TY - JOUR
T1 - Use of super resolution reconstruction MRI for surgical planning in Placenta accreta spectrum disorder
T2 - Case series
AU - Mufti, Nada
AU - Chappell, Joanna
AU - O'Brien, Patrick
AU - Attilakos, George
AU - Irzan, Hassna
AU - Sokolska, Magda
AU - Narayanan, Priya
AU - Gaunt, Trevor
AU - Humphries, Paul D.
AU - Patel, Premal
AU - Whitby, Elspeth
AU - Jauniaux, Eric
AU - Hutchinson, J. Ciaran
AU - Sebire, Neil J.
AU - Atkinson, David
AU - Kendall, Giles
AU - Ourselin, Sebastien
AU - Vercauteren, Tom
AU - David, Anna L.
AU - Melbourne, Andrew
N1 - Funding Information:
Out of twenty-two recruited patients with suspected PAS, twelve (55%) had successful MRI reconstruction and were included in the final analysis. Unsuccessful SRR was due to insufficient stacks, and/or moderate/severe motion leading to artefact and suboptimal image quality. Out of the included twelve cases, at delivery four patients had placenta praevia with no abnormal attachment, and eight were confirmed as PAS (histopathological confirmation n = 6, intraoperative clinical diagnosis n = 2). Of those six women who had histological PAS confirmation (hysterectomy n = 5, and focal myometrial excision n = 1), two met the histological criteria of FIGO grade 1, and four satisfied the criteria of FIGO grade 2 [3], (Fig. 1). The two women who had intraoperative growth signs supporting a clinical PAS diagnosis, had this performed in accordance with the IS-AIP clinical severity grading system adapted from recent FIGO guidance [10]. One of those patients had an IS-AIP clinical severity grading of 2 whereby there was no placental separation with oxytocin or CCT and manual removal of the placenta was required with the entire placenta noted to be adherent by a senior experienced clinical operator. The second patient had an intraoperative IS-AIP clinical severity grading of 3 whereby the uterus over the placenta appeared bluish in appearance with an obvious ‘placental buldge’ (10 × 10cm over the lower segment) with no signs of separation with oxytocin. Gentle CCT resulted in the ‘dimple sign’ and therefore manual removal of the placenta was required. The whole placental bed was again thought to be adherent by the same senior clinical operator.In women with suspected PAS, the addition of SRR to 2D MRI may potentially improve anatomical assessment of certain pathological MRI markers that are predictive of adverse maternal outcomes. This may benefit surgical planning by ensuring appropriate clinical teams and equipment are available. Additional technical development and validation with a larger data set is however necessary to support the reconstruction fidelity, and SRR imaging should be considered as supportive information and not a replacement of the original 2D-MRI stacks.All MRI data were analysed under the study entitled ‘‘Guided Instrumentation for Fetal Therapy and Surgery (GIFT-Surg): Fetal MRI to Improve Prenatal Diagnosis and Therapy for Fetal Abnormality’’ (Hampstead Research Ethics Committee, 15/LO/1488), funded by the Wellcome Trust [203148/Z/16/Z; 203145Z/16/Z; WT101957] and Engineering and Physical Sciences Research Council (EPSRC) [NS/A000049/1; NS/A000050/1; NS/A000027/1; EP/L016478/1]. Funders had no role in the study design, collection, analysis, data interpretation, writing of the manuscript or decision to submit the article for publication. S.O. is the principal investigator on this grant, and A.L.D., T.V. and A.M. are co-investigators. N.M. is funded with support of the Wellcome/EPSRC centre for Interventional and Surgical Sciences (WEISS) (203145Z/16/Z). A.L.D. is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.
Funding Information:
All MRI data were analysed under the study entitled ‘‘Guided Instrumentation for Fetal Therapy and Surgery (GIFT-Surg): Fetal MRI to Improve Prenatal Diagnosis and Therapy for Fetal Abnormality’’ (Hampstead Research Ethics Committee, 15/LO/1488), funded by the Wellcome Trust [ 203148/Z/16/Z ; 203145Z/16/Z ; WT101957 ] and Engineering and Physical Sciences Research Council (EPSRC) [ NS/A000049/1 ; NS/A000050/1 ; NS/A000027/1 ; EP/L016478/1 ]. Funders had no role in the study design, collection, analysis, data interpretation, writing of the manuscript or decision to submit the article for publication. S.O. is the principal investigator on this grant, and A.L.D., T.V. and A.M. are co-investigators. N.M. is funded with support of the Wellcome / EPSRC centre for Interventional and Surgical Sciences (WEISS) ( 203145Z/16/Z ). A.L.D. is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre .
