Role of MRI In Prediction of Success of Resective Technique of Lower Uterine Segment in Placenta Accreta Spectrum

This prospective interventional study evaluated the accuracy of prenatal MRI in predicting the invasiveness and surgical management of placenta accreta spectrum (PAS) cases. Conducted over one year at Mansoura University Hospitals, the study involved 30 patients with PAS and at least one prior cesarean delivery. Standardized MRI protocols were used to assess the feasibility of uterine-sparing surgery based on criteria such as placental position, bladder wall integrity, and absence of parametric or cervical invasion.Intraoperative findings were classified according to the FIGO system. Uterine preservation was attempted for FIGO grades 1, 2, and 3a, while higher grades underwent cesarean hysterectomy. MRI predictions were compared with surgical outcomes to evaluate diagnostic accuracy.Results showed MRI correctly predicted the surgical approach in 27 of 30 cases. It accurately identified all five cases requiring hysterectomy and correctly indicated uterine preservation in 22 of 25 cases. Diagnostic performance of MRI for predicting successful uterine-sparing surgery included sensitivity of 88%, specificity of 100%, accuracy of 90%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 62%.MRI signs significantly associated with hysterectomy included bladder wall interruption (P = 0.0069) and cervical invasion (P = 0.0011). Parametric invasion was more common in the hysterectomy group but was not statistically significant (P = 0.1188).In conclusion, MRI is a valuable adjunct to ultrasound in prenatal planning and surgical decision-making for PAS. Key MRI findings can help anticipate surgical challenges and guide multidisciplinary management.