Value of Crystal Vue technique in detecting the placenta accreta spectrum located in c-section scar area

Shaoqi Chen, Qingzi Chen, Xiya Du, Sumin Chen, Weiping Li, Shigao Chen


Aims: Excessive placental invasion is a life-threatening obstetric disease. Determining the extent of placental villi invasion prenatally is crucial for formulating a surgical plan for pregnant women. The objective of this study was to explore the diagnostic accuracy of the Crystal Vue technique combined with two-dimensional (2D) ultrasound in detecting the degree of placenta accreta spectrum (PAS) located in the C-section scar area.

Materials and methods: Twenty-seven pregnant women with a strong suspicion of PAS underwent 2D ultrasound combined with a Crystal Vue examination. The diagnosis of 2D ultrasound alone and Crystal Vue combined with 2D ultrasound was statistically calculated, respectively. Cohen’s kappa (k) was used to measure the consistency between these two ultrasound diagnosis and the postoperative diagnosis.

Results: The postoperative diagnosis of 27 pregnant women was as follows: 6 cases of placental accreta, 11 cases of placental increta, 2 cases of placental percreta, 2 cases of placental accrete and placental increta, 2 cases of placental accreta and placental percreta, and 4 cases without PAS. Compared with the postoperative diagnosis, 20 cases (74.07%) were correctly diagnosed by 2D ultrasound alone, 6 cases were misdiagnosed, and one case the diagnosis was incomplete, which were substantially consistent with the postoperative diagnosis (k=0.612, p<0.01). Twenty-six cases (96.30%) were correctly diagnosed by Crystal Vue combined with 2D ultrasound; only one case was incomplete diagnosed which was almost perfectly consistent with the postoperative diagnosis (k=0.934, p<0.01).

Conclusions: Combining the Crystal Vue technique with 2D ultrasound can improve the diagnostic accuracy of ultrasound for detecting all types of PAS located in C-section scar area


placenta accreta spectrum; prenatal diagnosis; ultrasound; Crystal Vue technique; obstetrics

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Silver RM, Branch DW. Placenta Accreta Spectrum. N Engl J Med 2018;378:1529-1536.

Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol 2013;208:219.e1-219.e7.

O'Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 1996;175:1632-1638.

Vinograd A, Wainstock T, Mazor M, et al. Placenta accreta is an independent risk factor for late pre-term birth and perinatal mortality. J Matern Fetal Neonatal Med 2015;28:1381-1387.

Hull AD, Moore TR. Multiple repeat cesareans and the threat of placenta accreta: incidence, diagnosis, management. Clin Perinatol 2011;38:285-296.

Jauniaux E, Collins SL, Jurkovic D, Burton GJ. Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness. Am J Obstet Gynecol 2016;215:712-721.

Pagani G, Cali G, Acharya G, et al. Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018;97:25-37.

Collins SL, Ashcroft A, Braun T, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol 2016;47:271-275.

D'Antonio F, Iacovella C, Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013;42:509-517.

Cali G, Forlani F, Timor-Trisch I, et al. Diagnostic accuracy of ultrasound in detecting the depth of invasion in women at risk of abnormally invasive placenta: A prospective longitudinal study. Acta Obstet Gynecol Scand 2018;97:1219-1227.

Palacios-Jaraquemada JM, Bruno CH, Martin E. MRI in the diagnosis and surgical management of abnormal placentation. Acta Obstet Gynecol Scand 2013;92:392-397.

Calì G, Forlani F. Three-dimensional sonographic virtual cystoscopy in a case of placenta percreta. Ultrasound Obstet Gynecol 2014;43:481-482.

Al-Khan A, Guirguis G, Zamudio S, et al. Preoperative cystoscopy could determine the severity of placenta accreta spectrum disorders: An observational study. J Obstet Gynaecol Res 2018;23:126-132.

