European Radiology

, Volume 28, Issue 9, pp 3770–3778 | Cite as

T2-weighted balanced steady-state free procession MRI evaluated for diagnosing placental adhesion disorder in late pregnancy

  • Ang Yang
  • Xue Hong Xiao
  • Zhi Long Wang
  • Ze Yan Wang
  • Ke Yi Wang



This study evaluated the imaging characteristics and accuracy of T2-weighted (T2W) balanced steady-state free procession (b-SSFP) magnetic resonance imaging, relative to b-SSFP or single-shot fast spin echo (SSFSE), for the diagnosis of placental adhesion disorder (PAD). Methods: Fifty-one pregnant patients suspected of PAD were examined with T2W b-SSFP, b-SSFP and SSFSE. The image types were independently analysed for signs of PAD: abnormal placental bulge (APB), dark intraplacental bands (DIB), placental heterogeneity (PH) and placental protrusion into adjacent structures (PPAS). The sequences were compared for muscle-to-placenta signal ratio, signs of PAD and area under the receiver operating characteristic curve (AUC) for diagnostic accuracy of PAD.


PAD was confirmed in 34 women. The muscle-to-placenta signal ratio was highest in the T2W b-SSFP. The diagnostic rates of APB in T2W b-SSFP were comparable to that of b-SSFP, but were significantly higher than that of SSFSE. The rates of PH in SSFE were comparable to that of b-SSFP, but both were significantly lower than that of T2W b-SSFP. The rates of DIB were significantly higher in T2W b-SSFP images compared with SSFSE. Rates of PPAS were comparable among three sequences. The AUCs of the T2W b-SSFP, b-SSFP and SSFSE were 0.966, 0.890 and 0.823, respectively.


T2W b-SSFP has high diagnostic accuracy for PAD relative to SSFSE or b-SSFP, which may be due to its high SNR, T2-weighting and lack of blur.

Key Points

• Signal myometrium-to-placenta ratio was highest in the T2W b-SSFP images.

• Diagnostic rate of APB in T2W b-SSFP was highest.

• Diagnostic rate of DIB was higher in T2W b-SSFP than in SSFSE.

• Diagnostic rate of PH in T2W b-SSFP was highest.

• Maximum AUC for diagnostic accuracy of PAD was in T2W b-SSFP.


Placenta accreta Magnetic resonance imaging Pregnancy Diagnosis ROC curve 



Abnormal placental bulge


Receiver operating characteristic curve


Balanced steady-state free procession


Dark intraplacental bands


Fast field echo


Multiple (sequential) 2D slices


Number of signals averaged


Placental adhesion disorder


Placental heterogeneity


Placental protrusion into adjacent structures


Region of interest


Spin echo




Spectral presaturation inversion recovery


Single-shot fast spin echo




Turbo field echo



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Ang Yang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional review board approval was obtained.


• prospective

• diagnostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.MR department of Affiliated Zhongshan City Hospital of Sun Yat-sen UniversityZhongshan CityChina

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