Volume 109, June 2024, Pages 180-186Author links open overlay panel, , , , , , AbstractObjectives

Increasing trend of PAS (placenta accreta spectrum disorders) incidence is a major health concern as PAS is associated with high maternal morbidity and mortality during cesarean section. Prenatal identification of PAS is crucial for delivery planning and patients management. This study aims to explore whether diffusion-derived vessel density (DDVD) computed from a simple diffusion MRI protocol differs in PAS from normal placenta.

Methods

We enrolled 86 patients with PAS disorders and 40 pregnant women without PAS disorders. Each patient underwent intravoxel incoherent motion (IVIM) MRI sequence with 11 b-values. Placenta diffusion-derived vessel density (DDVD-b0b50) was the signal difference between b = 0 and b = 50 s/mm2 images. DDVD(b0b50) A/N was calculated as [accreta lesion DDVD(b0b50)]/ [normal placenta DDVD(b0b50)]. The correlation between DDVD and gestational age was explored using Spearman rank correlation. Differences of DDVD(b0b50) A/N in patients with normal placentas and with PAS, and in patients with different subtypes of PAS were explored.

Results

DDVD was negatively correlated with gestational age (p = 0.023, r = −0.359) in patients with normal placentas. DDVD(b0b50) A/N was significantly higher in patients with PAS (median:1.16, mean: 1.261) than normal placenta (median:1.02, mean: 1.032, p < 0.001) and especially higher in patients with placenta increta (median:1.14, mean: 1.278) and percreta (median: 1.20, mean: 1.396, p < 0.001).

Conclusion

As a higher DDVD indicates higher physiological volume of micro-vessels in PAS, this study suggests DDVD can be a potential biomarker to evaluate the placenta perfusion.

Section snippetsKey points

Placenta DDVD can be used to detect placenta accreta spectrum disorders.

Placenta accreta spectrum (PAS) disorders are a spectrum of conditions characterized by abnormal adherence or invasion of trophoblastic tissues to the myometrium of gravid uterus. According to a recent investigation from United States, the incidence of PAS may increase to 1/200 in women undergoing cesarean section(CS) by 2025 [1]. PAS is usually associated with massive hemorrhage, surrounding organ damage, hysterectomy and

Patients

This retrospective study was approved by our institutional review board (IRB) and written informed consent was obtained from each study participant. From November 2018 to May 2023, 255 pregnant women underwent placental MRI including a DWI sequence (Fig. 1). All study subjects had cesarean section for delivery. The inclusion criteria were: (1) singleton pregnancy suspected with PAS disorders based on clinical risk factors or uncertain ultrasound results and (2) fetal development consistent with

Results

The study group consisted of 40 cases of controls and 86 cases of PAS disorders patients (mean age: 32 years, ranging: 22–45 years; mean gestational age at examination: 31 weeks, ranging: 22–38 weeks) (Fig. 1). The clinical characteristics of the control group and PAS groups are shown in Table 1. 86 PAS patients included 16 accreta cases, 56 increta cases, and14 percreta cases. 3 patients with PAS disorders had hysterectomy. Patients with PAS disorders were older in age compared to those

Discussion

On DWI, blood vessels show high signal when there is no diffusion gradient (b = 0 s/mm2) and low signal when there were even very low b-values on. DDVD, an imaging biomarker reflecting micro-circulation, is calculated from the signal difference between diffusion weighted images when diffusion gradient is off and on with large vessel signals commonly removed during image processing [11,13,18]. One important advantage of DDVD is that the data acquisition can be very short, and data can be

Author statement

Conception and design of this manuscript was carried out by TL, administrative support was carried out by YXW, provision of study materials was carried out by TL and YW, collection and assembly of data was carried out by ML and LW, Data analysis and interpretation was carried out by MC and B-H X, and manuscript writing and the final approval of manuscript was carried out by all authors. All authors have read and approved the final version of this manuscript.

CRediT authorship contribution statement

Tao Lu: Investigation, Data curation, Conceptualization. Li Wang: Resources, Methodology. Mou Li: Software, Methodology. Yishuang Wang: Methodology, Investigation. Meining Chen: Software. Ben-Heng Xiao: Software. Yì Xiáng J. Wáng: Project administration, Methodology, Investigation.

Declaration of competing interest

None.

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