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Invasive placenta previa: Placental bulge with distorted uterine outline and uterine serosal hypervascularity at 1.5T MRI – useful features for differentiating placenta percreta from placenta accreta

  • Magnetic Resonance
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Abstract

Objectives

To characterise MRI features of invasive placenta previa and to identify specific features for differentiating placenta percreta (PP) from placenta accreta (PA).

Methods

Forty-five women with PP and 93 women with PA who underwent 1.5T placental MRI were included. Two radiologists independently evaluated the MRI features of invasive placenta previa, including our novel type of placental bulge (i.e. placental bulge type-II, characterized by placental bulge with distorted uterine outline). Pearson’s chi-squared or Fisher’s two-sided exact test was performed to compare the MRI features between PP and PA. Logistic stepwise regression analysis and the area under the receiver operating characteristic curve (AUC) were performed to select the optimal features for differentiating PP from PA.

Results

Significant differences were found in nine MRI features between women with PP and those with PA (P <0.05). Placental bulge type-II and uterine serosal hypervascularity were independently associated with PP (odds ratio = 48.618, P < 0.001; odds ratio = 4.165, P = 0.018 respectively), and the combination of the two MRI features to distinguish PP from PA yielded an AUC of 0.92 for its predictive performance.

Conclusion

Placental bulge type-II and uterine serosal hypervascularity are useful MRI features for differentiating PP from PA.

Key Points

• Placental bulge type-II demonstrated the strongest independent association with PP.

• Uterine serosal hypervascularity is a useful feature for differentiating PP from PA.

• MRI features associated with abnormal vessels increase the risk of massive haemorrhage.

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Abbreviations

AIP:

Abnormal invasive placenta

AUC:

Area under the receiver operating characteristic curve

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PA:

Placenta accreta

PP:

Placenta percreta

PPV:

Positive predictive value

ROC:

Receiver operating characteristic curve

T2-Haste:

T2-weighted half-Fourier single-shot turbo spin echo

T2-True FISP:

T2-weighted true fast imaging with steady-state precession

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Guangbin Wang.

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Guarantor

The scientific guarantor of this publication is Guangbin Wang.

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.

Funding

This work was supported by the National Natural Science Foundation of China under Grant No. 81371534, 81171380.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived in this retrospective study.

Methodology

• retrospective

• comparative study 

• performed at one institution

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Chen, X., Shan, R., Zhao, L. et al. Invasive placenta previa: Placental bulge with distorted uterine outline and uterine serosal hypervascularity at 1.5T MRI – useful features for differentiating placenta percreta from placenta accreta. Eur Radiol 28, 708–717 (2018). https://doi.org/10.1007/s00330-017-4980-z

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  • DOI: https://doi.org/10.1007/s00330-017-4980-z

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