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Cesarean section scar in 3 T magnetic resonance imaging and ultrasound: image characteristics and comparison of the methods

  • Janine Hoffmann
  • Marc Exner
  • Kristina Bremicker
  • Matthias Grothoff
  • Patrick Stumpp
  • Susanne Schrey-Petersen
  • Holger Stepan
Maternal-Fetal Medicine

Abstract

Purpose

Uterine rupture during labor is a rare but life-threatening complication after previous cesarean section (CS). Prenatal risk is assessed using ultrasound thickness measurement of the lower uterine segment (LUS). Due to inhomogeneous study results, however, clinical obstetrics still lacks for standard protocols and reliable reference values. As 3 T magnetic resonance imaging (MRI) has not yet been sufficiently studied regarding LUS diagnostics after previous CS, we sought to evaluate its feasibility focusing on thickness measurements and typical characteristics of the CS-scar region in comparison to ultrasound and the intraoperative status.

Methods

In this prospective study, 25 asymptomatic patients with one previous CS and inconspicuous ultrasound findings were included. An additional 3 T MRI with either a T2-weighted Turbo-Spin-Echo or a Half Fourier-Acquired-Single-shot-Turbo-spin-Echo sequence in a sagittal orientation was performed. We analyzed categorical image quality, inter- and intra-rater reliability as well as anatomy, morphology and thickness of the LUS. Results were compared to ultrasound and intraoperative findings.

Results

MRI provided good to excellent image quality in all patients. The imaged structures presented with a high variability in anatomy and morphology. Image characteristics indicating the uterine scar were only found in 11/25 (44%) patients. LUS thickness measurements with MRI showed good inter- and intra-rater reliability but poor agreement with ultrasound.

Conclusions

MRI is appropriate for additional LUS diagnostics in patients with previous CS. The strong individual variability of LUS-anatomy and morphology might explain the difficulties in establishing uniform diagnostic standards after CS.

Keywords

Cesarean section Prenatal diagnosis Magnetic resonance imaging Ultrasonography Uterine rupture 

Notes

Author contributions

JH: design/methods/administration of the study, data acquisition: MRI, ultrasound and clinical data, measurements, analyzing and interpreting data, writing the manuscript; ME: administration, acquiring MRI data, MRI measurements; KB: data acquisition: MRI, MRI measurements; MG: supervision, support in writing the manuscript; PS: concept/methods, administration, data acquisition: MRI, writing the manuscript; SS-P: data acquisition: ultrasound, analyzing data/interpretations; HS: design/concept, analyzing data/interpretations, ;supervision, writing the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of ObstetricsUniversity of LeipzigLeipzigGermany
  2. 2.Department of RadiologyUniversity of LeipzigLeipzigGermany
  3. 3.Department of RadiologyUniversity of Leipzig-Heart CenterLeipzigGermany

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