Prenatal planning of placenta previa: diagnostic accuracy of a novel MRI-based prediction model for placenta accreta spectrum (PAS) and clinical outcome

  • Andrea Delli Pizzi
  • Alessandra Tavoletta
  • Roberta Narciso
  • Domenico Mastrodicasa
  • Stefano Trebeschi
  • Claudio Celentano
  • Jacopo Mastracchio
  • Roberta Cianci
  • Barbara Seccia
  • Luisa Marrone
  • Marco Liberati
  • Antonio Raffaele Cotroneo
  • Massimo Caulo
  • Raffaella Basilico



To investigate the diagnostic accuracy of MRI for placenta accreta spectrum (PAS) and clinical outcome prediction in women with placenta previa, using a novel MRI-based predictive model.


Thirty-eight placental MRI exams performed on a 1.5T scanner were retrospectively reviewed by two radiologists in consensus. The presence of T2 dark bands, myometrial thinning, abnormal vascularity, uterine bulging, placental heterogeneity, placental protrusion sign, placental recess, and percretism signs was scored using a 5-point scale. Pathology and clinical intrapartum findings were the standard of reference for PAS, while intrapartum/peripartum bleeding and emergency hysterectomy defined the clinical outcome. Receiver-operating characteristic (ROC) analysis and discriminant function analysis were performed to test the predictive power of MRI findings for both PAS and clinical outcome prediction.


Abnormal vascularity and percretism signs were the two most predictive MRI features of PAS. The area under the curve (AUC) of the predictive function was 0.833 (cutoff 0.39, 67% sensitivity, 100% specificity, p = 0.001). Percretism signs and myometrial thinning were the two most predictive MRI features of poor outcome. AUC of the predictive function was 0.971 (cutoff − 0.55, 100% sensitivity, 77% specificity, p < 0.001).


The diagnostic accuracy of MRI, especially considering the combination of the most predictive MRI findings, is higher when the target of the prediction is the clinical outcome rather than the PAS.


Magnetic resonance Placenta accreta spectrum (PAS) Placenta previa Placental invasion Intrapartum bleeding Clinical outcome 


Author contributions

All authors were involved in patient management and wrote and/or reviewed the report. Written consent to publication was obtained.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participant were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the patients included in this study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Andrea Delli Pizzi
    • 1
  • Alessandra Tavoletta
    • 2
  • Roberta Narciso
    • 2
  • Domenico Mastrodicasa
    • 3
  • Stefano Trebeschi
    • 4
  • Claudio Celentano
    • 5
  • Jacopo Mastracchio
    • 6
  • Roberta Cianci
    • 2
  • Barbara Seccia
    • 2
  • Luisa Marrone
    • 6
  • Marco Liberati
    • 6
  • Antonio Raffaele Cotroneo
    • 1
    • 2
  • Massimo Caulo
    • 1
    • 2
  • Raffaella Basilico
    • 2
  1. 1.ITAB Institute of Advanced Biomedical Technologies“G. d’Annunzio” UniversityChietiItaly
  2. 2.Department of Neuroscience, Imaging and Clinical Sciences“G. d’Annunzio” UniversityChietiItaly
  3. 3.Department of RadiologyStanford University School of MedicineStanfordUSA
  4. 4.Department of RadiologyNetherlands Cancer InstituteAmsterdamThe Netherlands
  5. 5.Department of Medicine and Ageing SciencesG. d’Annunzio University of Chieti-PescaraChietiItaly
  6. 6.Department of Obstetrics and GynaecologyG. d’Annunzio University of Chieti-PescaraChietiItaly

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