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CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(01): 017-023
DOI: 10.1055/s-0038-1675803
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Assessment of Sensitivity and Specificity of Ultrasound and Magnetic Resonance Imaging in the Diagnosis of Placenta Accreta

Avaliação da sensibilidade e especificidade da ultrassonografia e ressonância magnética no diagnóstico da placenta acreta
Elisa Santos Lopes
1   Department of Maternal and Child, Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Francisco Edson de Lucena Feitosa
1   Department of Maternal and Child, Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Antonio Viana Brazil
1   Department of Maternal and Child, Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
José Daniel Vieira de Castro
1   Department of Maternal and Child, Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Jesus Irajacy Fernandes da Costa
1   Department of Maternal and Child, Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Edward Araujo Júnior 
2   Paulista School of Medicine, Department of Obstetrics, Universidade Federal de São Paulo, SP, Brazil
,
Alberto Borges Peixoto
3   Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
,
Francisco Herlânio Costa Carvalho
1   Department of Maternal and Child, Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
› Author Affiliations
Further Information

Publication History

29 May 2018

01 October 2018

Publication Date:
14 November 2018 (online)

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Abstract

Objective To assess and compare the sensitivity and specificity of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta in patients with placenta previa.

Methods This retrospective cohort study included 37 women, and was conducted between January 2013 and October 2015; 16 out of the 37 women suffered from placenta accreta. Histopathology was considered the gold standard for the diagnosis of placenta accreta; in its absence, a description of the intraoperative findings was used. The associations among the variables were investigated using the Pearson chi-squared test and the Mann-Whitney U-test.

Results The mean age of the patients was 31.8 ± 7.3 years, the mean number of pregnancies was 2.8 ± 1.1, the mean number of births was 1.4 ± 0.7, and the mean number of previous cesarean sections was 1.2 ± 0.8. Patients with placenta accreta had a higher frequency of history of cesarean section than those without it (63.6% versus 36.4% respectively; p < 0.001). The mean gestational age at birth among women diagnosed with placenta previa accreta was 35.4 ± 1.1 weeks. The mean birth weight was 2,635.9 ± 374.1 g. The sensitivity of the ultrasound was 87.5%, with a positive predictive value (PPV) of 65.1%, and a negative predictive value (NPV) of 75.0%. The sensitivity of the magnetic resonance imaging was 92.9%, with a PPV of 76.5%, and a NPV of 75.0%. The kappa coefficient of agreement between the 2 tests was 0.69 (95% confidence interval [95%CI]: (0.26–1.00).

Conclusion The ultrasound and the magnetic resonance imaging showed similar sensitivity and specificity for the diagnosis of placenta accreta.

Resumo

Objetivo Avaliar e comparar a sensibilidade e especificidade da ultrassonografia e da ressonância magnética no diagnóstico do acretismo placentário em pacientes com placenta prévia.

Métodos Estudo de coorte retrospectivo com 37 mulheres, sendo 16 com acretismo placentário, realizado de janeiro de 2013 a outubro de 2015. Considerou-se padrão-ouro para o diagnóstico de acretismo placentário o exame anatomopatológico, sendo que, na sua ausência, a descrição do achado intraoperatório. As associações entre variáveis foram investigadas utilizando o teste qui-quadrado de Pearson e o teste U de Mann-Whitney.

Resultados A idade média foi de 31,8 ± 7,3 anos, o número médio de gestações foi de 2,8 ± 1,1, o número médio da quantidade de partos foi de 1,4 ± 0,7, e o número médio de cesáreas prévias foi de 1,2 ± 0,8. O grupo do acretismo placentário apresentou antecedente de cesariana mais frequentemente do que o grupo sem acretismo (63,6% versus 36,4%, respectivamente; p < 0,001). A idade gestacional no parto em mulheres com diagnóstico de placenta prévia com acretismo foi de 35,4 ± 1,1 semanas. O peso ao nascer médio foi de 2.635,9 ± 374,1 g. A sensibilidade do ultrassom foi de 87,5%, com valor preditivo positivo (VPP) de 65,1%, e valor preditivo negativo (VPN) de 75,0%. Para a ressonância magnética, a sensibilidade foi de 92,9%, com VPP de 76,5% e VPN de 75,0%. O índice kappa para concordância entre os dois testes foi de 0,69 (intervalo de confiança de 95% [IC95%]: 0,26–1,00).

Conclusão O ultrassom e a ressonância magnética apresentaram sensibilidade e especificidade semelhantes no diagnóstico do acretismo placentário.

Keywords

placenta previa - placenta accreta - ultrasound - magnetic resonance imaging

Palavras-chave

placenta prévia - acretismo placentário - ultrassom - ressonância magnética

Contributors

Lopes ES, Feitosa FEL, Brazil AV, Castro JDV, Costa JIF, Araujo Júnior E, Peixoto AB and Carvalho FHC designed the study, analyzed and interpreted the data, wrote the article, and approved the final version of the manuscript for publication.


 

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