Publisher Copyright:
© 2023 The Authors
PY - 2023/10
Y1 - 2023/10
N2 - Introduction: Comprehensive imaging using ultrasound and MRI of placenta accreta spectrum (PAS) aims to prevent catastrophic haemorrhage and maternal death. Standard MRI of the placenta is limited by between-slice motion which can be mitigated by super-resolution reconstruction (SRR) MRI. We applied SRR in suspected PAS cases to determine its ability to enhance anatomical placental assessment and predict adverse maternal outcome. Methods: Suspected PAS patients (n = 22) underwent MRI at a gestational age (weeks + days) of (32+3±3+2, range (27+1-38+6)). SRR of the placental-myometrial-bladder interface involving rigid motion correction of acquired MRI slices combined with robust outlier detection to reconstruct an isotropic high-resolution volume, was achieved in twelve. 2D MRI or SRR images alone, and paired data were assessed by four radiologists in three review rounds. All radiologists were blinded to results of the ultrasound, original MR image reports, case outcomes, and PAS diagnosis. A Random Forest Classification model was used to highlight the most predictive pathological MRI markers for major obstetric haemorrhage (MOH), bladder adherence (BA), and placental attachment depth (PAD). Results: At delivery, four patients had placenta praevia with no abnormal attachment, two were clinically diagnosed with PAS, and six had histopathological PAS confirmation. Pathological MRI markers (T2-dark intraplacental bands, and loss of retroplacental T2-hypointense line) predicting MOH were more visible using SRR imaging (accuracy 0.73), in comparison to 2D MRI or paired imaging. Bladder wall interruption, predicting BA, was only easily detected by paired imaging (accuracy 0.72). Better detection of certain pathological markers predicting PAD was found using 2D MRI (placental bulge and myometrial thinning (accuracy 0.81)), and SRR (loss of retroplacental T2-hypointense line (accuracy 0.82)). Discussion: The addition of SRR to 2D MRI potentially improved anatomical assessment of certain pathological MRI markers of abnormal placentation that predict maternal morbidity which may benefit surgical planning.
AB - Introduction: Comprehensive imaging using ultrasound and MRI of placenta accreta spectrum (PAS) aims to prevent catastrophic haemorrhage and maternal death. Standard MRI of the placenta is limited by between-slice motion which can be mitigated by super-resolution reconstruction (SRR) MRI. We applied SRR in suspected PAS cases to determine its ability to enhance anatomical placental assessment and predict adverse maternal outcome. Methods: Suspected PAS patients (n = 22) underwent MRI at a gestational age (weeks + days) of (32+3±3+2, range (27+1-38+6)). SRR of the placental-myometrial-bladder interface involving rigid motion correction of acquired MRI slices combined with robust outlier detection to reconstruct an isotropic high-resolution volume, was achieved in twelve. 2D MRI or SRR images alone, and paired data were assessed by four radiologists in three review rounds. All radiologists were blinded to results of the ultrasound, original MR image reports, case outcomes, and PAS diagnosis. A Random Forest Classification model was used to highlight the most predictive pathological MRI markers for major obstetric haemorrhage (MOH), bladder adherence (BA), and placental attachment depth (PAD). Results: At delivery, four patients had placenta praevia with no abnormal attachment, two were clinically diagnosed with PAS, and six had histopathological PAS confirmation. Pathological MRI markers (T2-dark intraplacental bands, and loss of retroplacental T2-hypointense line) predicting MOH were more visible using SRR imaging (accuracy 0.73), in comparison to 2D MRI or paired imaging. Bladder wall interruption, predicting BA, was only easily detected by paired imaging (accuracy 0.72). Better detection of certain pathological markers predicting PAD was found using 2D MRI (placental bulge and myometrial thinning (accuracy 0.81)), and SRR (loss of retroplacental T2-hypointense line (accuracy 0.82)). Discussion: The addition of SRR to 2D MRI potentially improved anatomical assessment of certain pathological MRI markers of abnormal placentation that predict maternal morbidity which may benefit surgical planning.
KW - Bladder adherence
KW - Magnetic resonance imaging
KW - Major obstetric haemorrhage
KW - Placenta accreta spectrum
KW - Placental attachment depth
KW - Super resolution reconstruction
UR - http://www.scopus.com/inward/record.url?scp=85168754824&partnerID=8YFLogxK
U2 - 10.1016/j.placenta.2023.08.066
DO - 10.1016/j.placenta.2023.08.066
M3 - Article
C2 - 37634372
AN - SCOPUS:85168754824
SN - 0143-4004
VL - 142
SP - 36
EP - 45
JO - Placenta
JF - Placenta
ER -