Impact of placental location matter in placenta accreta spectrum disorders

Abstract

Background: Multiple magnetic resonance imaging (MRI) features suggestive of placenta accreta spectrum (PAS) disorders exist. However, the impact of placental location on clinical characteristics and MRI features in PAS has not been fully explored. The aim of this study was to explore the difference of MRI signs in different placental position in PAS disorders. Methods: We retrospectively reviewed surgically or pathologically confirmed PAS cases at Sichuan Provincial People’s Hospital from 2016 to 2021. Placental location was categorized based on MRI as anterior, posterior, or anterior/posterior. MRI features were thoroughly reviewed and compared. Results: A total of 262 patients were included in the study, comprising 38 (14.50%) with placenta accreta, 120 (45.80%) with placenta increta, 21 (8.02%) with placenta percreta, and 83 (31.68%) with normal placentas. The distribution of placental location was as follows: 32.06% posterior, 48.09% anterior, and 19.85% anterior/posterior. Placental location varied significantly between patients with and without PAS disorders and among patients with different PAS subtypes (P<0.05). The prevalence of placental bulge was higher in anterior and anterior/posterior placentas than in the posterior placentas (P<0.05). Moreover, T2 dark bands, placental heterogeneity, abnormal intraplacental vascularity, focal exophytic mass, and bladder wall interruption varied among different subtypes of PAS disorders (P<0.05). Conclusions: Placental bulge emerged as the only MRI sign that exhibited differences based on placental location. Furthermore, MRI features demonstrated variations across different subtypes of PAS.