Skip to main content
SpringerLink
Log in

The gravid uterus: MR imaging and reporting of abnormal placentation

  • Pictorial Essay
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Appropriate placentation is critical to maternal and fetal outcomes. Abnormal placentation, including placenta previa and morbidly adherent placenta, is increasing in incidence and is associated with multiple risk factors including advanced maternal age and history of prior cesarean delivery. Magnetic resonance imaging (MRI) is increasingly used in assessing the type and extent of abnormal placentation, often leading to modifications in surgical approach. Here, we review the MRI features and appropriate reporting of placenta previa and the placenta accreta spectrum.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Committee on Obstetric Practice (2012) Committee Opinion No. 529: placenta accreta. Obstet Gynecol 120:207–211

    Article  Google Scholar 

  2. Masselli G, Brunelli R, Casciani E, et al. (2008) Magnetic resonance imaging in the evaluation of placental adhesive disorders: correlation with color Doppler ultrasound. Eur Radiol 18:1292–1299

    Article  PubMed  Google Scholar 

  3. Lim PS, Greenberg M, Edelson MI, et al. (2011) Utility of ultrasound and MRI in prenatal diagnosis of placenta accreta: a pilot study. AJR Am J Roentgenol 197:1506–1513

    Article  PubMed  Google Scholar 

  4. Palacios Jaraquemada JM, Bruno CH (2005) Magnetic resonance imaging in 300 cases of placenta accreta: surgical correlation of new findings. Acta Obstet Gynecol Scand 84:716–724

    Article  PubMed  Google Scholar 

  5. Levine D, Hulka CA, Ludmir J, Li W, Edelman RR (1997) Placenta accreta: evaluation with color Doppler US, power Doppler US, and MR imaging. Radiology 205:773–776

    Article  CAS  PubMed  Google Scholar 

  6. Lax A, Prince MR, Mennitt KW, Schwebach JR, Budorick NE (2007) The value of specific MRI features in the evaluation of suspected placental invasion. Magn Reson Imaging 25:87–93

    Article  PubMed  Google Scholar 

  7. Victoria T, Jaramillo D, Roberts TPL, et al. (2014) Fetal magnetic resonance imaging: jumping from 1.5 to 3 tesla (preliminary experience). Pediatr Radiol 44:376–386 (quiz 373–375)

    Article  PubMed  Google Scholar 

  8. Merkle EM, Dale BM, Paulson EK (2006) Abdominal MR imaging at 3T. Magn Reson Imaging Clin N Am 14:17–26

    Article  PubMed  Google Scholar 

  9. Derman AY, Nikac V, Haberman S, et al. (2011) MRI of placenta accreta: a new imaging perspective. AJR Am J Roentgenol 197:1514–1521

    Article  PubMed  Google Scholar 

  10. Masselli G, Brunelli R, Parasassi T, Perrone G, Gualdi G (2011) Magnetic resonance imaging of clinically stable late pregnancy bleeding: beyond ultrasound. Eur Radiol 21:1841–1849

    Article  PubMed  Google Scholar 

  11. Siauve N, Chalouhi GE, Deloison B, et al. (2015) Functional imaging of the human placenta with magnetic resonance. Am J Obstet Gynecol 213:S103–S114

    Article  PubMed  Google Scholar 

  12. Kanal E, Barkovich AJ, Bell C, et al. (2007) ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 188:1447–1474

    Article  PubMed  Google Scholar 

  13. Kanda T, Fukusato T, Matsuda M, et al. (2015) Gadolinium-based contrast agent accumulates in the brain even in subjects without severe renal dysfunction: evaluation of autopsy brain specimens with inductively coupled plasma mass spectroscopy. Radiology 276:228–232

    Article  PubMed  Google Scholar 

  14. Kanda T, Osawa M, Oba H, et al. (2015) High signal intensity in dentate nucleus on unenhanced T1-weighted MR images: association with linear versus macrocyclic gadolinium chelate administration. Radiology 275:803–809

    Article  PubMed  Google Scholar 

  15. McDonald RJ, McDonald JS, Kallmes DF, et al. (2015) Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology 275:772–782

    Article  PubMed  Google Scholar 

  16. Errante Y, Cirimele V, Mallio CA, et al. (2014) Progressive increase of T1 signal intensity of the dentate nucleus on unenhanced magnetic resonance images is associated with cumulative doses of intravenously administered gadodiamide in patients with normal renal function, suggesting dechelation. Invest Radiol 49:685–690

    Article  CAS  PubMed  Google Scholar 

  17. Okuda Y, Sagami F, Tirone P, et al. (1999) Reproductive and developmental toxicity study of gadobenate dimeglumine formulation (E7155) (3)—study of embryo-fetal toxicity in rabbits by intravenous administration. J Toxicol Sci 24(Suppl 1):79–87

    Article  CAS  PubMed  Google Scholar 

  18. Tanaka YO, Sohda S, Shigemitsu S, Niitsu M, Itai Y (2001) High temporal resolution dynamic contrast MRI in a high risk group for placenta accreta. Magn Reson Imaging 19:635–642

