Title: MRI Appearance of Placenta Percreta and Placenta Accreta
Abstract: Disorders of placental implantation comprise a spectrum ranging from the mildest form, placenta accreta, which involves myometrial invasion, to the most severe form, placenta percreta, in which tissue invades through the uterine serosa and can involve adjacent organs. Placenta increta, with deep myometrial invasion, is an intermediate state. Any of these disorders can lead to profuse bleeding, which often occurs at the time of delivery. Accurate antepartum diagnosis can prompt an alternative surgical approach. This study is a retrospective review of the findings of magnetic resonance imaging (MRI) in four patients, three with a history of cesarean delivery and one with three prior myomectomies. All four women presented with antepartum spotting or frank vaginal bleeding. Magnetic resonance imaging was performed at 33 to 36 weeks’ gestation, and the findings were reviewed by two radiologists, who examined T2-weighted images recorded in the sagittal, axial, and coronal planes. Two women had findings of placenta percreta with previa. One each presented with placenta accreta and previa and with placenta accreta with a fundal placenta (at the site of previous myomectomies). In all instances, the MRI findings agreed completely with the surgical and pathological findings. In placenta accreta, the myometrium was focally thinned and indistinct near the placenta, but there was a lower-signal-intensity component subjacent to the abnormality. In placenta percreta, the uterine wall was focally obliterated in the area of abnormality and traversed by tissue that was isointense to and confluent with the intrauterine placenta. In one of these cases, placental tissue was seen abutting on the bladder wall, and superficial invasion of the detrusor muscle was confirmed pathologically. All four women underwent total hysterectomy. Blood loss in three cases was estimated at 800 to 1000 ml. Magnetic resonance imaging is an accurate means of assessing abnormalities of placental implantation, displaying soft tissue contrast far better than ultrasonography. Antepartum MRI may prevent morbidity and even death in women who have had previous uterine surgery when the results of ultrasonography are inconclusive. The method is especially helpful when an abnormality is present at a posterior or fundal site that is not very accessible to examination with a high-frequency transducer. Magn Reson Imaging 1999;17:965–971
Publication Year: 2000
Publication Date: 2000-03-01
Language: en
Type: article
Indexed In: ['crossref']
Access and Citation
Cited By Count: 8
AI Researcher Chatbot
Get quick answers to your questions about the article from our AI researcher chatbot