28 year old primipara with adherent placenta - 12th postnatal day.
2A1: pre contrast T2 weighted MRI sagittal image (TR 5464 TE 44; 1.5 Tesla Siemens Avanto-TIM machine, Germany, using pelvic phased array coil; matrix 320×640 FOV 26×26). Red arrow shows the hyperintense placenta invading the myometrium almost up to the serosa at this part of the uterus. White arrow shows the plane of placenta at myometrium sparing the deep myometrial layer corresponding to accreta. 2B1: pre contrast T2 weighted tirm MRI coronal image (TR 7911 TE 44 TI 160; Siemens Avanto 1.5 Tesla MRI). Red arrows point to the hyperintense lesion corresponding to the retained placental tissue. The hyperintense placental tissue is invading more than 50% of the myometrial thickness consistent with increta. 2C1: Pre contrast T2 weighted TRUFI MRI axial image (TR 2.82 TE 1.2; Siemens Avanto 1.5 Tesla MRI). Red arrows point to the hyperintense lesion corresponding to the retained placental tissue.
2A2: Post-natal day- post Gadolinium contrast venous phase T1 weighted fat suppressed MRI sagittal image (TR 319 TE 2.5; Siemens Avanto 1.5 Tesla MRI; 8 ml of Gadolinium). Red arrows point to the irregular heterogenous intense enhancement of the placenta and its invasion through myometrium upto the serosa in the fundus of the uterus. White arrow points to the hyperintense placenta abutting the superficial layer of myometrium. 2B2: Post Gadolinium venous phase T1 weighted fat suppressed MRI coronal image (TR 3.2 TE 1.1; Siemens Avanto 1.5 Tesla MRI). Red arrow points to the intensely enhancing lesion corresponding to the retained placental tissue. 2C2: Post Gadolinium venous phase T1 weighted MRI axial image (TR 270 TE 4.76; Siemens Avanto 1.5 Tesla MRI). Red arrow points to the intensely enhancing lesion corresponding to the retained placental tissue and white arrow to the lesser intense surrounding myometrium.