Purpose: The purpose of this study was to evaluate the capability of MRI in depicting the topography of placenta percreta (PP) and to further explore the correlation between invasion topography and maternal outcomes.
Methods: 55 patients with histologically or surgically confirmed PP were included in this retrospective study. Two senior radiologists evaluated the topography of PP based on MR images: the invasion topography was depicted as S1, S2, parametrial, bladder, and cervical invasion. The correlation between invasion topography and maternal outcomes was analyzed using Chi-square statistic.
Results: MRI showed high sensitivity and specificity in delineating the invasion topography of PP (ranging from 87.5 to 100%). MRI had 100% specificity for predicting the parametrial, bladder, and cervical invasion. The rate of cesarean hysterectomy, ureteral injuries and ICU administration, and the amount of blood transfusions in PP with S2 invasion were higher than S1 invasion (P < 0.05). In addition, all patients with bladder invasion (8/8) received partial bladder resection by urologists. All the patients with S2 parametrial invasion (12/12) or cervical invasion (9/9) underwent cesarean hysterectomy.
Conclusion: MRI was capable in predicting the invasion topography of PP patients. Moreover, PP patients with S2, parametrial, bladder or cervical invasion had more severe maternal morbidity.
Keywords: Magnetic resonance imaging; Morbidity; Placenta accreta; Placenta percreta.