Benacerraf BR, Benson CB, Abuhamad AZ, et al. Three and 4 dimensional ultrasound in obstetrics and gynecology: proceedings of the American Institute of Ultrasound in Medicine Consensus Conference. J Ultrasound Med 2005;24:1587–1597.

Shih JC, Palacios Jaraquemada JM, Su YN, et al. Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray-scale and color Doppler techniques. Ultrasound Obstet Gynecol 2009;33:193-203.

Haidar ZA, Papanna R, Sibai BM, et al. Can 3-dimensional power Doppler indices improve the prenatal diagnosis of a potentially morbidly adherent placenta in patients with placenta previa? Am J Obstet Gynecol 2017;217:202.e1–202.e13.

Pires P, Ferreira AC, Souza GD, Queiroz PS, Araujo Júnior E. Prenatal Diagnosis of Ambiguous Genitalia by 3-Dimensional Ultrasonography Using the Crystal Vue Technique. J Ultrasound Med 2017;36:1963–1966.

Dall'Asta A, Paramasivam G, Lees CC. Crystal Vue technique for imaging fetal spine and ribs. Ultrasound Obstet Gynecol 2016;47:383-384.

Dall'Asta A, Paramasivam G, Lees CC. Qualitative evaluation of Crystal Vue rendering technology in assessment of fetal lip and palate. Ultrasound Obstet Gynecol 2017;49:549-552.

Dall'Asta A, Paramasivam G, Ghi T, Lees CC. Imaging the optic chiasm and nerves using Crystal Vue and Crystal Vue flow. Ultrasound Obstet Gynecol 2017;50:147-147.

Volpe N, Migliavacca C, Dall'Asta A, Kaihura CT, Ghi T, Frusca T. Prenatal diagnosis of fetal multiple hemivertebrae: the importance of 3D ultrasound assessment. J Matern Fetal Neonatal Med 2018;29:1-3.

Saso S, Al-Memar M, Bobdiwala S, Timmerman D. Use of Crystal Vue technique for imaging of adnexal masses: a pilot study. Ultrasound Obstet Gynecol 2017;50:96-96.

Dall'Asta A, Shah H, Masini G, et al. Evaluation of tramline sign for prenatal diagnosis of abnormally invasive placenta using three-dimensional ultrasound and Crystal Vue rendering technology. Ultrasound Obstet Gynecol 2018;52:403-404.

Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y. Placenta accreta--summary of 10 years: a survey of 310 cases. Placenta 2002;23:210-214.

Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol 2018;218:75-87.

Meng X, Xie L, Song W. Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: a systematic review and meta-analysis. Ultrasound Med Biol 2013;39:1958-1965.

Hamada S, Hasegawa J, Nakamura M, et al. Ultrasonographic findings of placenta lacunae and a lack of a clear zone in cases with placenta previa and normal placenta. Prenat Diagn 2011;31:1062-1065.

Bowman ZS, Eller AG, Kennedy AM, et al. Interobserver variability of sonography for prediction of placenta accreta. J Ultrasound Med 2014;33:2153-2158.

Aryananda RA, Akbar A, Wardhana MP, et al. New three-dimensional/four-dimensional volume rendering imaging software for detecting the abnormally invasive placenta. J Clin Ultrasound 2018;23:9-13.

Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med 1992;11:333-334.

Comstock CH. Antenatal diagnosis of placenta accrete: a review. Ultrasound Obstet Gyneco 2005;26:89-96.

Allen L, Jauniaux E, Hobson S, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management. Int J Gynaecol Obstet 2018;140:281-290.

Zosmer N, Jauniaux E, Bunce C, Panaiotova J, Shaikh H, Nicholaides KH. Interobserver agreement on standardized ultrasound and histopathologic signs for the prenatal diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2018;140:326-331.

Palacios-Jaraquemada JM. Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases. Acta Obstet Gynecol Scand 2011;90:1036-1042.

Bailit JL, Grobman WA, Rice MM, et al. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 2015;125:683-689.



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