Role of Doppler US and MRI in diagnosis of placenta accreta

Abstract

The aim of this work is to evaluate the role of Doppler US and MRI in the diagnosis of placenta accreta.
Patients and methods: During period between 2012 to 2013, 120 pregnant patients with previous cesarean section were investigated by ultrasound and Doppler and then in suspected cases MRI was obtained (10 cases). The Sonographic and MRI diagnoses were compared with the final pathologic or operative findings or with both.
Results: The mean age of this study group was 29 years ranging from 20 to 40. Among patients with confirmed placenta accreta, the mean age was 32.25 ranging from 25 to 40 years. The mean parity of patients ranged from 1 to 6 with a mean of 1.6. Among patients with placenta accreta, the mean parity ranged from 2 to 6 with a mean of 3.75. The total number of cases with placenta accreta in this study was 4, all of which were previa. This was out of a total of 25 cases of placenta previa. Transabdominal US features were the presence of intraplacental lacunae (sonolucencies), loss of retroplacental clear zone and disruption of bladder–uterine serosa interface with smallest myometrial thickness <1 mm over site of placental implantation by using color Doppler ultrasonography, the most prominent color Doppler  feature in this study was the presence of intraplacental lacunar flow. Magnetic resonance imaging  accurately predicted placenta accreta in 4 of 4 cases with placenta accreta and correctly ruled out  placenta accreta in the rest six cases.
Conclusion: In conclusion, data of the present study show that the use of transabdominal color Doppler ultrasonography complemented by MRI in suspected cases improves the diagnostic accuracy in  prediction of placenta accreta in patients with previous cesarean delivery.

KEYWORDS: Cesarean section (cs); Magnetic resonance imaging (MRI); Placenta accreta (PA);  Retroplacental complex (RPC); Fast low angle shot (FLASH); Single shot fast spin echo (SSFSE)