Diagnostic Accuracy of Ultrasonography and Magnetic Resonance Imaging for FIGO Grading of Placenta Accreta Spectrum: A Histopathology-Based Study

The incidence of placenta accreta spectrum (PAS) has been increasing globally due to the increased rate of cesarean section. Radiology had a crucial role in PAS early diagnosis but the comparison studies between USG and MRI for PAS grading are lacking. This study aimed to compare USG and MRI with histopathology examination for placenta accreta invasion grading. This cross-sectional study was conducted in Hasan Sadikin Central General Hospital using medical records from January 2025 to June 2025. The USG and MRI results would be reviewed by radiologists or researchers for placental invasion grading based on the International Federation of Gynecology and Obstetrics (FIGO) classification. The diagnostic performance were determined using Statistical Package for Social Sciences (SPSS) software version 25.0. Twenty-four patients met the inclusion and exclusion criteria, with a mean age of 36.75 ± 4.46 years. Most PAS cases were FIGO III based on USG (58.3%) and MRI (41.7%), but based on the histopathologic results, most PAS cases were FIGO II (45.8%). The analysis revealed that MRI was superior to USG for PAS invasion grading (Cronbach's alpha 0.964 versus 0.521). Magnetic resonance imaging is crucial for PAS invasion grading, particularly if the USG was inconclusive or negative in high-risk pregnant women.