    Article  CAS  PubMed  Google Scholar 

  19. Riteau A-S, Tassin M, Chambon G, et al. (2014) Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. PLoS ONE 9:e94866

    Article  PubMed  PubMed Central  Google Scholar 

  20. Brosens JJ, Pijnenborg R, Brosens IA (2002) The myometrial junctional zone spiral arteries in normal and abnormal pregnancies: a review of the literature. Am J Obstet Gynecol 187:1416–1423

    Article  PubMed  Google Scholar 

  21. Baergen Rebecca N (2005) Manual of Benirschke and Kaufmann’s pathology of the human placenta. New York: Springer

    Google Scholar 

  22. Clark SL, Koonings PP, Phelan JP (1985) Placenta previa/accreta and prior cesarean section. Obstet Gynecol 66:89–92

    CAS  PubMed  Google Scholar 

  23. Nielsen TF, Hagberg H, Ljungblad U (1989) Placenta previa and antepartum hemorrhage after previous cesarean section. Gynecol Obstet Invest 27:88–90

    Article  CAS  PubMed  Google Scholar 

  24. Rao KP, Belogolovkin V, Yankowitz J, Spinnato JA (2012) Abnormal placentation: evidence-based diagnosis and management of placenta previa, placenta accreta, and vasa previa. Obstet Gynecol Surv 67:503–519

    Article  PubMed  Google Scholar 

  25. Miller DA, Chollet JA, Goodwin TM (1997) Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 177:210–214

    Article  CAS  PubMed  Google Scholar 

  26. Reddy UM, Abuhamad AZ, Levine D, Saade GR (2014) Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecolog. J Ultrasound Med 33:745–757

    Article  PubMed  Google Scholar 

  27. Wexler P, Gottesfeld KR (1979) Early diagnosis of placenta previa. Obstet Gynecol 54:231–234

    CAS  PubMed  Google Scholar 

  28. Heller HT, Mullen KM, Gordon RW, Reiss RE, Benson CB (2014) Outcomes of pregnancies with a low-lying placenta diagnosed on second-trimester sonography. J Ultrasound Med 33:691–696

    Article  PubMed  Google Scholar 

  29. Wu S, Kocherginsky M, Hibbard JU (2005) Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 192:1458–1461

    Article  PubMed  Google Scholar 

  30. Hung TH, Shau WY, Hsieh CC, et al. (1999) Risk factors for placenta accreta. Obstet Gynecol 93:545–550

    CAS  PubMed  Google Scholar 

  31. Bour L, Placé V, Bendavid S, et al. (2014) Suspected invasive placenta: evaluation with magnetic resonance imaging. Eur Radiol 24:3150–3160

    Article  PubMed  Google Scholar 

  32. Silver RM, Landon MB, Rouse DJ, et al. (2006) Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107:1226–1232

    Article  PubMed  Google Scholar 

  33. Ueno Y, Kitajima K, Kawakami F, et al. (2014) Novel MRI finding for diagnosis of invasive placenta praevia: evaluation of findings for 65 patients using clinical and histopathological correlations. Eur Radiol 24:881–888

    Article  PubMed  Google Scholar 

  34. Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y (2002) Placenta accreta—summary of 10 years: a survey of 310 cases. Placenta 23:210–214

    Article  CAS  PubMed  Google Scholar 

  35. Usta IM, Hobeika EM, Musa AAA, Gabriel GE, Nassar AH (2005) Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol 193:1045–1049

    Article  PubMed  Google Scholar 

  36. Timor-Tritsch IE, Monteagudo A, Cali G, et al. (2014) Cesarean scar pregnancy and early placenta accreta share common histology. Ultrasound Obstet Gynecol 43:383–395

    Article  CAS  PubMed  Google Scholar 

  37. Timor-Tritsch IE, Monteagudo A, Cali G, et al. (2014) Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol 44:346–353

    Article  CAS  PubMed  Google Scholar 

  38. Zelop C, Nadel A, Frigoletto FD, et al. (1992) Placenta accreta/percreta/increta: a cause of elevated maternal serum alpha-fetoprotein. Obstet Gynecol 80:693–694

    CAS  PubMed  Google Scholar 

  39. Leyendecker JR, DuBose M, Hosseinzadeh K, et al. (2012) MRI of pregnancy-related issues: abnormal placentation. AJR Am J Roentgenol 198:311–320

    Article  PubMed  Google Scholar 

  40. Bretelle F, Courbière B, Mazouni C, et al. (2007) Management of placenta accreta: morbidity and outcome. Eur J Obstet Gynecol Reprod Biol 133:34–39

    Article  PubMed  Google Scholar 

  41. Hudon L, Belfort MA, Broome DR (1998) Diagnosis and management of placenta percreta: a review. Obstet Gynecol Surv 53:509–517

    Article  CAS  PubMed  Google Scholar 

  42. Meng X, Xie L, Song W (2013) Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: a systematic review and meta-analysis. Ultrasound Med Biol 39:1958–1965

