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)

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