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Quality and Safety

Effect of Structured Reporting on Concordance Rates Between Imaging, Operative, and Pathology Diagnoses in Patients with Placenta Accreta Spectrum

Saturday, May 6, 2023

    First Author(s)

  • RW

    Robert M. Weinstein, N/A, BE

    Medical Student
    Johns Hopkins School of Medicine
    Baltimore, Maryland, United States

    • Co-Author(s)

  • TB

    Theresa Boyer, MS, MSPH

    Graduate Student
    Johns Hopkins School of Public Health, United States

  • AV

    Arthur Vaught, MD

    Assistant Professor of Gynecology and Obstetrics
    Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, United States

  • TH

    Torre Halscott, MD, MS

    Assistant Professor of Gynecology and Obstetrics
    Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, United States

  • KM

    Katarzyna Macura, MD, Ph. D

    Professor of Radiology and Radiological Science
    The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, United States

  • EG

    Erin Gomez, MD

    Assistant Professor of Radiology
    Johns Hopkins Hospital
    Baltimore, Maryland, United States

Purpose: Placenta Accreta Spectrum (PAS) is a range of clinical conditions in which the placenta is pathologically adherent to the uterine myometrium. When a placentation anomaly is identified or suspected based on ultrasound findings, magnetic resonance imaging (MRI) may serve as an adjunct tool in diagnosis. Use of structured reporting in the interpretation of MRI may lead to improved concordance rates between imaging, operative, and pathology diagnoses in patients with PAS, with the potential to improve patient outcomes and the quality of patient care.

Methods/Materials: This retrospective, single-institution study was approved by our IRB. An institutional OB database was used to identify all patients with a diagnosis of PAS between 2008-2022. Inclusion criteria included a history of cesarean section and pathology report with a final diagnosis of PAS. Discordance rates between MRI findings and operative and pathologic diagnoses were calculated in patients undergoing cesarean delivery for suspected PAS. Discordance was defined as a difference in diagnosis between MRI and ultrasound, operative or pathology reports.

Results: Of 112 patients meeting inclusion criteria, 59 (52.7%) underwent placental MRI prior to delivery. Of the 59 MRIs performed, 8 (13.6%) were interpreted using structured reporting, which was universally adopted at our institution in 2021. Of the 51 unstructured reports, 32 (62.7%) contained one or more discordances (Table 1), while of the 8 structured reports, only 1 (12.5%) contained any discordance (p = .017). The use of structured reporting was also associated with improved patient outcomes (Figure 1) including a decrease in ICU admissions (p=.045).

Conclusions: The use of structured reporting in the interpretation of placental MRI may decrease the amount of discordance between imaging and intraoperative or pathologic diagnoses by promoting an algorithmic review of the images and highlighting pertinent positives and negative findings necessary for accurate diagnosis. A decrease in discordant image interpretation may lead to improvements in patient outcomes and quality of patient care by permitting more thorough operative and/or procedural planning.