Placenta accreta: dark intraplacental T2 bands

Case contributed by Dr Mohammad A. ElBeialy

Presentation

38 weeks of gestation, G3P1A1 with previous Cesarean section.

Patient Data

Age: 25 years.
Gender: Female
Modality: MRI

The placenta is completely covering the internal os (Type IV placenta or placenta praevia complete centralis)

Focal indistinctness of the uterine myometrium hypointense line with a dark T2 intraplacental band noted at the anterior lower uterine segment with mild placental heterogeneity as well as mild focal uterine bulge with bladder indentation. 

 

Case Discussion

Placenta Accreta was confirmed at surgery and hysterectomy was done.

Placenta accreta is a life-threatening condition with increasing incidence in the previous years due to the increase in the caesarean section deliveries. The pathogenesis is mostly related to deficient decidua at the caesarean section site.  

The two most important predisposing factors are previous caesarean section and placenta previa.

Placenta accreta is a general term describing abnormal placentation and includes three subtypes;

  • placenta accreta vera: adherent to the myometrium.
  • placenta increta: invasion of the myometrium.
  • placenta percreta : perforation of the myometrium and invading the perimetrium

Radiological manifestations of placenta praevia includes:

Main diagnostic signs:

  • dark T2 intraplacental bands: are areas of fibrin deposition within the placenta; they appear as thick T2-WI nodular or linear areas of low signal intensity extending within the placenta from the placenta–myometrium interface with random distribution.
  • heterogeneity of the placenta.
  • abnormal placental vascularity with disorganization.

Less reliable signs:

  • focal interruptions or indistinctness of the myometrial wall: it might be subtle with placenta accrete vera, yet with high specificity for placenta increta and percreta)
  • focal uterine bulging.
  • tenting of urinary bladder or invasion of the adjacent pelvic structures (highly specific for percreta rather than increta or accreta)
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Case Information

rID: 39015
Case created: 16th Aug 2015
Last edited: 8th Oct 2015
Inclusion in quiz mode: Included

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