Top

Insights into Imaging

Published in:

Open Access 01-12-2023 | Original Article

Differentiation of placenta percreta through MRI features and diffusion-weighted magnetic resonance imaging

Authors: Hang Li, Tao Lu, Mou Li, Yishuang Wang, Feng Zhang, Yi Yuan, Meilin Zhu, Xinyi Zhao

Published in: Insights into Imaging | Issue 1/2023

Abstract

Objectives

To identify whether parameters measured from diffusion kurtosis and intravoxel incoherent motion help diagnose placenta percreta.

Methods

We retrospectively enrolled 75 patients with PAS disorders including 13 patients with placenta percreta and 40 patients without PAS disorders. Each patients underwent diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI). The apparent diffusion coefficient (ADC), perfusion fraction (f), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), mean diffusion kurtosis (MK) and mean diffusion coefficient (MD) were measured by the volumetric analysis and compared. MRI features were also analyzed and compared. The receiver operating characteristic (ROC) curve and logistic regression analysis were used to evaluate the diagnostic efficiency of different diffusion parameters and MRI features for distinguishing placental percreta.

Results

D* was an independent risk factor from DWI for predicting placenta percreta with sensitivity of 73% and specificity of 76%. Focal exophytic mass remained as independent risk factor from MRI features for predicting placenta percreta with sensitivity of 72.7% and specificity of 88.1%. When the two risk factors were combined together, the AUC was the highest, 0.880 (95% CI 0.8–0.96).

Conclusion

D* and focal exophytic mass were associated with placenta percreta. A combination of the 2 risk factors can be used to predict placenta percreta.

Critical relevance statement

A combination of D* and focal exophytic mass can be used to differentiate placenta percreta.

Silver RM (2015) Abnormal placentation. Obstet Gynecol 126:654–668CrossRefPubMed

O’Brien JM, Barton JR, Donaldson ES (1996) The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 175:1632–1638CrossRefPubMed

Silver RM, Landon MB, Rouse DJ et al (2006) National institute of child health and human development maternal-fetal medicine units network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107:1226–1232CrossRefPubMed

Marcellin L, Delorme P, Bonnet MP (2018) Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta. Am J Obstet Gynecol 219:193-e1CrossRef

Jha P, Pōder L, Bourgioti C et al (2020) Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders. Eur Radiol 30:2604–2615CrossRefPubMed

Bourgioti C, Zafeiropoulou K, Fotopoulos S et al (2018) MRI features predictive of invasive placenta with extrauterine spread in high-risk gravid patients: a prospective evaluation. AJR Am J Roentgenol 211(3):701–711CrossRefPubMed

Ghezzi CL, Silva CK, Casagrande AS, Westphalen SS, Salazar CC, Vettorazzi J (2021) Diagnostic performance of radiologists with different levels of experience in the interpretation of MRI of the placenta accreta spectrum disorder. BJR 94:20210827CrossRefPubMedPubMedCentral

Le Bihan D (1988) Intravoxel incoherent motion imaging using steady-state free precession. Magn Reson Med 7:346–351CrossRefPubMed

Jensen JH, Helpern JA, Ramani A, Lu H, Kaczynski K (2005) Diffusional kurtosis imaging: the quantification of non-Gaussian water diffusion by means of magnetic resonance imaging. Magn Reson Med 53:1432–1440CrossRefPubMed

10.

Lu T, Wang Y, Guo A et al (2022) Monoexponential, biexponential and diffusion kurtosis MR imaging models: quantitative biomarkers in the diagnosis of placenta accreta spectrum disorders. BMC Pregnancy Childbirth 22:349CrossRefPubMedPubMedCentral

11.

Lu T, Wang Y, Deng Y, Wu C, Li X, Wang G (2022) Diffusion and perfusion MRI parameters in the evaluation of placenta accreta spectrum disorders in patients with placenta previa. Magn Reson Mater Phys Biol Med 35:1009–20CrossRef

12.

Xiao Z, Zhong Y, Tang Z et al (2018) Standard diffusion-weighted, diffusion kurtosis and intravoxel incoherent motion MR imaging of sinonasal malignancies: correlations with Ki-67 proliferation status. Eur Radiol 28:2923–2933CrossRefPubMed

13.

Cui Y, Yang X, Du X, Zhuo Z, Xin L, Cheng X (2018) Whole-tumour diffusion kurtosis MR imaging histogram analysis of rectal adenocarcinoma: correlation with clinical pathologic prognostic factors. Eur Radiol 28:1485–1494CrossRefPubMed

14.

Ding Y, Tan Q, Mao W et al (2019) Differentiating between malignant and benign renal tumors: do IVIM and diffusion kurtosis imaging perform better than DWI? Eur Radiol 29:6930–6939CrossRefPubMed

15.

