T2-weighted balanced steady-state free procession MRI evaluated for diagnosing placental adhesion disorder in late pregnancy
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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.
• 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.
KeywordsPlacenta 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 protrusion into adjacent structures
Region of interest
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.
Written informed consent was obtained from all subjects in this study.
Institutional review board approval was obtained.
• diagnostic study
• performed at one institution
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