / Q000000981:diagnostic imaging* / Q000473:pathology; D011247:Pregnancy; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014599:Uterus / Q000000981:diagnostic imaging
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