Accuracy of antepartum ultrasound in evaluating placental pathology
using superb microvascular imaging: main research article
Abstract
Objectives: To clarify whether microvascular ultrasound Doppler (SMI:
superb microvascular imaging) can detect antenatal histological findings
in pathologic placentas. Methods: In this prospective diagnostic
observational study (STROBE), pregnant women who were admitted to our
perinatal center for perinatal management were enrolled. Ultrasound
examinations to identify placental pathologies using SMI were performed
before delivery. After delivery, the placental tissue was clipped for
microscopic examination, as the location of the placenta obtained
ultrasound findings. The accuracy of antenatal ultrasound detection of
placental pathologies was compared between women who were admitted due
to fetal growth restriction (FGR), pre-eclampsia, and other indications.
Results: The highest accuracy was observed with placental infarction in
FGR (positive predictive value [PPV], 100%; sensitivity, 89%; area
under the curve [AUC], 0.945), whereas PPV, sensitivity, and AUC in
cases of preeclampsia were relatively low (AUC 0.540). Additionally,
PPV, sensitivity, and AUC for avascular villi were 100%, 57%, and
0.785 in cases with FGR, 67%, 67%, and 0.780 in cases with
preeclampsia, and 80%, 80%, and 0.920, respectively. The diagnostic
accuracies predictive of congestion of stem villi and chorangiosis were
insufficient (AUC<0.700). Conclusions: SMI can accurately
detect placental pathologic findings, such as placental infarction and
avascular villi. This modality may improve the perinatal management in
cases of placental abnormalities.