MRI evaluation of invasive placenta: “Cool” answers to radiologists’ “hot” questions

Charis Bourgioti, Konstantina Zafeiropoulou, Lia Angela Moulopoulos


During the last decades, the incidence of invasive placenta has risen significantly, probably due to the increased rate of caesarian delivery. Invasive placenta may cause massive intra-or postpartum hemorrhage; therefore, prenatal diagnosis of the presence and extent of myometrial invasion or extrauterine placental spread is critical for optimal management. Sonography is the imaging modality of choice for the evaluation of abnormal placenta; MRI performs equally well and can be used as a reliable alternative in cases of equivocal sonographic findings. Indications for MRI include evaluation of a posteriorly located placenta and the need for precise delineation of placenta percreta for pre-delivery planning. Suspicious MRI findings for abnormal placentation include, marked placental heterogeneity, low T2 signal intraplacental bands, extensive intraplacental vascularity, focal uterine bulge, myometrial thinning or disruption with loss of utero-placental interface, bladder ‘tenting’ and the placental protrusion sign. Currently, there is no official standardization of MRI protocols and there are no large series addressing the interobserver variability for the evaluation of invasive placenta. The aim of this review is to report current literature data regarding MRI assessment of invasive placenta in an attempt to familiarize radiologists with the ‘hot’ topic of abnormal placentation.


placenta accreta; placenta percreta; placenta increta; ultrasound (US); Magnetic Resonance Imaging (MRI)

Full Text:



Al-Serehi A, Mhoyan A, Brown M, et al. Placenta accreta: An association with fibroids and Asherman syndrome. J Ultrasound Med 2008; 27(11): 1623-1628.

Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: Twenty-year analysis. Am J Obstet Gynecol 2005; 192(5): 1458-1461.

Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985; 66(1): 89-92.

American Congress of Obstetricians and Gynecologists; Committee on Obstetric Practice. Committee opinion no. 529: Placenta accreta. Obstet Gynecol 2012; 120(1): 207-11.

Camuzcuoglu H, Toy H, Vural M, et al. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy. J Obstet Gynaecol Res 2010; 36(3): 538-543.

Soyer P, Dohan A, Dautry R, et al. Transcatheter arterial embolization for postpartum hemorrhage: Indications, technique, results, and complications. Cardiovasc Intervent Radiol 2015; 38(5): 1068-1081.

Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 2006; 107(4): 927-941.

Carnevale FC, Kondo MM, de Oliveira Sousa W Jr, et al. Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhage in placenta accreta. Cardiovasc Intervent Radiol 2011; 34(4): 758-764.

Tan CH, Tay KH, Sheah K, et al. Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta. AJR Am J Roentgenol 2007; 189(5): 1158-1163.

Podrasky AE, Javitt MC, Glanc P, et al. ACR appropriateness Criteria® second and third trimester bleeding. Ultrasound Q 2013; 29(4): 293-301.

Finberg HJ, Williams JW. Placenta accreta: Prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med 1992; 11(7): 333-343.

Belfort MA. Placenta accreta. Am J Obstet Gynecol 2010; 203(5): 430-439.

Shih JC, Palacios Jaraquemada JM, Su YN, et al. Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: Comparison with gray-scale and color Doppler techniques. Ultrasound Obstet Gynecol 2009; 33(2): 193-203.

D’Antonio F, Iacovella C, Palacios-Jaraquemada J, et al. Prenatal identification of invasive placentation using magnetic resonance imaging: Systematic review and meta-analysis. Ultrasound Obstet Gynecol 2014; 44(1): 8-16.

Dwyer BK, Belogolovkin V, Tran L, et al. Prenatal diagnosis of placenta accreta sonography: Or magnetic resonance imaging? J Ultrasound Med 2008; 27(9): 1275-1281.

Palacios-Jaraquemada JM. Efficacy of surgical techniques to control obstetric hemorrhage: Analysis of 539 cases. Acta Obstet Gynecol Scand 2011; 90(9): 1036-1042.

Warshak CR, Eskander R, Hull AD, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 2006; 108(3 Pt 1): 573-581.

Meng X, Xie L, Song W. Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: A systematic review and meta-analysis. Ultrasound Med Biol 2013; 39(11): 1958-1965.

Derman AY, Nikac V, Haberman S, Zelenko N, Opsha O, Flyer M. MRI of placenta accreta: A new imaging perspective. AJR Am J Roentgenol 2011; 197(6): 1514-1521.

Blaicher W, Brugger PC, Mittermayer C, et al. Magnetic resonance imaging of the normal placenta. Eur J Radiol 2006; 57(2): 256-260.

Huppertz B. The anatomy of the placenta. J Clin Pathol 2008; 61(12): 1296-1302.

Lax A, Prince MR, Mennitt KW, et al. The value of specific MRI features in the evaluation of suspected placental invasion. Magn Reson Imaging 2007; 25(1): 87-93.

Collins SL, Ashcroft A, Braun T, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol 2016; 47(3): 271-275.

Baughman WC, Corteville JE, Shah RR. Placenta accreta: spectrum of US and MR imaging findings. Radiographics 2008; 28(7): 1905-1916.

Bour L, Place V, Bendavid S, et al. Suspected invasive placenta: Evaluation with magnetic resonance imaging. Eur Radiol 2014; 24(12): 3150-3160.

Fox H, Sebire NJ (eds). Pathology of the placenta. 3rd ed. Philadelphia: Saunders Elsevier 2007, pp 80-94.

Kim JA, Narra VR. Magnetic resonance imaging with true fast imaging with steady-state precession and half-Fourier acquisition single-shot turbo spin-echo sequences in cases of suspected placenta accreta. Acta Radiol 2004; 45(6): 692-698.

Maldjian C, Adam R, Pelosi M, et al. MRI appearance of placenta percreta and placenta accreta. Magn Reson Imaging 1999; 17(7): 965-971.

Ueno Y, Kitajima K, Kawakami F, et al. Novel MRI finding for diagnosis of invasive placenta praevia: Evaluation of findings for 65 patients using clinical and histopathological correlations. Eur Radiol 2014; 24(4): 881-888.

American College of Radiology. ACR-SPR practice parameter for the safe and optimal performance of fetal magnetic resonance imaging (MRI). Available via Revised 2015. Accessed June 24, 2016.

Ueno Y, Maeda T, Tanaka U, et al. Evaluation of interobserver variability and diagnostic performance of developed MRI-based radiological scoring system for invasive placenta previa. J Magn Reson Imaging 2016; doi: 10.1002/jmri.25184. Epub 2016 Feb 21.

Elsayes KM, Trout AT, Friedkin AM. Imaging of the placenta: A multimodality pictorial review. Radiographics 2009; 29(5): 1371-1391.

Masselli G, Gualdi G. MR imaging of the placenta: what a radiologist should know. Abdom Imaging 2013; 38(3): 573-587.


  • There are currently no refbacks.