彩色多普勒超声联合MRI对植入型前置胎盘孕产妇的诊断价值
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摘要
目的探讨西门子G60S型彩色多普勒超声联合MRI对植入型前置胎盘孕产妇的诊断价值,为前置胎盘的影像诊断提供理论依据。方法本次研究对象为2016年1月至2017年1月于鄂州市第三医院诊断与治疗的60例确诊为前置胎盘的孕产妇,产前均进行常规彩色多普勒超声、MRI检查,以手术及病理诊断结果为金标准,比较彩色多普勒超声、MRI以及彩色多普勒超声联合MRI检查的诊断价值。结果手术及病理诊断结果确诊38例孕产妇为前置胎盘合并胎盘植入,其中粘连性前置胎盘4例、植入性前置胎盘24例、穿透性前置胎盘10例;彩色多普勒超声诊断敏感度、特异度、漏诊率、误诊率、阳性预测值、阴性预测值分别为57.9%、90.9%、36.8%、18.2%、84.3%、58.8%;MRI诊断敏感度、特异度、漏诊率、误诊率、阳性预测值、阴性预测值分别为60.5%、77.3%、39.5%、13.2%、82.1%、53.1%;彩色多普勒超声联合MRI诊断敏感度、特异度、漏诊率、误诊率、阳性预测值、阴性预测值分别为76.3%、68.2%、23.7%、31.8%、80.6%、62.5%。彩色多普勒超声联合MRI诊断敏感度显著高于彩色多普勒超声与MRI,差异有统计学意义(P<0.05),彩色多普勒超声与MRI诊断敏感度差异无统计学意义(P>0.05);彩色多普勒超声联合MRI诊断特异度显著低于彩色多普勒超声与MRI,彩色多普勒超声诊断特异度显著高于MRI,差异有统计学意义(P<0.05)。结论 MRI与彩色多普勒超声在前置胎盘合并胎盘植入的诊断方面具有一定的临床价值,联合诊断能显著提升诊断敏感度,降低漏诊率,为制定临床干预治疗措施提供理论依据。
Objective To investigate the diagnostic value of Siemens G60 S color Doppler ultrasonography combined with MRI in implanted pre-placenta pregnancy,so as to provide theoretical evidence for imaging diagnosis of placenta praevia. Methods Sixty parturients with placenta previa diagnosed and treated in our hospital from January 2016 to January 2017,were recruited as study subjects. Before delivery,prenatal routine color Doppler ultrasonography and MRI scanning were performed,and the results of surgery and pathological diagnosis were of gold standards. The diagnostic values of color Doppler ultrasonography,MRI scanning,and color Doppler ultrasonogrphy combined with MRI were evaluated and compared between them. Results Diagnosis by surgery and pathological examination confirmed that a total of 38 cases were placenta previa combined with placenta accreta,of which 4 cases were adhesive placenta previa,24 cases were implanted pre-placenta previa and 10 cases were penetrating placenta previa. Diagnostic sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,positive predictive value and negative predictive value by color Doppler ultrasonography were57. 9%,90. 9%,36. 8%,18. 2%,84. 3% and 58. 8%,respectively. The above diagnostic values by MRI were 60. 5%,77. 3%,39. 5%,13. 2%,82. 1% and 53. 1%,respectively. The diagnostic values of the above indicators by color Doppler ultrasonography combined with MRI were 76. 3%,68. 2%,23. 7%,31. 8%,80. 6% and 62. 5% respectively. The diagnostic sensitivity of color Doppler ultrasonography combined with MRI was significantly higher than that of simple color Doppler ultrasonography and simple MRI detection. However,there was no statistical significance when comparisons were made between color Doppler ultrasonography and simple MRI detection( P < 0. 05). and there was no significant difference between color Doppler ultrasonography and MRI( P > 0. 05); The diagnostic specificity of color Doppler ultrasonography combined with MRI was significantly lower than that of color Doppler ultrasonography and MRI detection alone,and the color Doppler ultrasonography was significantly better than MRI. Statistical significance could be seen when comparisons were made between them( P < 0. 05). Conclusion Simple MRI and color Doppler ultrasonography all have certain clinical value in the diagnosis of implanted pre-placenta previa complicated with placenta accreta,and combined diagnosis can significantly improve diagnostic sensitivity,reduce the rate of misdiagnosis,and provide a theoretical basis for clinical intervention measures.
