Placenta accreta spectrum beyond previa: why clinical context and imaging expertise matter

Placenta accreta spectrum (PAS) in non-previa placenta is increasingly recognized in association with assisted reproductive technology, particularly hormone replacement cycle frozen embryo transfer (HRC-FET). In this issue, Ueno et al. address this diagnostic challenge by developing an MRI- and clinical-based predictive model derived from 101 non-previa pregnancies. Their work demonstrates that several SAR-ESUR consensus MRI features classically associated with previa-related PAS show near-zero sensitivity in this population, while abnormal vascularization of the placental bed and HRC-FET emerge as the highest-ranking predictors. We discuss the implications of these findings for radiological practice, emphasizing the shift in the diagnostic weight of MRI signs across clinical contexts, the essential integration of clinical risk factors in image interpretation, and the persistent need for dedicated imaging expertise and standardized interpretation criteria in this challenging diagnostic setting.