PICTORIAL ESSA

MAIN RADIOLOGICAL SIGNS IN ULTRASONOGRAPHY AND MAGNETIC RESONANCE OF PLACENTARY ACRETISM

Abstract

OBJECTIVE: To describe and demonstrate the main radiological signs on ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of placental accretism. CASUISTICS AND METHODS: Retrospective study carried out at Femme Laboratory of some pregnant women referred with clinical suspicion of placental accretism or who underwent routine US referrals from medical offices in greater São Paulo. Gestational age ranged from 24 to 37 weeks. Patients with suspected accretism were followed up through contact with the obstetrician and we identified the outcome that occurred. The examinations were performed using the equipment of US Toshiba and Voluson GE and the MRIs in Aera Siemens, acquired HASTE, TURBO FISP sequences, in the axial, sagittal and coronal planes and Gradiente echo (GE) in the best plane of acquisition of the placenta and the most common cases. Elucidative data were selected. The analysis of the images was performed by experienced doctors in fetal medicine and 1 radiologist with 18 years of experience in the diagnosis of accretism. RESULTS: The main signs found at US were: retroplacental hypoechoic gaps, increased vascularization of the myometrial wall, loss of boundaries between the placenta and the myometrium. MRI included thinning of the myometrial wall, heterogeneity of the placental signal, discontinuity of the myometrial wall, and hyposignal bands on the myometrial wall. FINAL CONSIDERATIONS AND CONCLUSION: US and MRI are useful in identifying placental accretism. It is essential that ultrasonographers and radiologists know and identify the main signs suggestive of accretism, as well as assess its extent for the delivery be safer.