Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Eur J Radiol. 2023 Mar;160:110695. doi: 10.1016/j.ejrad.2023.110695. Epub 2023 Jan 13.
Placental accreta spectrum (PAS) disorder with bladder involvement can be associated with maternal and neonatal morbidity. Magnetic resonance imaging (MRI) may provide accurate preoperative diagnoses.
This study had 2 aims: to retrospectively review the MRI findings for bladder involvement in PAS with placental previa and to correlate bladder involvement with maternal and neonatal outcomes.
MRI images of 48 patients with severe PAS (increta and percreta) with placenta previa/low-lying placenta were evaluated by 2 experienced radiologists blinded to the final diagnoses. Nine MRI findings and stepwise logistic regression analysis were assessed to identify predictive MRI findings for bladder involvement. The correlations between PAS patients with bladder involvement and clinical outcomes were analyzed using Fisher's exact test.
Of the 48 patients, 27 did not have bladder involvement, while 21 did. Logistic regression analysis identified 2 predictive MRI features for bladder involvement. They were abnormal vascularization (OR,6.94; 95 %CI,1.05-45.75) and loss of the chemical shift line at the uterovesical interface (OR, 4.41; 95 %CI, 0.63-30.98). The sensitivity and specificity of the combined MRI features were 38.1 % and 100 %, respectively (p = 0.001). A significant correlation was found between bladder involvement and massive blood loss during surgery (p = 0.022).
PAS with bladder involvement was significantly correlated with massive surgical blood loss. Prenatally, the disorder was predicted with high specificity by the combination of loss of chemical shift artifacts in the steady-state free precession sequence and abnormal vascularization at the uterovesical interface on MRI.
伴有膀胱受累的胎盘植入谱系（PAS）疾病可导致产妇和新生儿发病率增加。磁共振成像（MRI）可提供准确的术前诊断。
本研究有两个目的：回顾性分析胎盘前置伴 PAS 膀胱受累的 MRI 表现，并将膀胱受累与母婴结局相关联。
对 48 例严重 PAS（包括胎盘植入和胎盘穿透）伴胎盘前置/低置胎盘患者的 MRI 图像进行评估，由 2 名经验丰富的放射科医生进行评估，他们对最终诊断结果不知情。评估了 9 种 MRI 表现和逐步逻辑回归分析，以确定预测膀胱受累的 MRI 表现。采用 Fisher 确切检验分析 PAS 伴膀胱受累患者与临床结局的相关性。
在 48 例患者中，27 例无膀胱受累，21 例有膀胱受累。逻辑回归分析确定了 2 种预测膀胱受累的 MRI 特征。它们是异常血管化（OR，6.94；95%CI，1.05-45.75）和子宫-膀胱界面化学位移线丢失（OR，4.41；95%CI，0.63-30.98）。联合 MRI 特征的灵敏度和特异性分别为 38.1%和 100%（p=0.001）。膀胱受累与手术期间大量失血之间存在显著相关性（p=0.022）。
伴有膀胱受累的 PAS 与大量手术失血显著相关。在产前，磁共振成像上稳态自由进动序列中化学位移伪影的丢失和子宫-膀胱界面异常血管化的组合可以高度特异性预测该疾病。
