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The MRI features of placental adhesion disorder and their diagnostic significance: systematic review
1University of Sheffield, Academic Department Reproductive and Developmental Medicine, 4th Floor, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK.
Aim:
To identify the most frequently used MRI features in the diagnosis of placenta adhesion disorder (PAD) in the antenatal period and their significance.
Materials And Methods:
The online databases Medline via PubMed and Ovid, Google Scholar, and Scopus were searched using the keywords and subject headings MRI*, magnetic resonance imaging*, prenatal diagnosis and placenta accreta*, morbidly adherent placenta* or placenta. Cases where MRI was carried out at/after 20 weeks gestation with detailed information available in relation to criteria and sequences used were included in the review. Exclusion criteria were case report study and studies that used intravenous contrast agents. Information regards sensitivity and specificity for each feature was taken, or calculated where possible, from the papers. Any new features were identified. The overall contribution of each feature to the diagnostic process was noted.
Results:
Six hundred and fourteen potentially relevant articles were identified of which only 11 met the inclusion criteria. The commonest MRI criteria used were T2 dark intraplacental bands, heterogeneity of placenta, abnormal uterine bulging, and disruption of the uteroplacental zone. A newly described criterion is disorganised vasculature of placenta. MRI sensitivity and specificity varied between 75-100% and 65-100% respectively.
Conclusion:
MRI diagnosis of PAD relies on unstandardised criteria of diagnosis that enable systematic image interpretation of invasion status in all studies and enable the reproducibility. However, it is still has a high diagnostic accuracy and frequently aids in surgical planning, emphasising its value in supporting ultrasound. Most studies are of a small sample size. Additional multicentre studies are recommended to enhance the generalisability of the findings and asses the value of the newly described criteria.
Insights
Magnetic resonance imaging (MRI) uses several features to diagnose placenta adhesion disorder (PAD) during pregnancy. Common MRI findings include dark intraplacental bands and abnormal uterine bulging, aiding surgical planning.
Area of Science:
- Radiology
- Obstetrics
- Maternal-Fetal Medicine
Background:
- Placenta adhesion disorder (PAD) is a significant obstetric complication.
- Accurate antenatal diagnosis of PAD is crucial for effective management and surgical planning.
Purpose of the Study:
- To identify and evaluate the most frequently utilized magnetic resonance imaging (MRI) features for diagnosing placenta adhesion disorder (PAD) in the antenatal period.
- To assess the diagnostic significance and accuracy of these MRI features.
Main Methods:
- A systematic review of online databases (Medline, Ovid, Google Scholar, Scopus) was conducted.
- Studies involving MRI at/after 20 weeks gestation without intravenous contrast agents were included.
- Sensitivity and specificity data for identified MRI features were extracted or calculated.
Main Results:
- Eleven studies met the inclusion criteria, identifying common MRI features: T2 dark intraplacental bands, heterogeneous placenta, abnormal uterine bulging, and disrupted uteroplacental zone.
- A novel criterion, disorganized placental vasculature, was also noted.
- MRI demonstrated high sensitivity (75-100%) and specificity (65-100%) for PAD diagnosis.
Conclusions:
- Antenatal MRI diagnosis of PAD relies on currently unstandardized criteria, impacting reproducibility.
- Despite variations in criteria, MRI exhibits high diagnostic accuracy and is valuable for surgical planning, complementing ultrasound.
- Further multicenter studies are recommended to improve generalizability and validate new criteria.
