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Published on: September 10, 2018
Suspected invasive placenta: evaluation with magnetic resonance imaging
Laurence Bour1, Vinciane Placé, Sandra Bendavid
1Department of Abdominal and Interventional Imaging, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris cedex 10, France, jlaurence.bour@gmail.com.
Purpose:
To determine the utility of magnetic resonance imaging (MRI) in diagnosing invasive placenta (IP).
Materials And Methods:
MRI findings in 32 women with suspected IP were evaluated independently by four readers. Interobserver agreement was calculated with kappa (κ) statistics. Associations between MRI findings and IP were assessed by univariate and multivariate analyses. Sensitivity, specificity and accuracy of MRI for the diagnosis of IP were estimated.
Results:
Sixteen women (16/32; 50%) had confirmed IP. Interobserver correlation for the diagnosis of IP was fair (κ = 0.40). Univariate analysis revealed that thinning or focal defect of the uteroplacental interface (P < 0.0001) was the most discriminating MRI variable in the differentiation between normal and IP. Overall sensitivity and specificity of MRI for the diagnosis of IP were 84% [95% CI: 75-94%] and 80% [95% CI: 66-93%], respectively. Thinning or focal defect of the uteroplacental interface was the most accurate finding (88%) in the diagnosis of IP. Multivariate analysis revealed that thinning or focal defect of the uteroplacental interface was the single independent predictor of IP (P = 0.0006; OR = 64.99).
Conclusion:
MR imaging has 84% sensitivity [95% CI: 75-94%] and 80% specificity [95% CI: 66-93%] for the diagnosis of IP. Thinning or focal defect of the uteroplacental interface is the most discriminating independent MR variable in differentiating between normal placenta and IP.
Key Points:
MR imaging has acceptable degrees of accuracy to diagnose invasive placenta. Focal uteroplacental interface defect is the best finding to diagnose invasive placenta. Focal uteroplacental interface defect is the single independent predictor of invasive placenta.
Insights
Magnetic resonance imaging (MRI) effectively diagnoses invasive placenta (IP) with 84% sensitivity and 80% specificity. A focal defect in the uteroplacental interface is the most reliable indicator for diagnosing IP.
Area of Science:
- Obstetrics and Gynecology
- Radiology
- Medical Imaging
Background:
- Invasive placenta (IP) presents diagnostic challenges.
- Accurate diagnosis of IP is crucial for appropriate management and patient outcomes.
Purpose of the Study:
- To evaluate the diagnostic utility of magnetic resonance imaging (MRI) for invasive placenta (IP).
- To identify specific MRI features indicative of IP.
Main Methods:
- MRI scans of 32 women with suspected IP were independently reviewed by four readers.
- Interobserver agreement was assessed using kappa statistics.
- Univariate and multivariate analyses were performed to correlate MRI findings with confirmed IP, estimating sensitivity, specificity, and accuracy.
Main Results:
- Fifty percent (16/32) of women had confirmed IP.
- Thinning or focal defect of the uteroplacental interface was the most significant MRI finding differentiating normal from invasive placenta (P < 0.0001).
- MRI demonstrated 84% sensitivity and 80% specificity for diagnosing IP, with thinning or focal defect of the uteroplacental interface showing 88% accuracy.
Conclusions:
- MRI is a valuable tool for diagnosing invasive placenta, offering acceptable accuracy.
- Thinning or focal defect of the uteroplacental interface is the most discriminating independent predictor of IP.
- This finding aids in differentiating normal placental implantation from invasive placenta.
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