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Prediction of placenta accreta spectrum in patients with placenta previa using clinical risk factors, ultrasound and magnetic resonance imaging findings

  • Magnetic Resonance Imaging
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Abstract

Objectives

To predict placental accreta spectrum (PAS) in patients with placenta previa (PP) evaluating clinical risk factors (CRF), ultrasound (US) and magnetic resonance imaging (MRI) findings.

Methods

Seventy patients with PP were retrospectively selected. CRF were retrieved from medical records. US and MRI images were evaluated to detect imaging signs suggestive of PAS. Univariable analysis was performed to identify CRF, US and MRI signs associated with PAS considering histology as standard of reference. Receiver operating characteristic curve (ROC) analysis was performed, and the area under the curve (AUC) was calculated. Multivariable analysis was also performed.

Results

At univariable analysis, the number of previous cesarean section, smoking, loss of the retroplacental clear space, myometrial thinning < 1 mm, placental lacunae, intraplacental dark bands (IDB), focal interruption of myometrial border (FIMB) and abnormal vascularity were statistically significant. The AUC in predicting PAS progressively increased using CRF, US and MRI signs (0.69, 0.79 and 0.94, respectively; p < 0.05); the accuracy of MRI alone was similar to that obtained combining CRF, US and MRI variables (AUC = 0.97) and was significantly higher (p < 0.05) than that combining CRF and US (AUC = 0.83). Multivariable analysis showed that only IDB (p = 0.012) and FIMB (p = 0.029) were independently associated with PAS.

Conclusions

MRI is the best modality to predict PAS in patients with PP independently from CRF and/or US finding. It is reasonable to propose the combined assessment of CRF and US as the first diagnostic level to predict PAS, sparing MRI for selected cases in which US findings are uncertain for PAS.

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Abbreviations

CRF:

Clinical risk factors

PAS:

Placenta accreta spectrum

US:

Ultrasound

MRI:

Magnetic resonance imaging

PP:

Placenta previa

CS:

Cesarean sections

AUC:

Area under the curve

ROC:

Receiver operating characteristic

LRCS:

Loss of the retroplacental clear space

PL:

Placental lacunae

MT:

Myometrial thinning

IDB:

Intraplacental dark bands

FIMB:

Focal interruption of myometrial border

AV:

Abnormal vascularity

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via S. Pansini, 5, 80123, Naples, Italy

    Valeria Romeo, Francesco Verde, Maria D’Armiento, Arturo Brunetti & Simone Maurea

  2. Department of Neuroscience, Reproductive and Dentistry Sciences, University of Naples “Federico II”, Naples, Italy

    Laura Sarno, Sonia Migliorini & Maurizio Guida

  3. Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy

    Mario Petretta

  4. Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples, Italy

    Pier Paolo Mainenti

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  1. Valeria Romeo
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Contributions

All authors whose names appear on the submission. VR, FV, MD made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; LS, SM, MG drafted the work or revised it critically for important intellectual content; MP approved the version to be published; and PPM agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Francesco Verde.

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The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

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This retrospective study was approved by our Institutional Review Board and written informed consent was waived.

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Romeo, V., Verde, F., Sarno, L. et al. Prediction of placenta accreta spectrum in patients with placenta previa using clinical risk factors, ultrasound and magnetic resonance imaging findings. Radiol med 126, 1216–1225 (2021). https://doi.org/10.1007/s11547-021-01348-6

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  • DOI: https://doi.org/10.1007/s11547-021-01348-6

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