IMAGING OF THE PLACENTA ACCRETA SPECTRUM, A CONCEPTUAL REVIEW FEATURING INTERESTING CASES

Authors

Kashan University of Medical Sciences

10.22034/icrj.2022.173711

Abstract

Purpose:
Placenta accreta spectrum (PAS) disorders are quite challenging for the purpose of diagnosis and treatment. Timely diagnosis is of great importance, as maternal and fetal mortality drastically increases if patients go through the third phase of delivery in not well-suited facilities. Imaging evaluation is the mainstay to diagnose PAS disorders antenatally. Herewith, we review the recommended imaging approaches, as well as reported US and MRI features of PAS disorders. We also represent some interesting and challenging cases of PAS imaging in first and second trimester.
Imaging Findings:
Imaging in normal non-invasive placentation, ultrasound findings in PAS (including placenta previa, focal exophytic mass, multiple placental lacunae, loss of the retroplacental clear space, myometrial thinning, bladder wall abnormalities, and abnormal Doppler imaging patterns) will all be shortly and concisely discussed. Reported conventional and functional MRI, and DWI features of PAS (including abnormal uterine/placental bulge, placental heterogenicity, focal placental mass, bladder wall abnormalities, dark T2 band, irregular placental-myometrial interface, myometrial thinning, and abnormal uteroplacental vascularity) will be briefly reviewed as well. For each case, we touch on potential pitfalls in imaging and reported figures and stats of any feature for diagnosing PAS. Imaging role in diagnosing PAS in first trimester, along with cesarean section pregnancy will also be overviewed.
Discussion:
Neither pathology nor imaging (US or MRI) findings of PAS in isolation are not very strong, independent, and confident to predict PAS. Both pathology and radiology may bring about false negative or positive results, and none of them are capable of predicting the depth of abnormal placentation confidently.
Conclusion:
A multidisciplinary approach considering clinical risk factors, imaging features, and pathological findings should make the diagnosis. With all these being said, diagnosing PAS is challenging and postoperative complications are quite common, even in facilities with a high level of expertise in managing PAS disorders.
Iranian Congress of Radiology
Volume 37, Issue 4
September 2022
Pages 67-67

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History

  • Receive Date: 29 June 2023
  • Accept Date: 29 June 2023

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