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Utility of diffusion-weighted MR imaging in the diagnosis of placenta accreta spectrum abnormality

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Abstract

Purpose

The aim of this study was to evaluate the utility of added DWI sequences as an adjunct to traditional MR imaging in the evaluation of abnormal placentation in patients with suspicion for placenta accreta spectrum abnormality or morbidly adherent placenta (MAP).

Materials and methods

The study was approved by local ethics committee. The subjects included pregnant women with prenatal MRI performed between July 2013 to July 2015. All imaging was performed on a Philips 1.5T MR scanner using pelvic phased-array coil. Only T2-weighted and diffusion-weighted imaging (DWI) series were compiled for review. Two randomized imaging sets were created: set 1 included T2-weighted series only (T2W); set 2 included T2W with DWI series together (T2W + DWI). Three radiologists, blinded to history and pathology, reviewed the imaging, with 2 weeks of time between the two image sets. Sensitivity, specificity, and overall accuracy for MAP were calculated and compared between T2W only and T2W + DWI reads. Associations between imaging findings and invasion on pathology were tested using the Chi-squared test. Confidence scores, inter-reader agreement, and systematic differences were documented.

Results

A total of 17 pregnant women were included in the study. 8 cases were pathologically diagnosed with MAP. There were no significant differences in the diagnostic accuracy between T2W and T2W + DWI in the diagnosis of MAP in terms of overall accuracy (62.7% for T2W vs. 68.6% for T2W + DWI, p = 0.68), sensitivity (70.8% for T2W vs. 95.8% for T2W + DWI, p = 0.12), and specificity (55.6% for T2W vs. 44.4% for T2W + DWI, p = 0.49). There was no significant difference in the diagnostic confidence between the review of T2W images alone and the T2W + DWI review (mean 7.3 ± 1.8 for T2W vs. 7.5 ± 1.8 for T2W + DWI, p = 0.37).

Conclusion

With the current imaging technique, addition of DWI sequence to the traditional T2W images cannot be shown to significantly increase the accuracy or reader confidence for diagnosis of placenta accreta spectrum abnormality. However, DWI does improve identification of abnormalities in the placental–myometrial interface.

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Authors and Affiliations

  1. Department of Radiology, University of Washington Medical Center, 1959 Pacific Street, Seattle, WA, 98195, USA

    Bhagya Sannananja, Anna Ellermeier, Daniel S. Hippe & Manjiri K. Dighe

  2. RA-MINW, P.S., 1535, Tacoma, WA, 98401, USA

    Anna Ellermeier

  3. Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 N 1900 E # 1A071, Salt Lake City, UT, 84132, USA

    Thomas C. Winter III

  4. Department of Radiology, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA

    Stella K. Kang

  5. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA

    Susanna I. Lee

  6. Department of Pathology, University of Washington Medical Center, 1959 Pacific Street, Seattle, WA, 98195, USA

    Mark R. Kilgore

Authors
  1. Bhagya Sannananja
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  2. Anna Ellermeier
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  3. Daniel S. Hippe
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  4. Thomas C. Winter III
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  5. Stella K. Kang
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  6. Susanna I. Lee
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  7. Mark R. Kilgore
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  8. Manjiri K. Dighe
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Corresponding author

Correspondence to Bhagya Sannananja.

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Funding

No funding was received for this study.

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

Retrospective study, hence no informed consents were obtained.

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Sannananja, B., Ellermeier, A., Hippe, D.S. et al. Utility of diffusion-weighted MR imaging in the diagnosis of placenta accreta spectrum abnormality. Abdom Radiol 43, 3147–3156 (2018). https://doi.org/10.1007/s00261-018-1599-8

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  • DOI: https://doi.org/10.1007/s00261-018-1599-8

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