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Assessment of the massive hemorrhage in placenta accreta spectrum with magnetic resonance imaging
Jie Zhang1, Han Xu1, Yinghui Xin1
1Department of Radiology, Shandong Provincial Hospital, Jinan, Shandong 250021, P.R. China.
Abstract:
The aim of the present study was to evaluate whether MRI features are able to predict massive hemorrhage of patients with placenta accreta spectrum (PAS). A total of 40 patients with suspected PAS after ultrasound examination were subjected to MRI. Of these, 29 patients were confirmed as having PAS. MRI data were analyzed independently by two radiologists in a blinded manner. Inter-observer agreement was determined. The 29 confirmed patients were divided into two groups (moderate and massive hemorrhage) according to the estimated blood loss (EBL) and blood transfusion, and the MRI features were compared between the two groups. The EBL, as well as blood transfusion, between the patients with and without each MRI feature were compared. The inter-observer agreement between the two radiologists for the 11 MRI features had statistical significance (P<0.05). Intra-placental thick dark bands and markedly heterogeneous placenta were the most important MRI features in predicting massive hemorrhage and blood transfusion (P<0.05). The difference in EBL between the patients with and without focal defect of the uteroplacental interface (UPI) was significant (P<0.05). The differences in blood transfusion between the patients with and without myometrial thinning, disruption of the inner layer of the UPI, increased placental vascularity and increased vascularity at the UPI were significant (P<0.05). These results indicate that MRI features may predict massive hemorrhage of patients with PAS, which may be helpful for pre-operative preparation of PAS patients.
Insights
MRI features can predict massive hemorrhage in patients with placenta accreta spectrum (PAS). Specific findings like intra-placental dark bands and heterogeneous placenta are key indicators for massive hemorrhage and transfusion needs.
Area of Science:
- Radiology
- Obstetrics
- Maternal-Fetal Medicine
Background:
- Placenta accreta spectrum (PAS) poses significant risks, including massive hemorrhage.
- Accurate prediction of hemorrhage is crucial for surgical planning and patient management.
Purpose of the Study:
- To determine if Magnetic Resonance Imaging (MRI) features can predict massive hemorrhage in patients with suspected PAS.
- To identify specific MRI findings associated with increased blood loss and transfusion requirements.
Main Methods:
- 40 patients with suspected PAS underwent MRI.
- 29 confirmed PAS patients were analyzed, divided into moderate and massive hemorrhage groups.
- Two radiologists independently assessed 11 MRI features in a blinded manner.
- Comparison of MRI features between hemorrhage groups and correlation with Estimated Blood Loss (EBL) and transfusion data.
Main Results:
- High inter-observer agreement was achieved for MRI feature assessment (P<0.05).
- Intra-placental thick dark bands and markedly heterogeneous placenta were significant predictors of massive hemorrhage and blood transfusion (P<0.05).
- Focal defect of the uteroplacental interface (UPI) correlated with significant differences in EBL (P<0.05).
- Myometrial thinning, disrupted UPI inner layer, and increased vascularity at the UPI were associated with significant differences in blood transfusion requirements (P<0.05).
Conclusions:
- Specific MRI features demonstrate potential in predicting massive hemorrhage in PAS patients.
- These findings can aid in pre-operative preparation and risk stratification for PAS management.
- MRI is a valuable tool for assessing hemorrhage risk in placenta accreta spectrum.
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