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MRI of placenta percreta: differentiation from other entities of placental adhesive disorder

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To retrospectively review the MRI findings of placenta percreta and identify those helpful for differentiation from non-placenta percreta.

Materials and methods

The MRI images of 21 patients with a preliminary diagnosis of placental adhesive disorder scanned between 2005 and 2014 were evaluated. Radiologists blinded to the final diagnosis evaluated six previously described MRI findings of placenta adhesive disorder. The sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predictive value (PPV) of MRI for the diagnosis of placenta percreta were also calculated.


The study included 12 cases of placenta percreta and 9 cases of non-placenta percreta. Invasion of placental tissue outside the uterus was found only in placenta percreta (p = 0.045; sensitivity 41.7 %; specificity 100 %). All placenta percreta cases also had a moderate to marked degree of heterogeneous placental signal intensity (p = 0.063; sensitivity 100 %; specificity 33.3 %). The size of the dark bands on T2-weighted imaging, and the presence of disorganized intra-placental vessels, showed no statistically significant difference between placenta percreta and non-placenta percreta. The sensitivity, specificity, NPV, PPV, and accuracy of MRI for detection of placenta percreta were 91.7, 44, 80, 68, and 71.4 %, respectively.


MRI is recommended for the evaluation of placenta percreta, with the most specific signs including the invasion of placental tissue outside the uterus on B-FFE sequences, and consideration of the degree of placental signal heterogeneity. The size of the T2 dark band alone, or bizarre disorganized intra-placental vessels, did not correlate with the severity of invasion.

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  1. Wu S, Kocherginsky M, Hibbard JU (2005) Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 192:1458–1466

    Article  PubMed  Google Scholar 

  2. Miller DA, Chollet JA, Goodwin TM (1997) Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 177:210–214

    Article  CAS  PubMed  Google Scholar 

  3. Grobman WA, Gersnoviez R, Landon MB, Spong CY, Leveno KJ, Rouse DJ et al (2007) Pregnancy outcomes for women with placenta previa in relation to the number of prior cesarean deliveries. Obstet Gynecol 110:1249–1255

    Article  PubMed  Google Scholar 

  4. Vahanian SA, Lavery JA, Ananth CV, Vintzileos A (2015) Placental implantation abnormalities and risk of preterm delivery: a systematic review and metaanalysis. Am J Obstet Gynecol 213:78–90

    Article  Google Scholar 

  5. Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M (2014) The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG 121:62–70

    Article  CAS  PubMed  Google Scholar 

  6. Clausen C, Lönn L, Langhoff-Roos J (2014) Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand 93:138–143

    Article  PubMed  Google Scholar 

  7. Comstock CH (2005) Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol 26:89–96

    Article  CAS  PubMed  Google Scholar 

  8. Masselli G, Brunelli R, Casciani E, Polettini E, Piccioni MG, Anceschi M et al (2008) Magnetic resonance imaging in the evaluation of placental adhesive disorders: correlation with color Doppler ultrasound. Eur Radiol 18:1292–1299

    Article  PubMed  Google Scholar 

  9. Maldijan C, Adam R, Pelosi M, Pelosi MI, Rudell RD, Maldijan J (1999) MRI appearance of placenta percreta and placenta accreta. Magn Reson Imaging 17:965–971

    Article  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Alamo L, Anaye A, Rey J, Denys A, Bongartz G, Terraz S et al (2013) Detection of suspected placental invasion by MRI: do the results depend on observer’ experience? Eur J Radiol 82:51–57

    Article  Google Scholar 

  12. 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

    Article  CAS  PubMed  Google Scholar 

  13. Derman AY, Nikac V, Haberman S, Zelenko N, Opsha O, Flyer M (2011) MRI of placenta accreta: a new imaging perspective. AJR 197:1514–1521

    Article  PubMed  Google Scholar 

  14. Noda Y, Kanematsu M, Goshima S, Kondo H, Watanabe H, Kawada H et al (2015) Prenatal MR imaging diagnosis of placental invasion. Abdom Imaging 40:1273–1278

    Article  PubMed  Google Scholar 

  15. 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 

  16. Leyendecker JR, DuBose M, Hosseinzadeh K, Stone R, Gianini J, Childs DD et al (2012) MRI of pregnancy-related issues: abnormal placentation. AJR 198:311–320

    Article  PubMed  Google Scholar 

  17. Lim PS, Greenberg M, Edelson MI, Bell KA, Edmonds PR, Mackey AM (2011) Utility of ultrasound and MRI in prenatal diagnosis of placenta accreta: a pilot study. AJR 197:1506–1513

    Article  PubMed  Google Scholar 

  18. Rahaim NS, Whitby EH (2015) The MRI features of placental adhesion disorder and their diagnostic significance: systematic review. Clin Radiol 70:917–925

    Article  CAS  PubMed  Google Scholar 

  19. Dwyer BK, Belogolovkin V, Tran L, Rao A, Carroll I, Barth R et al (2008) Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging? J Ultrasound Med 27:1275–1281

    PubMed  PubMed Central  Google Scholar 

  20. Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Bernirschke K et al (2006) Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 108:573–581

    Article  PubMed  Google Scholar 

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Correspondence to Shanigarn Thiravit.

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This study has not received any funding.

Conflict of interest

We declare that we do not have any conflict of interest.

Informed consent

This retrospective study was approved by our institutional review board with a waiver for informed consent.

Ethical standards

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.

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Thiravit, S., Lapatikarn, S., Muangsomboon, K. et al. MRI of placenta percreta: differentiation from other entities of placental adhesive disorder. Radiol med 122, 61–68 (2017).

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