Objective: This study compares the Magnetic Resonance Imaging (MRI) sequences T2-Weighted Imaging (T2WI) and T2WI+Diffusion-Weighted Imaging (DWI) in the placenta accreta spectrum (PAS) with the findings of surgery and histopathology. Study Design: We conducted a retrospective cohort study of consecutive prenatally suspected PAS cases in a single tertiary-care PAS center who underwent non-contrast pelvic MRI at our hospital from 2018 to April 2023. The data were analysed to compare the multiplanar T2WI and multiplanar T2WI + DWI axial sections between the International Federation of Gynecology and Obstetrics (FIGO)-modified classification groups of degrees 1-2 and degree 3 (according to the surgical findings) as well as the accreta-increta and percreta groups (according to the histopathological findings) Result: There were 35 patients, six women (17.1%) in the FIGO grades 1-2 group and 29 women (82.8%) in the FIGO grade 3 group, according to the surgical findings. In addition, 29 women (82.8%) were included in the Accreta-Increta group, and six women (17.1%) were included in the Percreta group, according to the histopathological findings. The T2WI sequence showed a significantly higher difference in assessing loss of retroplacental dark zone and bladder wall interruption in the FIGO-modified classification compared to the T2WI+DWI sequence (p=0.026 vs p=0.063 p=0.008 vs p=0.146). In analysing each PAS subtype histopathologically, there were no significant variations in MRI features between the T2WI and T2WI+ DWI sequences. Conclusion: The addition of axial DWI sequences to multiplanar T2WI MRI sequences did not significantly provide additional information in relation with clinical and histopathology grading of placenta accreta spectrum.

T2W; DWI; Diffusion Weighted Imaging; Placenta Accreta Spectrum; PAS