ISSN 1305-3825 | E-ISSN 1305-3612
Original Article
The morbidly adherent placenta: when and what association of signs can improve MRI diagnosis? Our experience.
1 Department of Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy  
2 Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy  
Diagn Interv Radiol ; : -

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Objective: To verify whether combination of specific signs improves MRI accuracy in morbidly adherent placenta (MAP).


Material and Methods:  The Institutional Review Board granted permission for this retrospective study and a waiver of informed consent. The presence/absence of MRI findings for MAP were retrospectively evaluated in 27 women. Histopathology was the reference standard, showing  MAP in 8/27 and 19/27 normal cases. MRI results were analyzed by 2x2 tables. MRI SS, SP, PPV and NPP were calculated for every single sign; the Fisher exact Test was employed for statistical significance. Two skilled radiologists analyzed MRI findings, resolving discrepancies by consensus, using 3 diagnostic criteria during 3 consecutive sections: a) 1st criterion: at least any one of reported MRI signs indicates MAP and the absence of any sign is normal; b) 2nd criterion: at least 1statistically significant sign (SSS) indicates MAP and no sign or non-SSS is normal; c) 3rd criterion: at least 2 SSS signs indicate MAP and no sign, non-SSS or only 1 SSS is normal. The criteria were compared for diagnostic accuracy by the Exact McNemar test  (p < 0.05 significant).


Results: The 1st MRI criterion showed unacceptable rate of FP results (78.9%). Using the 2nd criterion FP results were less high (31.5%), and the Exact McNemar test stated that diagnostic accuracy of the  2nd  criterion was significantly higher than the 1st ; the 3rd criterion correctly classified 100% of cases.



Conclusion:  Only specific MRI signs can correctly predict MAP at histopathology, especially when associated.

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