Predicting Placenta Accreta Spectrum Disorders in a Cohort of Pregnant Patients in the North-East Region of Romania-Diagnostic Accuracy of Ultrasound and Magnetic Resonance Imaging.

Background

Placenta accreta spectrum (PAS) disorders are associated with high mortality and morbidity due to postpartum hemorrhage, hysterectomy, and organ injury, and a multidisciplinary team is required for an individualized case management. In this study, we assessed the diagnostic and prognostic accuracy of the most important ultrasonographic (US) and magnetic resonance imagining (MRI) markers for PAS disorders. Material and

Methods

The study included 39 adult pregnant patients with at least one previous cesarean delivery and both US and MRI investigations for placenta previa evaluated at the tertiary maternity hospital ‘Cuza Voda’, Iasi, between 2019 and 2021. The following US signs were evaluated: intra-placental lacunae, loss of the retroplacental hypoechoic zone, myometrial thinning < 1 mm, bladder wall interruption, placental bulging, bridging vessels, and the hypervascularity of the uterovesical or retroplacental space. The MRI signs that were evaluated were intra-placental dark T2 bands, placental bulging, loss of the retroplacental hypointense line on T2 images, myometrial thinning, bladder wall interruption, focal exophytic placental mass, and abnormal vascularization of the placental bed.

Results

The US and MRI signs analyzed in our study presented adequate sensitivities and specificities for PAS, but no sign proved to be a useful predictor by itself. The presence of three or more US markers for accretion was associated with a sensitivity of 84.6.6% and a specificity of 92.3% (p < 0.001). The presence of three or more MRI signs supplemented these results and were associated with a sensitivity of 92.3% and a specificity of 61.5% for predicting PAS (p < 0.001). Moreover, US and MRI findings were correlated with FIGO grading and severity of PAS.

Conclusions

Even though no US or MRI finding alone can predict PAS with high sensitivity and specificity, our study proves that the presence of three or more imagistic signs could significantly increase the diagnostic accuracy of this condition. Furthermore, US and MRI could be useful tools for evaluating prognostic and perinatal planning.