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Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders

  • Magnetic Resonance
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Abstract

Objectives

This study was conducted in order to establish the joint Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) guidelines on placenta accreta spectrum (PAS) disorders and propose strategies to standardize image acquisition, interpretation, and reporting for this condition with MRI.

Methods

The published evidence-based data and the opinion of experts were combined using the RAND–UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to questions regarding the details of patient preparation, MRI protocol, image interpretation, and reporting were collected, analyzed, and classified as “recommended” versus “not recommended” (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts).

Results

Consensus regarding image acquisition, interpretation, and reporting was determined using the RAND–UCLA Appropriateness Method. The use of a tailored MRI protocol and standardized report was recommended.

Conclusions

A standardized imaging protocol and reporting system ensures recognition of the salient features of PAS disorders. These consensus recommendations should be used as a guide for the evaluation of PAS disorders with MRI.

Key Points

• MRI is a powerful adjunct to ultrasound and provides valuable information on the topography and depth of placental invasion.

• Consensus statement proposed a common lexicon to allow for uniformity in MRI acquisition, interpretation, and reporting of PAS disorders.

• Seven MRI features, namely intraplacental dark T2 bands, uterine/placental bulge, loss of low T2 retroplacental line, myometrial thinning/disruption, bladder wall interruption, focal exophytic placental mass, and abnormal vasculature of the placental bed, reached consensus and are categorized as “recommended” for diagnosing PAS disorders.

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Abbreviations

ACR:

American College of Radiology

BGE:

Balanced gradient echo

DOR:

Diagnostic odds ratio

DWI:

Diffusion-weighted imaging

ECR:

European Congress of Radiology

ESGAR:

European Society of Gastrointestinal and Abdominal Radiology

ESUR:

European Society of Urogenital Radiology

FIGO:

International Federation of Gynecology and Obstetrics

HASTE:

Half Fourier single-shot turbo spin echo

IVF:

In vitro fertilization

NLR:

Negative likelihood ratio

NPV:

Negative predictive value

PAS:

Placenta accreta spectrum

PIWG:

Placental Imaging Working Group

PLR:

Positive likelihood ratio

PPV:

Positive predictive value

SAR:

Society of Abdominal Radiology

SSFSE:

Single-shot fast spin echo

SSH-TSE:

Single-shot turbo spin echo

UFSE:

Ultra-fast spin echo

UOC DFP:

Uterine and Ovarian Cancer Disease-Focused Panel

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, BOX 0628, San Francisco, CA, 94143, USA

    Priyanka Jha & Liina Pōder

  2. Division of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece

    Charis Bourgioti

  3. Department of Radiology, Imperial College Healthcare NHS Trust, London, UK

    Nishat Bharwani

  4. Department of Surgery & Cancer, Imperial College London, London, UK

    Nishat Bharwani

  5. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Sara Lewis & Amita Kamath

  6. Department of Radiology, Montpellier Cancer Research Institute (IRCM), Montpellier, France

    Stephanie Nougaret

  7. Department of Radiology, Cochin Hospital AP-HP, Paris, 75014, France

    Philippe Soyer

  8. University of Paris, Descartes-Paris 5, Paris, 75006, France

    Philippe Soyer

  9. Department of Radiology, St James’s University Hospital, Leeds, UK

    Michael Weston

  10. Department of Diagnostic Radiology, University of Miami, Miami, FL, USA

    Rosa P. Castillo

  11. Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan

    Aki Kido

  12. Department of Radiology, Paracelsus Medical University, Müllner Hauptstr, Salzburg, Austria

    Rosemarie Forstner

  13. Radiology Department, Umberto I Hospital, Sapienza University, Rome, Italy

    Gabriele Masselli

Authors
  1. Priyanka Jha
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  2. Liina Pōder
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  3. Charis Bourgioti
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  7. Stephanie Nougaret
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  8. Philippe Soyer
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  9. Michael Weston
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  10. Rosa P. Castillo
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  13. Gabriele Masselli
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Corresponding author

Correspondence to Priyanka Jha.

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Guarantor

The scientific guarantor of this publication is Gabriele Masseli.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because this is a consensus statement.

Ethical approval

Institutional Review Board approval was not required as no patient information was accessed for this study.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in previous studies referenced in the manuscript.

Methodology

• Retrospective

• Observational

• Multicenter study

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Jha, P., Pōder, L., Bourgioti, C. et al. Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders. Eur Radiol 30, 2604–2615 (2020). https://doi.org/10.1007/s00330-019-06617-7

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  • DOI: https://doi.org/10.1007/s00330-019-06617-7

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