Magnetic resonance imaging in the differential diagnosis of true placenta accreta: a clinical case

True placenta accreta is the attachment of chorionic villi to the myometrium, possibly penetrating into the thickness of the myometrium and its outside, including through the serous tunic. The main current diagnostic techniques are considered to be ultrasonography, laboratory diagnosis (elevated human chorionic gonadotropin and placental lactogen levels), and clinical data (pain and vaginal discharge). Magnetic resonance imaging is deemed to be an adjuvant technique. By using a clinical example, this paper considers the capabilities of magnetic resonance imaging to diagnose this abnormality and to choose a right treatment policy. The abnormality is compared with the conditions (trophoblastic tumor and myoma with lysis) that are similar in their diagnosis and magnetic resonance pattern). The disorder in question is rather rare and its detailed consideration, determination of the capabilities of various techniques, and comparison with externally similar cases are
important for the development of diagnostic opportunities.

1. Avva R., Shah H.R., Angtuaco T.L. US case of the day. Placenta increta. Radiographics 1999;19(4): 1089–92.

2. Krapp M., Baschat A.A., Hankeln M., Gembruch U. Gray scale and color Doppler sonography in the third stage of labor for early detection of failed placental separation. Ultrasound Obstet Gynecol 2000;15(2): 138–42.

3. Garmi G., Salim R. Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstet Gynecol Int 2012;2012:873929.

4. Cramer S.F., Heller D. Placenta accreta and placenta increta – an approach to pathogenesis based on the trophoblastic differentiation pathway. Pediatr Dev Pathol 2015. [Epub ahead of print].

5. Beuker J.M., Erwich J.J., Khong T.Y. Is endomyometrial injury during termination of pregnancy or curettage following miscarriage the precursor to placenta accreta? J Clin Pathol 2005;58(3):273–5.

6. Sakinci M., Kuru O., Tosun M. et al. Clinical analysis of emergency peripartum hysterectomies in a tertiary center. Clin Exp Obstet Gynecol 2014;41(6): 654–8.

7. Clausen C., Lonn L., Langhoff-Roos J. Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand 2014;93(2):138–43.

8. Androutsopoulos G., Gkogkos P., Decavalas G. Mid-trimester maternal serum HCG and alpha fetal protein levels: clinical significance and prediction of adverse pregnancy outcome. Int J Endocrinol Metab 2013;11(2):102–6.

9. Baughman W.C., Corteville J.E., Shah R.R. Placenta accreta: spectrum of US and MR imaging findings. Radiographics 2008;28(7):1905–16.

10. Dwyer B.K., Belogolovkin V., Tran L. et al. Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging? J Ultrasound Med 2008;27(9):1275–81.

11. Hoffman J.S., Silverman A.D., Gelber J., Cartun R. Placental site trophoblastic tumor: a report of radiologic, surgical, and pathologic methods of evaluating the extent of disease. Gynecol Oncol 1993;50(1): 110–4.

12. Abulafia O., Sherer D.M., Fultz P.J. et al. Unusual endovaginal ultrasonography and magnetic resonance imaging of placental site trophoblastic tumor. Am J Obstet Gynecol 1994;170(3):750–2.

13. Brandt K.R., Coakley K.J. MR appearance of placental site trophoblastic tumor: a report of three cases. Am J Roentgenol 1998;170(2): 485–7.

14. Стрельцова О.Н., Мещерякова Л.А., Тарачкова Е.В. и др. Магнитно-резонансная томография в диагностике трофобластической опухоли плацентарного ложа. Вестник РОНЦ им. Н.Н. Блохина 2014;25(3–4):107–10. [Strel’tsovа О.N., Меshcheryakovа L.А., Таrachkovа Е.V. et al. Маgnetic and resonance tomography in the diagnostics of the placental site trophoblastic tumor. Vesnik RONC im. N.N. Blokhina = Herald of N.N. Blokhin RCRC 2014;25 (3–4):107–10. (In Russ.)].

15. Dhanda S., Ramani S., Thakur M. Gestational trophoblastic disease: a multimodality imaging approach with impact on diagnosis and management. Radiol Res Pract 2014;2014:842751.

16. Hassadia A., Gillespie A., Tidy J. et al. Placental site trophoblastic tumour: clinical features and management. Gynecol Oncol 2005;99(3):603–7.

17. Vardar M.A., Altintas A. Placental-site trophoblastic tumor. Principles of diagnosis, clinical behaviour and treatment. Eur J Gynaecol Oncol 1995;16(4): 290–5.

18. Bower M., Paradinas F.J., Fisher R.A. et al. Placental site trophoblastic tumor: molecular analysis and clinical experience. Clin Cancer Res 1996;2(5):897–902.

19. Murase E., Siegelman E.S., Outwater E.K. et al. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics 1999;19(5):1179–97.

20. Weinreb J.C., Barkoff N.D., Megibow A., Demopoulos R. The value of MR imaging in distinguishing leiomyomas from other solid pelvic masses when sonography is indeterminate. Am J Roentgenol 1990;154(2):295–9.

21. Ueda H., Togashi K., Konishi I. et al. Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. Radiographics 1999;19 Spec No:S131–45.