Objective To investigate the diagnostic value of Siemens G60 S color Doppler ultrasonography combined with MRI in implanted pre-placenta pregnancy,so as to provide theoretical evidence for imaging diagnosis of placenta praevia. Methods Sixty parturients with placenta previa diagnosed and treated in our hospital from January 2016 to January 2017,were recruited as study subjects. Before delivery,prenatal routine color Doppler ultrasonography and MRI scanning were performed,and the results of surgery and pathological diagnosis were of gold standards. The diagnostic values of color Doppler ultrasonography,MRI scanning,and color Doppler ultrasonogrphy combined with MRI were evaluated and compared between them. Results Diagnosis by surgery and pathological examination confirmed that a total of 38 cases were placenta previa combined with placenta accreta,of which 4 cases were adhesive placenta previa,24 cases were implanted pre-placenta previa and 10 cases were penetrating placenta previa. Diagnostic sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,positive predictive value and negative predictive value by color Doppler ultrasonography were57. 9%,90. 9%,36. 8%,18. 2%,84. 3% and 58. 8%,respectively. The above diagnostic values by MRI were 60. 5%,77. 3%,39. 5%,13. 2%,82. 1% and 53. 1%,respectively. The diagnostic values of the above indicators by color Doppler ultrasonography combined with MRI were 76. 3%,68. 2%,23. 7%,31. 8%,80. 6% and 62. 5% respectively. The diagnostic sensitivity of color Doppler ultrasonography combined with MRI was significantly higher than that of simple color Doppler ultrasonography and simple MRI detection. However,there was no statistical significance when comparisons were made between color Doppler ultrasonography and simple MRI detection( P < 0. 05). and there was no significant difference between color Doppler ultrasonography and MRI( P > 0. 05); The diagnostic specificity of color Doppler ultrasonography combined with MRI was significantly lower than that of color Doppler ultrasonography and MRI detection alone,and the color Doppler ultrasonography was significantly better than MRI. Statistical significance could be seen when comparisons were made between them( P < 0. 05). Conclusion Simple MRI and color Doppler ultrasonography all have certain clinical value in the diagnosis of implanted pre-placenta previa complicated with placenta accreta,and combined diagnosis can significantly improve diagnostic sensitivity,reduce the rate of misdiagnosis,and provide a theoretical basis for clinical intervention measures.
引文
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[2]姚庆东,许崇永,王小蓉,等.前置胎盘和胎盘前置状态的MRI诊断价值[J].放射学实践,2014(7):827-830.DOI:10.13609/j.cnki.1000-0313.2014.07.023.
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[5]陈凤英,张大伟,刘正平,等.凶险型前置胎盘伴胎盘植入的产前MRI平扫影像学表现及诊断价值[J].中国临床医学影像杂志,2016,27(5):359-362.
[6]黄安茜,谭艳娟,包凌云,等.超声联合磁共振检查对植入型凶险性前置胎盘的诊断价值[J].中华急诊医学杂志,2014,23(5):567-569.DOI:10.3760/cma.j.issn.1671-0282.2014.05.024.
[7]申炜,许梅海,黄龙全,等.磁共振成像与彩超在凶险型前置胎盘诊断价值的比较[J].广东医学,2016,37(1):44-47.
[8]赵鑫,张凯,肖宜昌,等.MRI检查对超声诊断前置胎盘并胎盘植入阴性的诊断价值[J].实用放射学杂志,2017,33(6):602-605.
[9]申炜,韦洁勤,尹家瑜,等.MRI诊断凶险性与非凶险性前置胎盘的临床研究[J].临床放射学杂志,2016,35(9):1407-1411.
[10]赵嵩,陈志敏,安莲英,等.磁共振成像在前置胎盘诊断中的价值分析[J].中国CT和MRI杂志,2016,14(7):88-90.
[11]张艳,袁军,黄明刚.凶险性前置胎盘的MRI诊断[J].实用放射学杂志,2014,33(7):1161-1164.
[2]姚庆东,许崇永,王小蓉,等.前置胎盘和胎盘前置状态的MRI诊断价值[J].放射学实践,2014(7):827-830.DOI:10.13609/j.cnki.1000-0313.2014.07.023.
[3]申炜,李耀波.植入(侵入)性前置胎盘MRI的临床应用进展[J].磁共振成像,2014,27(3):236-240.DOI:10.3969/j.issn.1674-8034.2014.03.018.
[4]张方璟,曹满瑞,刘炳光,等.磁共振对植入型凶险性前置胎盘的诊断价值[J].实用放射学杂志,2015,31(5):797-801.DOI:10.3969/j.issn.1002-1671.2015.05.023.
[5]陈凤英,张大伟,刘正平,等.凶险型前置胎盘伴胎盘植入的产前MRI平扫影像学表现及诊断价值[J].中国临床医学影像杂志,2016,27(5):359-362.
[6]黄安茜,谭艳娟,包凌云,等.超声联合磁共振检查对植入型凶险性前置胎盘的诊断价值[J].中华急诊医学杂志,2014,23(5):567-569.DOI:10.3760/cma.j.issn.1671-0282.2014.05.024.
[7]申炜,许梅海,黄龙全,等.磁共振成像与彩超在凶险型前置胎盘诊断价值的比较[J].广东医学,2016,37(1):44-47.
[8]赵鑫,张凯,肖宜昌,等.MRI检查对超声诊断前置胎盘并胎盘植入阴性的诊断价值[J].实用放射学杂志,2017,33(6):602-605.
[9]申炜,韦洁勤,尹家瑜,等.MRI诊断凶险性与非凶险性前置胎盘的临床研究[J].临床放射学杂志,2016,35(9):1407-1411.
[10]赵嵩,陈志敏,安莲英,等.磁共振成像在前置胎盘诊断中的价值分析[J].中国CT和MRI杂志,2016,14(7):88-90.
[11]张艳,袁军,黄明刚.凶险性前置胎盘的MRI诊断[J].实用放射学杂志,2014,33(7):1161-1164.