Accuracy of ultrasound and magnetic resonance imaging in the diagnosis of placenta accreta and percreta

Autor: Carri Warshak, Robert F. Mattrey, Kurt Benirschke, Robert Resnik, Ramez N. Eskander, Andrew D. Hull, Angela L. Scioscia
Rok vydání: 2005
Předmět:
Zdroj: American Journal of Obstetrics and Gynecology. 193:S29
ISSN: 0002-9378
Popis: DIAGNOSIS OF PLACENTA ACCRETA AND PERCRETA CARRI WARSHAK (F), RAMEZ ESKANDER, ANDREW HULL, ANGELA SCIOSCIA, ROBERT MATTREY, KURT BENIRSCHKE, ROBERT RESNIK, University of California, San Diego, Reproductive Medicine, San Diego, California, University of California, San Diego, Radiology, San Diego, California, UCSD Medical Center, Reproductive Medicine, San Diego, California, University of California, San Diego, La Jolla, California OBJECTIVE: The incidence of placenta accreta and percreta (PA) has increased dramatically over the last three decades. Optimal management requires accurate prenatal diagnosis. The purpose of this study was to determine the precision and reliability of ultrasound and MRI to accurately diagnose PA. STUDY DESIGN: A retrospective review of our perinatal database from 1/ 2000 to 6/2005 yielded 433 patients with placenta previa. Ultrasound records were reviewed for findings considered to be positive for PA including obliteration of the bladder wall-uterine interface, loss of hypoechoic area between the placenta and the uterine wall, and adjacent placental sonolucent spaces with increased vascularity by color or power Doppler. We also reviewed 58 patients who underwent MRI from 1/1992 to 6/2005 for suspected PA on ultrasound. MRI findings considered to be positive included bulge of the outer margin of the uterus at the footprint of the placenta, a dark nodular band at the outer margin of the uterus and heterogenous placental signal with dark internal bands/vessels. RESULTS: Of the 433 women with placenta previa, 32 had PA confirmed by pathologic examination. Ultrasound accurately predicted PA in 25/32 women and correctly ruled out PA in 396/401 patients (sensitivity 0.78; specificity 0.99). Of the 58 women referred for MRI, 39 patients had PA. MRI accurately predicted 35/39 PA cases and ruled out 19/19 patients without disease (sensitivity 0.90; specificity 1.00). CONCLUSION: Pelvic ultrasound was highly accurate for ruling out PA, and should be the primary modality for screening women at high risk for PA. However, MRI should be considered as part of the evaluation of all suspected cases.
Databáze: OpenAIRE
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