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Objectives <p>To determine the performance of MRI features alone and combined in a model for the diagnosis of placenta accreta spectrum (PAS) disorders in pregnant women.</p> Materials and methods <p>This single health system IRB-approved retrospective study included 131 pregnant women who underwent MRI for placental (<i>n</i> = 122) or fetal (<i>n</i> = 9, controls) indications (2016–2021). Three independent observers assessed 11 PAS features on MRI, endorsed in prior studies, with consensus adjudication of discordances by 2 separate expert observers. The reference standard was established by intra-operative findings and/or pathology. Univariable and multivariable logistic regression and ROC analysis evaluated MRI feature performance for PAS diagnosis alone and combined in a model.</p> Results <p>131 pregnant patients (mean age 36 years, range 21–54 years; mean gestational age 28 weeks) were included. PAS was present in 54/131 (41.2%) patients. Consensus adjudication demonstrated that all MRI features and history of prior deliveries (vaginal or caesarean section) were associated with PAS (<i>p</i> ≤ 0.0003). Most MRI features, except the “serosal vessel sign,” were associated with PAS for the independent observers (<i>p</i> &lt; 0.04). At consensus, “loss of T2-retroplacental line” (sensitivity 0.87/specificity 0.43/<i>p</i> = 0.0003) and “myometrial thinning” (sensitivity 0.87/specificity 0.47/<i>p</i> &lt; 0.0001) showed the highest sensitivity for PAS, while “bladder vessel sign” had the highest specificity (sensitivity 0.28/specificity 1.0/<i>p</i> &lt; 0.0001). A multivariable model comprised of “uterine/placental bulge,” “focal exophytic placental mass,” and “bladder vessel sign” demonstrated an AUC = 0.83 (95% confidence interval 0.76–0.83) for PAS diagnosis using consensus data.</p> Conclusion <p>A model based on consensus interpretation of MRI findings demonstrated good performance for diagnosing PAS.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>The lack of validated MRI criteria and inter-observer variability limits MRI’s reliability for noninvasive placenta accreta spectrum (PAS) diagnosis in pregnant women.</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>MRI features demonstrated variable sensitivity and specificity across readers for PAS diagnosis, often at a trade-off, highlighting the need for consensus review.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>A model based on consensus interpretation of MRI findings, comprised of “uterine/placental bulge,” “exophytic placental mass,” and “bladder vessel sign,” demonstrated good performance for diagnosing PAS, which is essential given the risk of maternal morbidity and mortality at delivery.</i></p> Graphical Abstract <p></p>

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Endorsing consensus interpretation for diagnosing placenta accreta spectrum disorders on MRI

  • 期刊论文

  • 发表日期：

    2025年7月21日

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  • Benjamin Parnes,
  • Amita Kamath,
  • Barak Friedman,
  • Michael King,
  • Caroline Lieberman,
  • Kara Ho,
  • Kamran Ali,
  • Samantha Platt,
  • Himanshu Sharma,
  • Jackie Xiang,
  • Shima Rastegar,
  • Yuxin Liu,
  • John Doucette,
  • Konstantin Zakashansky,
  • Bachir Taouli,
  • Sara Lewis

摘要

Objectives

To determine the performance of MRI features alone and combined in a model for the diagnosis of placenta accreta spectrum (PAS) disorders in pregnant women.

Materials and methods

This single health system IRB-approved retrospective study included 131 pregnant women who underwent MRI for placental (n = 122) or fetal (n = 9, controls) indications (2016–2021). Three independent observers assessed 11 PAS features on MRI, endorsed in prior studies, with consensus adjudication of discordances by 2 separate expert observers. The reference standard was established by intra-operative findings and/or pathology. Univariable and multivariable logistic regression and ROC analysis evaluated MRI feature performance for PAS diagnosis alone and combined in a model.

Results

131 pregnant patients (mean age 36 years, range 21–54 years; mean gestational age 28 weeks) were included. PAS was present in 54/131 (41.2%) patients. Consensus adjudication demonstrated that all MRI features and history of prior deliveries (vaginal or caesarean section) were associated with PAS (p ≤ 0.0003). Most MRI features, except the “serosal vessel sign,” were associated with PAS for the independent observers (p < 0.04). At consensus, “loss of T2-retroplacental line” (sensitivity 0.87/specificity 0.43/p = 0.0003) and “myometrial thinning” (sensitivity 0.87/specificity 0.47/p < 0.0001) showed the highest sensitivity for PAS, while “bladder vessel sign” had the highest specificity (sensitivity 0.28/specificity 1.0/p < 0.0001). A multivariable model comprised of “uterine/placental bulge,” “focal exophytic placental mass,” and “bladder vessel sign” demonstrated an AUC = 0.83 (95% confidence interval 0.76–0.83) for PAS diagnosis using consensus data.

Conclusion

A model based on consensus interpretation of MRI findings demonstrated good performance for diagnosing PAS.

Key Points

Question The lack of validated MRI criteria and inter-observer variability limits MRI’s reliability for noninvasive placenta accreta spectrum (PAS) diagnosis in pregnant women.

Findings MRI features demonstrated variable sensitivity and specificity across readers for PAS diagnosis, often at a trade-off, highlighting the need for consensus review.

Clinical relevance A model based on consensus interpretation of MRI findings, comprised of “uterine/placental bulge,” “exophytic placental mass,” and “bladder vessel sign,” demonstrated good performance for diagnosing PAS, which is essential given the risk of maternal morbidity and mortality at delivery.

Graphical Abstract