Department of Obstetrics, Gynecology and Reproductive Science, NYU Langone Hospital - Long Island, New York University Long Island School of Medicine, Mineola, NY, USA.
Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):6008-6012. doi: 10.1080/14767058.2021.1903861. Epub 2021 Mar 26.
To determine if the use of magnetic resonance imaging (MRI) changes the diagnosis of placenta accreta spectrum (PAS) made on prenatal ultrasound (US) leading to an improvement in clinical outcomes.
This was a retrospective chart review of all patients with evidence of PAS on US from 2012 to 2018 in one tertiary care medical center with subsequent use of MRI of the uterus to confirm diagnosis. The type of PAS classified by imaging was compared between US and MRI, with a final diagnosis made using histology. Outcomes that were analyzed included the following: 1) MRI correctly changed diagnosis, 2) MRI incorrectly downgraded diagnosis, 3) MRI incorrectly upgraded diagnosis, and 4) MRI did not change diagnosis. A -test and Chi-squared test were performed to compare the clinical outcomes of patients with an upgraded diagnosis by MRI to those whose diagnosis was downgraded or stayed the same.
Forty-one patients received an MRI to validate the diagnosis of PAS after ultrasound and are included in the analysis. MRI changed the diagnosis in 36.6% (15/41) patients, correctly changing the diagnosis in 22% (9/41) and incorrectly upgrading the diagnosis in 14.6% (6/41). Patients whose diagnosis was upgraded by MRI (either correctly or incorrectly) were more likely to deliver earlier compared to those who were either downgraded or had no change in their diagnosis [33. 2 ± 3. 5 weeks vs 35. 2 ± 2. 9 weeks, = 0.05]. Patients who were upgraded were more likely to have interventional radiology and/or urology involvement at the time of delivery [91.7% (11/12) vs 25. 9% (7/27), = 0.001]. There were no complications from these procedures.
The use of MRI incorrectly changed the diagnosis as much as it correctly changed the diagnosis of PAS after US. MRI should not be used routinely as a clinical adjunct to ultrasound in the diagnosis of placenta accreta spectrum.
确定磁共振成像（MRI）是否会改变产前超声（US）诊断的胎盘植入综合征（PAS）谱，从而改善临床结局。
这是对 2012 年至 2018 年期间在一家三级保健医疗中心接受 US 检查有 PAS 证据的所有患者进行的回顾性图表审查，随后使用子宫 MRI 确认诊断。比较 US 和 MRI 对 PAS 分类的影像学类型，最终采用组织学诊断。分析的结果包括：1）MRI 正确改变诊断，2）MRI 错误降级诊断，3）MRI 错误升级诊断，以及 4）MRI 未改变诊断。采用 A 检验和卡方检验比较 MRI 升级诊断患者与降级或保持不变诊断患者的临床结局。
41 例患者在 US 后接受 MRI 以验证 PAS 的诊断，纳入分析。MRI 改变了 36.6%（41 例中有 15 例）患者的诊断，正确改变诊断 22%（41 例中有 9 例），错误升级诊断 14.6%（41 例中有 6 例）。MRI 诊断升级的患者（无论是正确还是错误）更早分娩的可能性更大[33.2±3.5 周比 35.2±2.9 周， = 0.05]。诊断升级的患者在分娩时更有可能接受介入放射学和/或泌尿科的治疗[91.7%（11/12）比 25.9%（7/27）， = 0.001]。这些手术没有并发症。
MRI 错误地改变了 PAS 的诊断，就像正确改变了 US 后的 PAS 诊断一样。MRI 不应该作为 PAS 的常规临床辅助诊断方法，用于超声检查。
