Join us Tuesday evening for our next #AJRChat where we'll be discussing Sh Thiravit, Inessa Goldman MD, Priyanka Jha, and Manjiri Dighe's article on diagnosis of severe placenta accreta spectrum disorder. ajronline.org/doi/abs/10.221…

Join us tonight for our #AJRChat where we'll discuss severe placenta accreta spectrum disorder with Sh Thiravit, Inessa Goldman MD, Priyanka Jha, and Manjiri Dighe. ajronline.org/doi/abs/10.221…

First time on an #AJRChat? Here's what you should know:

Q1. Could you review briefly what some of the US and MRI findings discussed in this paper represent? #AJRChat

Background and visual: PAS is caused by partial to complete absence of the decidua, so that the villous tissue is abnormally adherent to or invades through the myometrium. [helpful image to conceptualize imaging findings, courtesy of Robbins & Cotran]

AJR Other signs are placental changes which can be seen with less invasive PAS and not directly related to loss of myometrium at the site of myoinvasive PASD #AJRchat

#AJRChat Getting to know "placental bulge" sign for PAS diagnosis

Q3. What are some possible explanations for similar interobserver agreement between US and MRI with respect to placental bulge, but divergence of agreement between MRI and US for other findings like myometrial thinning? #AJRChat

AJR Q3.1 The exact findings of interobserver variability were as follows: On US, interobserver agreement was good (0.60 < κ ≤ 0.80) for abnormal lacunae only #AJRChat

Inessa Goldman, MD FSAR AJR That is so true for MRI. I always find it difficult to be confident about myo thinning. #AJRChat

Q4. With the greater accessibility and lower cost of US compared to MRI, do you think that near equivalence of US to MRI for diagnosing severe PAS suggests that US could serve as a primary modality for diagnosis and monitoring of PAS? #AJRChat

AJR Q4: A- I think both modalities add valuable information and we should be reading the exams together. I do that in my practice - I review the ultrasound blindly before I start reading the MRI. #AJRchat

AJR Q4 A- However I have seen even patients with definite PAS on US get MRI since the clinicians don't want to miss anything before the Sx and these cases can be a disaster if there is undiagnosed parametrial invasion or invasion of surrounding organs. #AJRChat

Closing thoughts? #AJRChat

Sh Thiravit Inessa Goldman, MD FSAR AJR Priyanka Jha has published a standard protocol in her paper endorsed by SAR and ESUR. pubmed.ncbi.nlm.nih.gov/32040730/ #AJRChat

AJR Use of MRI very much depends on the clinicians performing US. In the hands of very experienced MFMs I find that when they see suspisious findings for PAS we very rarely change the diagnosis on MRI. However, MRI helps with surgical planning in those cases #ACRChat

If you missed out on last night's #AJRChat, you can catch up on everything here: arrs.org/AJR/Multimedia…