Skip to main content
SpringerLink
Log in

Chemical Shift Artifact on Steady-State MRI Sequences for Detection of Vesical Wall Invasion in Placenta Percreta

  • Original Article
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Background

Antenatal diagnosis of the invasiveness of a placenta percreta helps in planning the surgical approach, reducing blood loss and morbidity. Doppler sonography is the mainstay diagnostic modality with a sensitivity of 80–95 %. With the advent of high magnetic field MRI techniques, there has been recent interest in evaluation of placenta by MRI. On an extensive PUBMED search, we could not find any citations describing imaging, ultrasound, or MRI features to evaluate vesical wall invasion by placenta percreta.

Purpose

We attempt to evaluate transmyometrial vesical wall invasion by placenta percreta using chemical shift artifact as a marker of intact bladder-myometrial interface on steady-state MRI sequences.

Materials and Methods

This is a prospective observational study, conducted at a university hospital. We have compiled clinico-radiological criteria for diagnosis of invasive placentae based on the existing body of evidences, in four patients. We further go on to analyze a specific proposed sign on a newly introduced MR imaging sequence i.e., loss of chemical shift artifact (India ink line) on steady-state GRE sequence (TrueFISP), to diagnose transmyometrial vesical invasion in placenta percreta.

Results

Though the sample size is small, the sensitivity, specificity, positive, and negative predictive value of the proposed sign for the purpose was 100 %.

Conclusions(s)

Loss of chemical shift artifact (India ink line) on steady-state GRE sequences at the vesico-myometrial junction in case of invasive placentae confirms vesical wall invasion, a prospective diagnoses of which can help in planning the surgical protocol and preventing potentially fatal blood loss.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Zhuo J, Gullapalli RP. MR artifacts, safety, and quality control. Radiographics. 2006;26:275–97.

    Article  PubMed  Google Scholar 

  2. Bitar R, Leung G, Perng R, et al. MR pulse sequences: what every radiologist wants to know but is afraid to ask. Radiographics. 2006;26:513–37.

    Article  PubMed  Google Scholar 

  3. Reiser MF. Magnetic resonance tomography. Berlin: Springer Verlag; 2007 ISBN:354029354X.

    Google Scholar 

  4. Hood MN, Ho VB, Smirniotopoulos JG, et al. Chemical shift: the artifact and clinical tool revisited. Radiographics. 1999;19:357–71.

    Article  CAS  PubMed  Google Scholar 

  5. Israel GM, Hindman N, Hecht E, et al. The use of opposed-phase chemical shift MRI in the diagnosis of renal angiomyolipomas. AJR. 2005;184:1868–72.

    Article  PubMed  Google Scholar 

  6. Chou MM, Ho ESC. Prenatal diagnosis of placenta previa accreta with power amplitude ultrasonic angiography. Am J Obstet Gynecol. 1997;177:1523–5.

    Article  CAS  PubMed  Google Scholar 

  7. Lax A, Prince MR, Mennitt KW, et al. The value of specific MRI features in the evaluation of suspected placental invasion. Magn Reson Imaging. 2007;25:87–93.

    Article  PubMed  Google Scholar 

  8. Maldjian C, Adam R, Pelosi M, et al. MRI appearance of placenta percreta and placenta accreta. Magn Reson Imaging. 1999;17(7):965–71.

    Article  CAS  PubMed  Google Scholar 

  9. Dwyer BK, Belogolovkin V, Tran L, et al. Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging? J Ultrasound Med. 2008;27(9):1275–81.

    PubMed  PubMed Central  Google Scholar 

  10. Masselli G, Brunelli R, Casciani E, et al. Magnetic resonance imaging in the evaluation of placental adhesive disorders: correlation with color Doppler ultrasound. Eur Radiol. 2008;18:1292–9.

    Article  PubMed  Google Scholar 

  11. Chavhan GB, Babyn PS, Jankharia BG, et al. Steady-state MR imaging sequences: physics, classification, and clinical applications. Radiographics. 2008;28:1147–60.

    Article  PubMed  Google Scholar 

  12. Monti L, Infante MV, Manias T, et al. India ink artifact on ECG-gated SSFP sequences predicts resectability of tumours invading the mediastinum. J Cardiovasc Magn Reson. 2012;14(Suppl 1):53.

    Article  Google Scholar 

  13. Kim YJ, Hur J, Lee HJ, et al. Lipomatous metaplasia in patients with myocardial infarction: evaluation with cardiac magnetic resonance. J Cardiovasc Magn Reson. 2010;12(Suppl 1):165.

    Article  Google Scholar 

Download references

Acknowledgments

None.

Compliance with ethical requirements and Conflict of interest

These studies were performed as per routine clinical referral following standardized technique for gestational MRI. Informed consent from patients were taken and has been already mentioned. No novel intervention mandating ethical clearance over and above the informed consent and clinical referral was hence required. The authors report no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Ishan Kumar, Ashish Verma (Assistant Professor), Shivi Jain, R. C. Shukla & Arvind Srivastava

  2. Department of Obstetrics & Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Madhu Jain

Authors
  1. Ishan Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashish Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shivi Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Madhu Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. C. Shukla
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arvind Srivastava
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashish Verma.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, I., Verma, A., Jain, S. et al. Chemical Shift Artifact on Steady-State MRI Sequences for Detection of Vesical Wall Invasion in Placenta Percreta. J Obstet Gynecol India 66, 101–106 (2016). https://doi.org/10.1007/s13224-014-0660-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-014-0660-y

Keywords

Search

Navigation