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Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders

Abstract

Objectives

This study was conducted in order to establish the joint Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) guidelines on placenta accreta spectrum (PAS) disorders and propose strategies to standardize image acquisition, interpretation, and reporting for this condition with MRI.

Methods

The published evidence-based data and the opinion of experts were combined using the RAND–UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to questions regarding the details of patient preparation, MRI protocol, image interpretation, and reporting were collected, analyzed, and classified as “recommended” versus “not recommended” (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts).

Results

Consensus regarding image acquisition, interpretation, and reporting was determined using the RAND–UCLA Appropriateness Method. The use of a tailored MRI protocol and standardized report was recommended.

Conclusions

A standardized imaging protocol and reporting system ensures recognition of the salient features of PAS disorders. These consensus recommendations should be used as a guide for the evaluation of PAS disorders with MRI.

Key Points

• MRI is a powerful adjunct to ultrasound and provides valuable information on the topography and depth of placental invasion.

• Consensus statement proposed a common lexicon to allow for uniformity in MRI acquisition, interpretation, and reporting of PAS disorders.

• Seven MRI features, namely intraplacental dark T2 bands, uterine/placental bulge, loss of low T2 retroplacental line, myometrial thinning/disruption, bladder wall interruption, focal exophytic placental mass, and abnormal vasculature of the placental bed, reached consensus and are categorized as “recommended” for diagnosing PAS disorders.

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Abbreviations

ACR:

American College of Radiology

BGE:

Balanced gradient echo

DOR:

Diagnostic odds ratio

DWI:

Diffusion-weighted imaging

ECR:

European Congress of Radiology

ESGAR:

European Society of Gastrointestinal and Abdominal Radiology

ESUR:

European Society of Urogenital Radiology

FIGO:

International Federation of Gynecology and Obstetrics

HASTE:

Half Fourier single-shot turbo spin echo

IVF:

In vitro fertilization

NLR:

Negative likelihood ratio

NPV:

Negative predictive value

PAS:

Placenta accreta spectrum

PIWG:

Placental Imaging Working Group

PLR:

Positive likelihood ratio

PPV:

Positive predictive value

SAR:

Society of Abdominal Radiology

SSFSE:

Single-shot fast spin echo

SSH-TSE:

Single-shot turbo spin echo

UFSE:

Ultra-fast spin echo

UOC DFP:

Uterine and Ovarian Cancer Disease-Focused Panel

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Funding

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

Author information

Correspondence to Priyanka Jha.

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Guarantor

The scientific guarantor of this publication is Gabriele Masseli.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because this is a consensus statement.

Ethical approval

Institutional Review Board approval was not required as no patient information was accessed for this study.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in previous studies referenced in the manuscript.

Methodology

• Retrospective

• Observational

• Multicenter study

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Jha, P., Pōder, L., Bourgioti, C. et al. 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 (2020). https://doi.org/10.1007/s00330-019-06617-7

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Keywords

  • Placenta accreta
  • Consensus
  • Magnetic resonance imaging
  • Placenta diseases