Skip to main content


Log in

Placental recess accompanied by a T2 dark band: a new finding for diagnosing placental invasion

  • Published:
Abdominal Radiology Aims and scope Submit manuscript



Our aim was to assess the usefulness of a new magnetic resonance imaging (MRI) finding, the placental recess, for diagnosing placental invasion.


This retrospective study included 51 patients (mean age 34.1 years, range 26–43 years) with suspected placental invasion who underwent cesarean section. Preoperative MRI was performed using a 1.5-T unit and included axial, sagittal, and coronal T2-weighted imaging (T2WI) with half-Fourier fast spin-echo sequences. Overall, 9 patients showed placental invasion, and 42 did not. Placental recess was defined as a placental deformity with contraction of the placental surface and outer rim of the uterus accompanied by a T2 dark band. Two radiologists independently assessed the presence of the placental recess and conventional findings including uterine bulging, abnormal placental vascularity, placental heterogeneous intensity on T2-weighted imaging (T2WI), and the T2 dark band. Fisher’s two-sided exact test was used to compare findings between patients with and without placental invasion. Interobserver reliability was assessed using the kappa statistic.


MRI features had interobserver reliability of >0.40. Placental recess yielded the highest kappa value (0.898). Significant differences were identified between patients with and without placental invasion regarding abnormal placental vascularity, placental heterogeneous intensity, a T2 dark band, and the placental recess on T2WI (p = 0.0282, 0.0003, 0.0003, <0.0001, respectively). The placental recess had sensitivity, specificity, positive and negative predictive values, and accuracy of 56, 100, 100, 91, and 92%, respectively.


The placental recess was useful for diagnosing placental invasion, with high interobserver variability and accuracy.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others


  1. Habek D, Becareviç R (2007) Emergency peripartum hysterectomy in a tertiary obstetric center: 8-year evaluation. Fetal Diagn Ther 22:139–142. doi:10.1159/000097114

    Article  PubMed  Google Scholar 

  2. Rahman J, Al-Ali M, Qutub HO, et al. (2008) Emergency obstetric hysterectomy in a university hospital: a 25-year review. J Obstet Gynaecol 28:69–72. doi:10.1080/01443610701816885

    Article  CAS  PubMed  Google Scholar 

  3. Zelop CM, Harlow BL, Frigoletto FD, Safon LE, Saltzman DH (1993) Emergency peripartum hysterectomy. Am J Obstet Gynecol 168:1443–1448

    Article  CAS  PubMed  Google Scholar 

  4. D’Arpe S, Franceschetti S, Corosu R, et al. (2015) Emergency peripartum hysterectomy in a tertiary teaching hospital: a 14-year review. Arch Gynecol Obstet 291:817–841. doi:10.1007/s00404-014-3487-y

    Google Scholar 

  5. Levine D, Hulka CA, Ludmir J, Li W, Edelman RR (1997) Placenta accreta: evaluation with color Doppler US, power Doppler US, and MR imaging. Radiology 205:773–776. doi:10.1148/radiology.205.3.9393534

    Article  CAS  PubMed  Google Scholar 

  6. Leyendecker JR, DuBose M, Hosseinzadeh K, et al. (2012) MRI of pregnancy-related issues: abnormal placentation. AJR Am J Roentgenol 198:311–320. doi:10.2214/AJR.11.7957

    Article  PubMed  Google Scholar 

  7. Maldjian C, Adam R, Pelosi M, et al. (1999) MRI appearance of placenta percreta and placenta accreta. Magn Reson Imaging 17:965–971

    Article  CAS  PubMed  Google Scholar 

  8. Kim JA, Narra VR (2004) Magnetic resonance imaging with true fast imaging with steady-state precession and half-Fourier acquisition single-shot turbo spin-echo sequences in cases of suspected placenta accreta. Acta Radiol 45:692–698

    Article  CAS  PubMed  Google Scholar 

  9. Derman AY, Nikac V, Haberman S, et al. (2011) MRI of placenta accreta: a new imaging perspective. AJR Am J Roentgenol 197:1514–1521. doi:10.2214/AJR.10.5443

    Article  PubMed  Google Scholar 

  10. Tanaka YO, Sohda S, Shigemitsu S, Niitsu M, Itai Y (2001) High temporal resolution dynamic contrast MRI in a high risk group for placenta accreta. Magn Reson Imaging 19:635–642

    Article  CAS  PubMed  Google Scholar 

  11. Chen MM, Coakley FV, Kaimal A, Laros RK (2008) Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 112(2 Pt 1):333–340. doi:10.1097/AOG.0b013e318180a505

    Article  PubMed  Google Scholar 

  12. Lax A, Prince MR, Mennitt KW, Schwebach JR, Budorick NE (2007) The value of specific MRI features in the evaluation of suspected placental invasion. Magn Reson Imaging 25:87–93. doi:10.1016/j.mri.2006.10.007

    Article  PubMed  Google Scholar 

  13. Teo TH, Law YM, Tay KH, Tan BS, Cheah FK (2009) Use of magnetic resonance imaging in evaluation of placental invasion. Clin Radiol 64:511–516. doi:10.1016/j.crad.2009.02.003

    Article  CAS  PubMed  Google Scholar 

  14. Lim PS, Greenberg M, Edelson MI, et al. (2011) Utility of ultrasound and MRI in prenatal diagnosis of placenta accreta: a pilot study. AJR Am J Roentgenol 197:1506–1513. doi:10.2214/AJR.11.6858

    Article  PubMed  Google Scholar 

  15. Ueno Y, Kitajima K, Kawakami F, et al. (2014) Novel MRI finding for diagnosis of invasive placenta praevia: evaluation of findings for 65 patients using clinical and histopathological correlations. Eur Radiol 24:881–888. doi:10.1007/s00330-013-3076-7

    Article  PubMed  Google Scholar 

  16. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  17. Irving FC, Hertig AT (1937) A study of placenta accreta. Surg Gynecol Obstet 64:178–200

    Google Scholar 

  18. Sumigama S, Itakura A, Ota T, et al. (2007) Placenta previa increta/percreta in Japan: a retrospective study of ultrasound findings, management and clinical course. J Obstet Gynaecol Res 33:606–611. doi:10.1111/j.1447-0756.2007.00619.x

    Article  PubMed  Google Scholar 

  19. O’Brien JM, Barton JR, Donaldson ES (1996) The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 175:1632–1638

    Article  PubMed  Google Scholar 

  20. American College of Obstetricians and Gynecologists (2006) ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 108:1039–1047

    Article  Google Scholar 

  21. Noda Y, Kanematsu M, Goshima S, et al. (2015) Prenatal MR imaging diagnosis of placental invasion. Abdom Imaging 40:1273–1278. doi:10.1007/s00261-014-0281-z

    Article  PubMed  Google Scholar 

  22. Tantbirojn P, Crum CP, Parast MM (2008) Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta 29:639–645. doi:10.1016/j.placenta.2008.04.008

    Article  CAS  PubMed  Google Scholar 

  23. Choo SW, Kim SH, Jeong YG, et al. (1997) MR imaging of segmental renal infarction: an experimental study. Clin Radiol 52:65–68

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Tomomi Sato.

Ethics declarations


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The local institutional review board approved this retrospective study, and informed consent was waived.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sato, T., Mori, N., Hasegawa, O. et al. Placental recess accompanied by a T2 dark band: a new finding for diagnosing placental invasion. Abdom Radiol 42, 2146–2153 (2017).

Download citation

  • Published:

  • Issue Date:

  • DOI: