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Am J Perinatol 2021; 38(09): 960-967
DOI: 10.1055/s-0040-1701196
Original Article

Accuracy and Interobserver Reliability of Magnetic Resonance Imaging for Placenta Accreta Spectrum Disorders

Brett D. Einerson
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2   Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
,
Christina E. Rodriguez
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
,
Robert M. Silver
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2   Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
,
Meghan A. Donnelly
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
,
Anne M. Kennedy
4   Department of Radiology, University of Utah Health, Salt Lake City, Utah
,
Paula J. Woodward
4   Department of Radiology, University of Utah Health, Salt Lake City, Utah
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Abstract

Objective This study aims to define the accuracy, predictive value, and interobserver reliability of magnetic resonance imaging (MRI) in the diagnosis of placenta accreta spectrum (PAS) disorders.

Study Design Two experienced radiologists independently interpreted the MRI studies of patients with possible PAS from two referral centers. Radiologists were blinded to sonographic and clinical information. We calculated diagnostic testing characteristics and kappa statistics of interobserver reliability for MRI findings of PAS.

Results Sixty-eight MRI cases were evaluated. Confirmed PAS and severe PAS were present in 44 (65%) and 20 (29%) cases. For the diagnosis of any PAS, MRI had a sensitivity 66%, specificity 71%, positive predictive value (PPV) 81%, negative predictive value (NPV) 53%, and accuracy 68%. For the diagnosis of severe PAS (percreta), MRI had a sensitivity 85%, specificity 79%, PPV 63%, NPV 93%, and accuracy 81%. The accuracy of individual signs of PAS was lower (44–65%). Interobserver agreement was almost perfect for previa; substantial for myometrial interruptions, PAS, severe PAS, and placental bulging/balling; and moderate to slight for other signs of PAS.

Conclusion Although the interobserver reliability of MRI for a diagnosis of PAS is substantial, the accuracy and predictive value are modest and lower than previously reported.

Keywords

accreta - diagnosis - magnetic resonance imaging - placenta accreta spectrum

Note

These study findings were presented at the Society for Maternal-Fetal Medicine meeting in Las Vegas, Nevada, January 23 to 27, 2017.




Publication History

Received: 28 July 2019

Accepted: 16 December 2019

Article published online:
27 January 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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