Highlights
- •MR angiography showed enlarged ovarian and intrapelvic parasitic arteries to the gravid uterus.
- •Enlarged ovarian arteries were rarely seen with or without placenta accreta spectrum.
- •Intrapelvic parasitic arteries were seen in the majority of cases with placenta accreta spectrum.
- •Intrapelvic parasitic arteries were not observed in cases with normal placentation.
Abstract
Purpose
To compare the prevalence of enlarged ovarian and intrapelvic parasitic arteries to
the gravid uterus between cases of placenta accreta spectrum (PAS) and those with
normal placentation using unenhanced magnetic resonance (MR) angiography.
Methods
Unenhanced time-of-flight MR angiography was performed in 12 consecutive women with
PAS (mean age, 34 years; range, 23–42 years) and 24 women with normal placentation
(mean age, 31 years; range, 24–42 years) in their third trimester and reviewed by
two independent observers. The consensus reading served as the reference standard.
Findings of pelvic arteriography performed at cesarean hysterectomy were reviewed
in all cases of PAS. The prevalence of enlarged ovarian and intrapelvic parasitic
arteries was compared using Fisher's exact test. The interobserver agreement was assessed
with Kappa statistics.
Results
The prevalence of enlarged ovarian arteries was not significantly different between
cases of PAS and normal placentation (17% [4/24 pelvic sides] vs. 4% [2/48 pelvic
sides], P = .091). The prevalence of intrapelvic parasitic arteries was significantly higher
in cases of PAS than in those with normal placentation (67% [16/24 pelvic sides] vs.
0% [0/48 pelvic sides], P < .0001). On a patient-by-patient basis, the intrapelvic parasitic artery was frequently
present in women with PAS (92% [11/12 patients]). The Kappa values were 0.915 and
0.852 for detecting enlarged ovarian and intrapelvic parasitic arteries, respectively,
indicating excellent interobserver agreement.
Conclusions
The development of intrapelvic parasitic arteries was an anomalous phenomenon observed
on unenhanced MR angiography in the majority of women with PAS but was not observed
in those with normal placentation.
Abbreviations:
PAS (placenta accreta spectrum), MR (magnetic resonance), IRB (institutional review board), MIP (maximum intensity projection), PPV (positive predictive value), NPV (negative predictive value), CI (confidence interval), TGF (transforming growth factor), VEGF (vascular endothelial growth factor)Keywords
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Article info
Publication history
Published online: February 27, 2020
Accepted:
February 25,
2020
Received in revised form:
February 25,
2020
Received:
November 28,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
