Department of Radiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
Department of Obstetrics and Gynecology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
Br J Radiol. 2023 Mar 1;96(1144):20220822. doi: 10.1259/bjr.20220822.
The purpose of this study is to evaluate the diagnostic performance of MRI parameters to predict adverse maternal peripartum outcomes in pregnant females at high-risk for placenta accreta spectrum (PAS) disorder.
This retrospective study evaluated 60 pregnant females who underwent MRI for placental assessment. MRI studies were reviewed by a radiologist blinded to all clinical data. MRI parameters were compared with five maternal outcomes: severe bleeding, cesarean hysterectomy, prolonged operation time, need for blood transfusion, and need for intensive care unit (ICU) admission. The MRI findings were associated with pathologic and/or intraoperative findings for PAS.
The study identified 46 cases of PAS disorder and 16 cases of placenta percreta. The agreement between the radiologist impression of PAS disorder and the intraoperative/histological findings was substantial (0.67, < 0.001), and almost perfect for the presence of placenta percreta (0.87, < 0.001). The presence of a placental bulge was highly associated with placenta percreta, with sensitivity of 87.5% and specificity of 90.9%. The MRI signs that associated with more maternal outcomes were myometrial thinning, with significant odds ratio for severe blood loss (20.2), hysterectomy (4.0), need for blood transfusion (4.8) and prolonged surgery time (4.9), and uterine bulging, with significant odds ratio for severe blood loss (11.9), hysterectomy (34.0), ICU admission (5.0), and need for blood transfusion (4.8).
MRI signs significantly correlated with invasive placenta and were independently associated with adverse maternal outcomes. The presence of a placental bulge was highly accurate in predicting placenta percreta.
First study to evaluate the strength of the association between individual MRI signs and five adverse maternal outcomes. Conclusions support published MRI signs associated with placental invasion, especially regarding the value placental bulging in predicting placenta percreta.
本研究旨在评估 MRI 参数对胎盘植入谱系疾病（PAS）高危孕妇围产期不良母婴结局的诊断性能。
本回顾性研究评估了 60 例接受 MRI 胎盘评估的孕妇。MRI 研究由一名对所有临床数据均不知情的放射科医生进行审查。将 MRI 参数与 5 种母婴结局进行比较：严重出血、剖宫产子宫切除术、手术时间延长、需要输血和需要入住重症监护病房（ICU）。MRI 结果与 PAS 的病理和/或术中结果相关。
本研究发现 46 例 PAS 疾病和 16 例胎盘植入。放射科医生对 PAS 疾病的印象与术中/组织学结果之间的一致性为中等（0.67，<0.001），而胎盘植入的一致性为极好（0.87，<0.001）。胎盘膨出与胎盘植入高度相关，敏感性为 87.5%，特异性为 90.9%。与更多母婴结局相关的 MRI 征象是子宫肌层变薄，严重出血（20.2）、子宫切除术（4.0）、需要输血（4.8）和手术时间延长（4.9）的显著优势比，子宫膨出与严重出血（11.9）、子宫切除术（34.0）、ICU 入住（5.0）和需要输血（4.8）的显著优势比相关。
MRI 征象与侵袭性胎盘显著相关，并与不良母婴结局独立相关。胎盘膨出的存在高度准确地预测胎盘植入。
首次评估个体 MRI 征象与五种不良母婴结局之间关联强度的研究。结论支持与胎盘侵犯相关的已发表 MRI 征象，尤其是胎盘膨出在预测胎盘植入方面的价值。
