title: [Accuracy of placenta accreta prenatal diagnosis by ultrasound and MRI in a high-risk population].
abstract: OBJECTIVE
  Main objective was to compare accuracy of ultrasonography and MRI for antenatal diagnosis of placenta accreta. Secondary objectives were to specify the most common sonographic and RMI signs associated with diagnosis of placenta accreta.
  
  
  METHODS
  This retrospective study used data collected from all potential cases of placenta accreta (patients with an anterior placenta praevia with history of scarred uterus) admitted from 01/2010 to 12/2014 in a level III maternity unit in Strasbourg, France. High-risk patients beneficiated antenatally from ultrasonography and MRI. Sonographic signs registered were: abnormal placental lacunae, increased vascularity on color Doppler, absence of the retroplacental clear space, interrupted bladder line. MRI signs registered were: abnormal uterine bulging, intraplacental bands of low signal intensity on T2-weighted images, increased vascularity, heterogeneous signal of the placenta on T2-weighed, interrupted bladder line, protrusion of the placenta into the cervix. Diagnosis of placenta accreta was confirmed histologically after hysterectomy or clinically in case of successful conservative treatment.
  
  
  RESULTS
  Twenty-two potential cases of placenta accreta were referred to our center and underwent both ultrasonography and MRI. All cases of placenta accreta had a placenta praevia associated with history of scarred uterus. Sensibility and specificity for ultrasonography were, respectively, 0.92 and 0.67, for MRI 0.84 and 0.78 without significant difference (p>0.05). The most relevant signs associated with diagnosis of placenta accreta in ultrasonography were increased vascularity on color Doppler (sensibility 0.85/specificity 0.78), abnormal placental lacunae (sensibility 0.92/specificity 0.55) and loss of retroplacental clear space (sensibility 0.76/specificity 1.0). The most relevant signs in MRI were: abnormal uterine bulging (sensitivity 0.92/specificity 0.89), dark intraplacental bands on T2-weighted images (sensitivity 0.83/specificity 0.80) or placental heterogeneity (sensitivity 0.92/specificity 0.89). Association of two sonographic or MRI signs had the best sensitivity/specificity ratio.
  
  
  CONCLUSIONS
  Ultrasonography and RMI represent two interesting and complementary diagnostic tools for antenatal diagnosis of placenta accreta. Because of its cost and accessibility, ultrasonography remains the first in line to be used for diagnosis. Use of an analytical grid for diagnosis of placenta accreta could be helpful.
authors: Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France. Electronic address: fanny.demarcillac@chru-strasbourg.fr.
authors: F
authors: F
authors: Daney de Marcillac
authors: Département de radiologie, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors: S
authors: S
authors: Molière
authors: Département de santé publique, hôpital Civil, hôpitaux universitaire de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.
authors: A
authors: A
authors: Pinton
authors: Département de gynécologie-obstétrique, CMCO, hôpitaux universitaire de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
authors: A-S
authors: AS
authors: Weingertner
authors: Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors: G
authors: G
authors: Fritz
authors: Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors: B
authors: B
authors: Viville
authors: Département de radiologie, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors: M-N
authors: MN
authors: Roedlich
authors: Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors: A
authors: A
authors: Gaudineau
authors: Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors: N
authors: N
authors: Sananes
authors: Département de gynécologie-obstétrique, CMCO, hôpitaux universitaire de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
authors: R
authors: R
authors: Favre
authors: Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors: I
authors: I
authors: Nisand
authors: Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors: B
authors: B
authors: Langer
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010921:Placenta Accreta / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011296:Prenatal Diagnosis / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal
keywords: Diagnostic anténatal; IRM pelvienne; Pelvic MRI; Pelvic ultrasound; Placenta accreta; Prenatal diagnosis; Échographie obstétricale