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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:1275-1281 • 0278-4297

Prenatal Diagnosis of Placenta Accreta

Sonography or Magnetic Resonance Imaging?

Bonnie K. Dwyer, MD, Victoria Belogolovkin, MD, Lan Tran, MD, Anjali Rao, MD, Ian Carroll, MD, MS, Richard Barth, MD and Usha Chitkara, MD

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (B.K.D., A.R., U.C.), and Departments of Anesthesiology (I.C.) and Radiology (R.B.), Stanford University, Stanford, California USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, New York, New York USA (V.B.); and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington USA (L.T.).

Address correspondence to Bonnie K. Dwyer, MD, 726 Rustic Ln, Mountain View, CA 94040 USA. E-mail: dwyerbk{at}gmail.com

Objective. The purpose of this study was to compare the accuracy of transabdominal sonography and magnetic resonance imaging (MRI) for prenatal diagnosis of placenta accreta. Methods. A historical cohort study was undertaken at 3 institutions identifying women at risk for placenta accreta who had undergone both sonography and MRI prenatally. Sonographic and MRI findings were compared with the final diagnosis as determined at delivery and by pathologic examination. Results. Thirty-two patients who had both sonography and MRI prenatally to evaluate for placenta accreta were identified. Of these, 15 had confirmation of placenta accreta at delivery. Sonography correctly identified the presence of placenta accreta in 14 of 15 patients (93% sensitivity; 95% confidence interval [CI], 80%–100%) and the absence of placenta accreta in 12 of 17 patients (71% specificity; 95% CI, 49%–93%). Magnetic resonance imaging correctly identified the presence of placenta accreta in 12 of 15 patients (80% sensitivity; 95% CI, 60%–100%) and the absence of placenta accreta in 11 of 17 patients (65% specificity; 95% CI, 42%–88%). In 7 of 32 cases, sonography and MRI had discordant diagnoses: sonography was correct in 5 cases, and MRI was correct in 2. There was no statistical difference in sensitivity (P = .25) or specificity (P = .5) between sonography and MRI. Conclusions. Both sonography and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. In the case of inconclusive findings with one imaging modality, the other modality may be useful for clarifying the diagnosis.

Key Words: magnetic resonance imaging • placenta accreta • prenatal diagnosis • sensitivity and specificity • sonography

Abbreviations: CI, confidence interval • NPV, negative predictive value • MRI, magnetic resonance imaging • PPV, positive predictive value

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.