Wan Q, Deng Y, Lei Q et al (2019) Differentiating between malignant and benign solid solitary pulmonary lesions: are intravoxel incoherent motion and diffusion kurtosis imaging superior to conventional diffusion-weighted imaging? Eur Radiol 29:1607–1615CrossRefPubMed

16.

Yang M, Yan Y, Wang H (2018) IMAge/enGINE: a freely available software for rapid computation of high-dimensional quantification. Quant Imaging Med Surg. https://doi.org/10.21037/qims.2018.12.03CrossRefPubMedPubMedCentral

17.

Sato T, Mori N, Hasegawa O, Shigihara T, Fujimori K, Tasaki K (2017) Placental recess accompanied by a T2 dark band: a new finding for diagnosing placental invasion. Abdom Radiol (NY) 42(8):2146–2153CrossRefPubMed

18.

Ueno Y, Kitajima K, Kawakami F et al (2014) Novel MRI finding for diagnosis of invasive placenta praevia: evaluation of findings for 65 patients using clinical and histopathological correlations. Eur Radiol 24:881–888CrossRefPubMed

19.

Srisajjakul S, Prapaisilp P, Bangchokdee S (2021) Magnetic resonance imaging of placenta accreta spectrum: a step-by-step approach. Korean J Radiol 22(2):198–212CrossRefPubMed

20.

Society of Gynecologic Oncology. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine

21.

Smith ZL, Sehgal SS, Van Arsdalen KN, Goldstein IS (2014) Placenta percreta with invaison into the urinary bladder. Urol Case Rep 2:31–32CrossRefPubMedPubMedCentral

22.

Jauniaux E, Collins S, Burton GJ (2018) Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol 218(1):75–87CrossRefPubMed

23.

Solheim KN, Esakoff TF, Little SE, Cheng YW, Sparks TN, Caughey AB (2011) The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med 24(11):1341–1346CrossRefPubMed

24.

Familiari A, Liberati M, Lim P et al (2018) Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 97:507–520CrossRefPubMed

25.

Thiravit S, Lapatikarn S, Muangsomboon K, Suvannarerg V, Thiravit P, Korpraphong P (2017) MRI of placenta percreta:differentiation from other entities of placental adhesive disorder. Radiol Med 122:61–68CrossRefPubMed

26.

Gowland P (2005) Placental MRI. Semin Fetal Neonatal Med. 10:485–490CrossRefPubMed

27.

Moore RJ, Issa B, Tokarczuk P et al (2000) In vivo intravoxel incoherent motion measurements in the human placenta using echo-planar imaging at 0.5 T. Magn Reson Med. 43:295–302CrossRefPubMed

28.

Chantraine F, Blacher S, Berndt S et al (2012) Abnormal vascular architecture at the placental-maternal interface in placenta increta. Am J Obstet Gynecol 207:188.e1-188.e9CrossRefPubMed

29.

de Santis S, Gabrielli A, Palombo M, Maraviglia B, Capuani S (2011) Non-Guassian diffusion imaging: a brief practical review. Magn Reson Imaging 29(10):1410–1416CrossRefPubMed

30.

Chen X, Shan R, Zhao L et al (2018) Invasive placenta previa: placental bulge with distorted uterine outline and uterine serosal hypervascularity at 1.5T MRI-useful features for differentiating placenta percreta from placenta accreta. Eur Radiol 28:708–717CrossRefPubMed

Title: Differentiation of placenta percreta through MRI features and diffusion-weighted magnetic resonance imaging
Authors: Hang Li
Tao Lu
Mou Li
Yishuang Wang
Feng Zhang
Yi Yuan
Meilin Zhu
Xinyi Zhao
Publication date: 01-12-2023
Publisher: Springer Vienna
Published in: Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-023-01448-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Differentiation of placenta percreta through MRI features and diffusion-weighted magnetic resonance imaging

Abstract

Objectives

Methods

Results

Conclusion

Critical relevance statement

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Critical relevance statement

Please log in to get access to this content

Other articles of this Issue 1/2023

MRI of acute neck infections: evidence summary and pictorial review

Ten reasons to screen women at risk of lung cancer

Chyluria: non-enhanced MR lymphography

Undergraduate radiology education in Europe in 2022: a survey from the European Society of Radiology (ESR)

Multi-algorithms analysis for pre-treatment prediction of response to transarterial chemoembolization in hepatocellular carcinoma on multiphase MRI

Subchondral insufficiency fractures, subchondral insufficiency fractures with osteonecrosis, and other apparently spontaneous subchondral bone lesions of the knee—pathogenesis and diagnosis at imaging