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Comparative accuracy of magnetic resonance morphometry and sonography in assessment of post-cesarean uterine scar
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Objective: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with that of ultrasonography (USG) for the measurement of lower segment cesarean scar during trial of labor after cesarean (TOLAC). Materials and Methods: This was a prospective case-control observational study conducted with a cohort of 30 participants being considered for TOLAC but eventually proceeding to lower segment cesarean section (LSCS) at a university-based teaching institute over a period of 2 years. Measurement of scar thicknesses were done by MRI and USG preoperatively and validated by surgical findings. Comparison of diagnostic accuracy as well as the cut-off values (to differentiate a normal scar from an abnormal scar) was done between the two modalities. Results: Insignificant systematic error between the measurements obtained by the two modalities was noted by a Bland–Altmann analysis. The diagnostic accuracy of USG for differentiating a normal from an abnormal uterine scar was 96.7% while that of MRI was at a slightly lower level of 90%. A strong level of agreement between the two modalities was observed. Conclusion: MRI offers no advantage in diagnostic accuracy for the measurement of LSCS scar thickness during consideration of TOLAC. Advances in Knowledge: Measurement of uterine scar by MRI has a good correlation with that done on USG in the setting of post-cesarean pregnancy. The results hold good both for normal (grades 1 and 2) and abnormal (grades 3) scars. MRI, however, does not offer any added advantage over sonographic scar thickness measurement for the differentiation of a normal (grades 1 and 2) from an abnormal (grade 3) scar.
KeywordsLower segment caesarian section - magnetic resonance imaging - scar thickness - uterine scar - vaginal birth after cesarean
26 July 2021 (online)
© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Hamilton BE, Hoyert DL, Martin JA, Strobino DM, Guyer B. Annual summary of vital statistics: 2010-2011. Pediatrics 2013; 131: 548-58
- 2 Biswass A. Management of previous cesareans section. Curr Opin Obstet Gynecol 2003; 15: 123-9
- 3 Quilligan EJ. Vaginal birth after cesarean section: 270 degrees. J Obstet Gynecol Res 2001; 27: 169-73
- 4 Martins WP, Bara DA, Gallarreta FMP, Irion O, Boulvain M. Inter and intraobserver variability in sonographic measurement of the lower uterine segment after a previous cesarean section. Ultrasound obstet gynecol 2006; 27: 420-4
- 5 Qureshi B, Inafuku K, Oshima K, Masamoto H, Kanazawa K. Ultrasonographic evaluation of lower uterine segment to predict the integrity and quality of cesarean scar during pregnancy: A prospective study. Tohoku J Exp Med 1997; 183: 55-65
- 6 Sen S, Malik S, Salhan S. Ultrasonographic evaluation of lower uterine segment thickness in patients of previous caesarean section. Int J Gynecol Obstet 2004; 87: 215-9
- 7 Dicle O, Kucukler C, Pirnar T, Erata Y, Posaci C. Magnetic resonance imaging evaluation of incision healing after cesarean sections. Eur Radiol 1997; 7: 31-4
- 8 Ofili-Yebovi D, Ben-Nagi J, Sawyer E, Yazbek J, Lee C, Gonzalez J. et al. Deficient lower-segment Cesarean section scars: Prevalence and risk factors. Ultrasound Obstet Gynecol 2008; 31: 72-7
- 9 Arnold F, Kishor S, Roy TK. Sex-Selective Abortions in India. Popul Dev Rev 2002; 28: 759-85
- 10 Pomorski M, Fuchs T, Zimmer M. Prediction of uterine dehiscence using ultrasonographic parameters of cesarean section scar in the nonpregnant uterus: A prospective observational study. BMC Pregnancy Childbirth 2014; 14: 365
- 11 Naji O, Abdallah Y, Bij de Vaate AJ, Smith A, Pexsters A, Stalder C. et al. Standardized approach for imaging and measuring Cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol 2012; 39: 252-9
- 12 Jastrow N, Chaillet N, Roberge S, Morency AM, Lacasse Y, Bujold E. Sonographic lower uterine segment thickness and risk of uterine scar defect: A systematic review. J Obstet Gynecol Can 2010; 32: 321-7
- 13 Drouin O, Bergeron T, Beaudry A, Demers S, Roberge S, Bujold E. Ultrasonographic Evaluation of Uterine Scar Niche before and after Laparoscopic Surgical Repair: A Case Report. AJP Rep 2014; 4: e65-8
- 14 Kumar I, Verma A, Matah M, Satpaty G. Utility of Multiparametric MRI in Caesarean Section Scar Characterization and pre-operative prediction of scar Dehiscence: A Prospective Study. Acta Radiol. 2017; 58: 890-6
- 15 Chen HY, Chen SJ, Hseih FJ. Observation of cesarean section scar by transvaginal ultrasonography. Ultrasound Med Biol 1990; 16: 443-7
- 16 Ogura A, Miyai A, Maeda F, Hongoh T, Kikumoto R. Comparison of contrast resolution between dynamic MRI and dynamic CT in liver scanning. Nihon Hoshasen Gijutsu Gakkai Zasshi 2002; 58: 286-91