MRI of placenta accreta: diagnostic accuracy and impact of interventional radiology on foetal-maternal delivery outcomes in high-risk women
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Objective: To assess accuracy and reproducibility of MRI diagnosis of invasive placentation (IP) in high-risk patients and to evaluate reliability of MRI features. Secondary aim was to evaluate impact of interventional radiology (IR) on delivery outcomes in patients with IP at MRI. Methods: 26 patients (mean age 36.24 y/o,SD 6.16) with clinical risk-factors and echographic suspicion of IP underwent 1.5 T-MRI. Two readers reviewed images. Gold-standard was histology in hysterectomised patients and obstetric evaluation at delivery for patients with preserved uterus. Accuracy and reproducibility of MRI findings were calculated. Results: Incidence of IP was 50% (13/26) and of PP was 11.54% (3/26). MRI showed 100% sensitivity (95% CI = 75.3–100%) and 92.3% specificity (95% CI = 64.0–100%) in the diagnosis of IP. Gold-standard was histology in 10 cases and obstetric evaluation in 16. MRI findings with higher sensitivity were placental heterogeneity, uterine bulging and black intraplacental bands. Uterine scarring, placental heterogeneity, myometrial interruption and tenting of the bladder showed better specificity. MRI inter-rater agreement with Cohen’s K was 1. 11 patients among 14 with MRI diagnosis of IP received IR assistance with positive impact on delivery outcomes in terms of blood loss, red cells count, intense care unit length of stay, days of hospitalisation and risk of being transfused. Conclusion: MRI is an accurate and reproducible technique in prenatal diagnosis of IP. MRI helps planning a safe and appropriate delivery eventually assisted by IR, which positively affects foetal and maternal outcomes. Advances in knowledge: The adoption of MRI evaluation in patients with high risk of invasive placentation allows a more accurate diagnosis in terms of both presence of the disease and its extension to or through or even beyond the myometrium. This led to a better dedicated delivery management with eventual adoption of interventional radiology with a global positive effect on foetal and maternal outcomes.
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The k-NN model outperformed manual MRI interpretation, which had an accuracy of 92.3%, for PAS diagnosis.
“The k-NN model outperformed manual MRI interpretation, which had an accuracy of 92.3% [29].”
From Machine Learning in Maternity: Early Diagnosis of Placenta Accreta Spectrum (2026) · cites this paper as [29]
The Results (p. 6) report 92.3% as the specificity of MRI diagnosis of invasive placentation, not its overall accuracy. The paper does not compare MRI interpretation with a k-NN model; the citation is attached to the incorrect 92.3% accuracy figure. (LLM, conf=0.88)
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References 43 · Cited by 14
- Authors
- Fiocchi, F., Monelli, F., Besutti, G., Casari, F., Petrella, E., Pecchi, A., Caporali, C., Bertucci, E., Busani, S., Botticelli, L., Facchinetti, F., & Torricelli, P.
- Affiliations
- Azienda Ospedaliero-Universitaria di Modena (IT)
- University of Modena and Reggio Emilia (IT)
- ORCID
- Venue
- The British Journal of Radiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-07-29
- Volume
- 93
- Issue
- 1114
- Pages
- 20200267-20200267
- ISSN
- 0007-1285 (ISSN-L)
- 1748-880X
- PMC
- PMC7548357
- OpenAlex
- W3044276045
- Cited by
- 14
- References
- 43
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 6 · 2021: 1
- FWCI
- 2.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- British Journal of Radiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- placenta accreta, invasive placentation, interventional radiology, high-risk pregnancy, delivery outcomes, maternal blood loss, placental heterogeneity, uterine scar, placental perfusion, diagnostic accuracy, interobserver agreement
- MeSH terms
- Adult, Female, Humans, Magnetic Resonance Imaging, Placenta Accreta, Pregnancy, Pregnancy Outcome, Sensitivity and Specificity, Reproducibility of Results, Ultrasonography, Prenatal, Pregnancy, High-Risk, Magnetic Resonance Imaging, Interventional
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