Women’s Imaging

Abstract

A comprehensive imaging review of early placental formation, normal placental imaging features, and various placental pathologic conditions is provided, with discussion of newer imaging techniques for evaluation of the placenta.

The placenta plays a crucial role throughout pregnancy, and its importance may be overlooked during routine antenatal imaging evaluation. Detailed systematic assessment of the placenta at ultrasonography (US), the standard imaging examination during pregnancy, is important. Familiarity with the normal and abnormal imaging appearance of the placenta along with the multimodality and methodical approach for evaluation of its related abnormalities is necessary, so that radiologists can alert clinicians regarding appropriate prompt management decisions. This will potentially decrease fetal and maternal morbidity and mortality. This article reviews early placental formation and the expected imaging appearance of the placenta during pregnancy, as well as variations in its morphology. It also discusses various placental diseases and their potential clinical consequences. Placental pathologic conditions include abnormalities of placental size, cord insertion, placental and cord location, and placental adherence. Other conditions such as bleeding in and around the placenta, as well as trophoblastic and nontrophoblastic tumors of the placenta, are also discussed. US with Doppler imaging is the initial imaging modality of choice for placental evaluation. Magnetic resonance (MR) imaging is reserved for equivocal cases or when additional information is needed. Computed tomography (CT) has a limited role in evaluation of placental abnormalities because of the ionizing radiation exposure and the relatively limited assessment of the placenta; however, CT can provide important information in specific circumstances, particularly evaluation of trauma and staging of choriocarcinoma. This article also addresses recent techniques and updates in placental imaging, including elastography, diffusion-weighted MR imaging, and blood oxygen level–dependent (BOLD) MR imaging. These advanced imaging techniques may provide additional information in evaluation of abnormal placental adherence and new insights into placental pathophysiology in selected patients.

Online supplemental material is available for this article.

^©RSNA, 2017

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Article History

Received: June 13 2016
Revision requested: Aug 24 2016
Revision received: Oct 7 2016
Accepted: Oct 24 2016
Published online: May 11 2017
Published in print: May 2017

Vol. 37, No. 3

Abbreviations

Abbreviations:
DWI	diffusion-weighted imaging
IUGR	intrauterine growth restriction
MAP	morbidly adherent placenta
PTN	persistent trophoblastic neoplasia

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