    Article  PubMed  Google Scholar 

  43. D’Antonio F, Iacovella C, Palacios-Jaraquemada J, et al. (2014) Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol 44:8–16

    Article  PubMed  Google Scholar 

  44. American College of Obstetricians and Gynecologists. (2009) ACOG Practice Bulletin No. 101: ultrasonography in pregnancy. Obstet Gynecol 113:451–461

    Article  Google Scholar 

  45. Horowitz JM, Berggruen S, McCarthy RJ, et al. (2015) When timing is everything: are placental MRI examinations performed before 24 weeks’ gestational age reliable? AJR Am J Roentgenol 205:685–692

    Article  PubMed  Google Scholar 

  46. Warshak CR, Eskander R, Hull AD, et al. (2006) Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 108:573–581

    Article  PubMed  Google Scholar 

  47. Dwyer BK, Belogolovkin V, Tran L, et al. (2008) Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging? J Ultrasound Med 27:1275–1281

    PubMed  PubMed Central  Google Scholar 

  48. Elhawary TM, Dabees NL, Youssef MA (2013) Diagnostic value of ultrasonography and magnetic resonance imaging in pregnant women at risk for placenta accreta. J Matern Fetal Neonatal Med 26:1443–1449

    Article  PubMed  Google Scholar 

  49. Rahaim NSA, Whitby EH (2015) The MRI features of placental adhesion disorder and their diagnostic significance: systematic review. Clin Radiol 70:917–925

    Article  CAS  PubMed  Google Scholar 

  50. Alamo L, Anaye A, Rey J, et al. (2013) Detection of suspected placental invasion by MRI: do the results depend on observer’ experience? Eur J Radiol 82:e51–e57

    Article  PubMed  Google Scholar 

  51. Kim JA, Narra VR (2004) Magnetic resonance imaging with true fast imaging with steady-state precession and half-Fourier acquisition single-shot turbo spin-echo sequences in cases of suspected placenta accreta. Acta Radiol 45:692–698

    Article  CAS  PubMed  Google Scholar 

  52. Teo TH, Law YM, Tay KH, Tan BS, Cheah FK (2009) Use of magnetic resonance imaging in evaluation of placental invasion. Clin Radiol 64:511–516

    Article  CAS  PubMed  Google Scholar 

  53. Noda Y, Kanematsu M, Goshima S, et al. (2015) Prenatal MR imaging diagnosis of placental invasion. Abdom Imaging 40:1273–1278

    Article  PubMed  Google Scholar 

  54. Blaicher W, Brugger PC, Mittermayer C, et al. (2006) Magnetic resonance imaging of the normal placenta. Eur J Radiol 57:256–260

    Article  PubMed  Google Scholar 

  55. Baughman WC, Corteville JE, Shah RR. Placenta accreta: spectrum of US and MR imaging findings. Radiographics. 28:1905–1916.

  56. Elchalal U, Ezra Y, Levi Y, et al. (2000) Sonographically thick placenta: a marker for increased perinatal risk—a prospective cross-sectional study. Placenta 21:268–272

    Article  CAS  PubMed  Google Scholar 

  57. Hoddick WK, Mahony BS, Callen PW, Filly RA (1985) Placental thickness. J Ultrasound Med 4:479–482

    CAS  PubMed  Google Scholar 

  58. Lee AJ, Bethune M, Hiscock RJ (2012) Placental thickness in the second trimester: a pilot study to determine the normal range. J Ultrasound Med 31:213–218

    PubMed  Google Scholar 

  59. Akgündüz E, Erkılınç S, Tokmak A, et al. (2015) Decreased placental thickness and impaired Doppler indices in idiopathic polyhydramnios: a prospective case-control study. J Matern Fetal Neonatal Med 28:722–725

    Article  PubMed  Google Scholar 

Download references

Funding

This study did not receive funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Icahn School of Medicine at Mount Sinai, Box 1234, One Gustave L. Levy Place, New York, NY, 10029, USA

    Lea Azour, Cecilia Besa, Sara Lewis & Bachir Taouli

  2. Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA

    Cecilia Besa & Bachir Taouli

  3. Austin Radiological Association, Austin, TX, 78727, USA

    Amita Kamath

  4. Department of Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Edward R. Oliver

Authors
  1. Lea Azour
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cecilia Besa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sara Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amita Kamath
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edward R. Oliver
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bachir Taouli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bachir Taouli.

Ethics declarations

Conflict of interest

Lea Azour declares that she has no conflict of interest. Cecilia Besa declares that she has no conflict of interest. Sara Lewis declares that she has no conflict of interest. Amita Kamath declares that she has no conflict of interest. Edward R. Olive declares that he has no conflict of interest. Bachir Taouli declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azour, L., Besa, C., Lewis, S. et al. The gravid uterus: MR imaging and reporting of abnormal placentation. Abdom Radiol 41, 2411–2423 (2016). https://doi.org/10.1007/s00261-016-0752-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-016-0752-5

Keywords

Search

Navigation