Prognosticators of intravoxel incoherent motion (IVIM) MRI for adverse maternal and neonatal clinical outcomes in patients with placenta accreta spectrum disorders

Tao Lu; Bin Song; Hong Pu; Kui-De Li; Meng-Wei Huang; Jie Mei; Shao-Yu Wang

doi:10.21037/tau.2019.12.27

Prognosticators of intravoxel incoherent motion (IVIM) MRI for adverse maternal and neonatal clinical outcomes in patients with placenta accreta spectrum disorders

Transl Androl Urol. 2020 Apr;9(2):258-266. doi: 10.21037/tau.2019.12.27.

Authors

Tao Lu¹, Bin Song², Hong Pu¹, Kui-De Li¹, Meng-Wei Huang³, Jie Mei³, Shao-Yu Wang⁴

Affiliations

¹ Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China.
² Department of Radiology, West China Hospital, Sichuan University, Chengdu 610037, China.
³ Department of Obstetrics, Sichuan Academy of Medical Sciences & Sichuan Provincial Peopleal Sciences sChengdu 610072, China.
⁴ MR Scientific Marketing Specialist, Siemens Healthineer, Shanghai 201318, China.

Abstract

Background: The incidence of placenta accreta spectrum (PAS) disorders has increased rapidly in recent years and is associated with several maternal and neonatal complications. Intravoxel incoherent motion (IVIM) imaging is a method which can assess placental perfusion quantitatively. Therefore, the first aim of this study was to investigate whether patients with adverse maternal and neonatal outcomes of PAS disorders differed in the parameters from IVIM. A second aim was to identify these parameters for adverse peripartum outcome in gravid patients at risk for PAS.

Methods: The subject group consisted of patients with placenta previa, in which 75 patients had PAS disorders and 24 patients did not have PAS disorders between 28+0 and 39+6 weeks, respectively. All women underwent magnetic resonance imaging (MRI) examination including an IVIM sequence with 8 b values on a 1.5T scanner. The perfusion fraction (f), pseudodiffusion coefficient (D*), and standard diffusion coefficient (D) were calculated. All medical records were received postpartum. The final degree of placental invasion was established either by placental villi alterations from a placental sample or from maternity records of the women's general practitioners.

Results: Women with PAS disorders had a higher perfusion fraction (34.12%) than women without the disease (29.39%) (P<0.05). The perfusion fraction was 36.86% in women with massive blood loss and was 35.15% in women requiring transfusion, which was higher than women without massive blood loss and not requiring transfusion (P<0.05). The D value was 1.65×10^-3 mm²/s in women with low birth weight, which was lower than that in women with appropriate birth weight (1.70×10^-3 mm²/s) (P<0.05).

Conclusions: Patients with PAS disorders differed in placental perfusion fraction from women without PAS disorders. The f and D value may be used to recognize patients with certain adverse clinical outcomes.

Keywords: Placenta accreta spectrum disorders (PAS disorders); clinical outcome; intravoxel incoherent motion (IVIM); magnetic resonance imaging (MRI); placenta.