title: Utility of ultrasound and magnetic resonance imaging in prenatal diagnosis of placenta accreta: A prospective study.
abstract: BACKGROUND
  Placenta accreta is the abnormal adherence of the placenta to the uterine wall and the most common cause for emergency postpartum hysterectomy. Accurate prenatal diagnosis of affected pregnancies allows optimal obstetric management.
  
  
  OBJECTIVE
  To summarize our experience in the antenatal diagnosis of placenta accreta on imaging in a tertiary care setup. To compare the accuracy of ultrasound (USG) with color Doppler (CDUS) and magnetic resonance imaging (MRI) in prenatal diagnosis of placenta accreta.
  
  
  METHODS
  Prospective study in a tertiary care setup.
  
  
  METHODS
  A prospective study was conducted on pregnant females with high clinical risk of placenta accreta. Antenatal diagnosis was established based on CDUS and MRI. The imaging findings were compared with final diagnosis at the time of delivery and/or pathologic examination.
  
  
  METHODS
  The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both CDUS and MRI. The sensitivity and specificity values of USG and MRI were compared by the McNemar test.
  
  
  RESULTS
  Thirty patients at risk of placenta accreta underwent both CDUS and MRI. Eight cases of placenta accreta were identified (3 vera, 4 increta, and 1 percreta). All patients had history of previous cesarean section. Placenta previa was present in seven out of eight patients. USG correctly identified the presence of placenta accreta in seven out of eight patients (87.5% sensitivity) and the absence of placenta accreta in 19 out of 22 patients (86.4% specificity). MRI correctly identified the presence of placenta accreta in 6 out of 8 patients (75.0% sensitivity) and absence of placenta accreta in 17 out of 22 patients (77.3% specificity). There were no statistical differences in sensitivity (P = 1.00) and specificity (P = 0.687) between USG and MRI.
  
  
  CONCLUSIONS
  Both USG and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. Both modalities have complimentary role and in cases of inconclusive findings with one imaging modality, the other modality may be useful for obtaining the diagnosis. CDUS remains the first primary modality for antenatal diagnosis of placenta accreta, with MRI reserved for cases where USG is inconclusive.
authors.affiliation: Department of Radiodiagnosis, Delhi State Cancer Institute, New Delhi, India.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Satija
authors.affiliation: Department of Radiodiagnosis, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India.
authors.forename: Sanyal
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Obstretics and Gynaecology, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India.
authors.forename: Leena
authors.initials: L
authors.lastname: Wadhwa
authors.affiliation: Department of Obstretics and Gynaecology, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India.
authors.forename: Taru
authors.initials: T
authors.lastname: Gupta
authors.affiliation: Department of Radiodiagnosis, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India.
authors.forename: Supreethi
authors.initials: S
authors.lastname: Kohli
authors.affiliation: Department of Pathology, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Chandoke
authors.affiliation: Department of Obstretics and Gynaecology, Employees State Insurance Hospital and Post Graduate Institute of Medical Science and Research, New Delhi, India.
authors.forename: Pratibha
authors.initials: P
authors.lastname: Gupta
keywords: Accreta; color Doppler ultrasound; magnetic resonance imaging; placenta