The value of contrast-enhanced ultrasound in evaluating the effect of uterine artery embolisation in morbidly adherent placenta after delivery

The purpose of this study was to explore the clinical value of Contrast-Enhanced Ultrasound (CEUS) using a microbubble contrast agent in evaluating placental vascularity and the effect of Uterine Artery Embolisation (UAE) treatment in morbidly adherent placenta after delivery. Twenty two cases of morbidly adherent placenta accreta after delivery were examined by gray-scale ultrasound, Color Doppler imaging, and CEUS. All the patients undergone UAE combining with Methotrexate (MTX) and were followed up by CEUS. The images of the CEUS before and after UAE were compared. The time that the enhancement began before UAE in the abnormal mass was earlier than that in the myometrium (abnormal mass 10.4 ± 1.7 s, myometrium 12.0 ± 2.1 s; p=0.007). The duration of enhancement before UAE in the abnormal mass was longer than that in the myometrium (262.0 ± 18.3 s vs. 174.0 ± 15.9 s; p=0.000). The PI and the abnormal mass before UAE were higher than that of the normal myometrium (25.8 dB ± 3.2 dB vs. 14.0 dB ± 2.8 dB; P=0.000). The abnormal mass displayed hyperenhancement before UAE. The abnormal mass displayed non-enhancement in 18 cases and isoenhancement in 4 cases after UAE. The 18 cases of nonenhancement expelled the placenta by Dilation and Curettage (D and C) completely 7 days after UAE and the 4 cases of isoenhancement expelled part of the placenta by D and C and hysteroscope were performed 30 days after UAE. CEUS may be a useful tool for the quantitative assessment of uteroplacental vascularity in morbidly adherent placenta after delivery and may be used to follow up the conservative treatment.