超微血流成像技术联合常规超声检查在胎盘植入产前诊断中的应用价值
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摘要
目的探讨超微血流成像(SMI)技术联合常规超声检查在胎盘植入产前诊断中的应用价值。方法选取在我院行产前超声检查和SMI检查且确诊为胎盘植入的孕妇59例(病例组),另随机选取同期分娩后临床诊断无胎盘植入者60例(正常对照组),观察两组胎盘与病变肌层边界情况、胎盘附着处肌层厚度、胎盘内绒毛部与绒毛间隙间的血管情况及胎盘附着处子宫肌层与浆膜层连续性,绘制ROC曲线分析上述检查项联合诊断胎盘植入的价值。以术中诊断及术后病理结果为金标准,分析常规超声联合SMI检查诊断产前胎盘植入的效能。结果常规超声联合SMI检查示病例组和正常对照组发生胎盘与周边肌层界限不清或呈毛刺或锯齿样改变者分别为42例和8例,胎盘附着处肌层菲薄(≤1 mm)或消失者分别为43例和14例,胎盘内绒毛部与绒毛间隙间血流丰富且血管交错者分别为45例和6例,两组比较差异均有统计学意义(均P<0.01)。常规超声诊断产前胎盘植入的准确率、敏感性、特异性分别为79.83%、78.00%和81.67%,常规超声联合SMI检查诊断子宫胎盘植入的准确率、敏感性、特异性分别为88.24%、83.05%和93.33%,二者诊断准确率和特异性比较,差异均有统计学意义(均P<0.05);常规超声与SMI联合诊断胎盘植入的ROC曲线下面积为0.886。结论 SMI检查能真实显示胎盘植入部位的低速血流情况,联合常规超声能较准确地评估胎盘植入的范围和程度,有重要的临床价值。
ObjectiveTo assess the application value of superb micro-vascular imaging combined with conventional ultrasound in prenatal diagnosis of placental accreta.MethodsA total of 59 patients with placenta accreta(placenta implantation group)examined by prenatal ultrasound examination and SMI were retrospectively analyzed. And sixty patients without placental implantation(non-placental implantation group)clinically diagnosed after delivery were randomly selected.The boundary between the placenta and the pathological muscle layer,the thickness of the muscle layer at the placental attachment,the blood vessels between the villus and the villus space in the placenta,and the continuity of the uterine muscle layer and serosa layer at the placental attachment were observed in the two groups. The receiver operating characteristic(ROC)curve was used to analyze the combined diagnostic value of the above items for placental implantation. Based on the gold standard of intraoperative diagnosis and postoperative pathological results,the effectiveness of conventional ultrasound and conventional ultrasound combined with SMI in diagnosis of placenta implantation was analyzed.ResultsCompared with the nonplacental implantation group,the incidence rate of the unclear boundary of the myometrium(42 cases vs. 8 cases),the myometrium becoming thinner(≤1 mm)or disappeared(43 cases vs. 14 cases),the interlace and disorder of blood vessels of the placenta implantation site(45 cases vs. 6 cases) increased significantly in the placenta implantation group,there were statistically significant differences(all P<0.01).The accuracy,sensitivity and specificity rating of prenatal routine ultrasound diagnosis in uterine placenta implantation were 79.83%,78.00%,81.67%,respectively. And,these respective ratings of the conventional ultrasound combined with SMI were 88.24%,83.05%,93.33%,respectively.The area under the ROC curve of placenta implantation diagnosed by conventional ultrasound combined with SMI was 0.886.ConclusionSMI can show the lower velocity blood flow in placenta accrete,and combined with conventional ultrasound can accurately assess the extent and extent of placenta implantation,which has important clinical value in diagnosing prenatal placenta accrete timely.
ObjectiveTo assess the application value of superb micro-vascular imaging combined with conventional ultrasound in prenatal diagnosis of placental accreta.MethodsA total of 59 patients with placenta accreta(placenta implantation group)examined by prenatal ultrasound examination and SMI were retrospectively analyzed. And sixty patients without placental implantation(non-placental implantation group)clinically diagnosed after delivery were randomly selected.The boundary between the placenta and the pathological muscle layer,the thickness of the muscle layer at the placental attachment,the blood vessels between the villus and the villus space in the placenta,and the continuity of the uterine muscle layer and serosa layer at the placental attachment were observed in the two groups. The receiver operating characteristic(ROC)curve was used to analyze the combined diagnostic value of the above items for placental implantation. Based on the gold standard of intraoperative diagnosis and postoperative pathological results,the effectiveness of conventional ultrasound and conventional ultrasound combined with SMI in diagnosis of placenta implantation was analyzed.ResultsCompared with the nonplacental implantation group,the incidence rate of the unclear boundary of the myometrium(42 cases vs. 8 cases),the myometrium becoming thinner(≤1 mm)or disappeared(43 cases vs. 14 cases),the interlace and disorder of blood vessels of the placenta implantation site(45 cases vs. 6 cases) increased significantly in the placenta implantation group,there were statistically significant differences(all P<0.01).The accuracy,sensitivity and specificity rating of prenatal routine ultrasound diagnosis in uterine placenta implantation were 79.83%,78.00%,81.67%,respectively. And,these respective ratings of the conventional ultrasound combined with SMI were 88.24%,83.05%,93.33%,respectively.The area under the ROC curve of placenta implantation diagnosed by conventional ultrasound combined with SMI was 0.886.ConclusionSMI can show the lower velocity blood flow in placenta accrete,and combined with conventional ultrasound can accurately assess the extent and extent of placenta implantation,which has important clinical value in diagnosing prenatal placenta accrete timely.
引文
[1]Tsai HJ.Terminology of“cesarean section ectopic pregnancy”and“placenta previa and accrete”[J].Taiwan J Obstet Gynecol,2016,55(5):760.
[2]Kayem G,Deneux-Tharaux C,Sentilhes L,et al.PACCRETA:clinical situations at high risk of placenta ACCRETA/percreta:impact of diagnostic methods and management on maternal morbidity[J].Obstet Gynecol Scand,2013,92(4):476-482.
[3]Gabriel M,Tomczak J,Snoch-ziólkiewicz M,et al.Comparison of superb micro-vascular ultrasound imaging(SMI)and contrast enhanced ultrasound(CEUS)for detection of endoleaks after endovascular aneurysm repair(EVAR)[J].Am J Case Rep,2016,25(17):43-46.
[4]Ma Y,Li G,Li J,et al.The diagnostic value of superb microvascular imaging(SMI)in detecting blood flow signals of breast lesions:a preliminary study comparing SMI to color Doppler flow imaging.Medicine(Baltimore),2015,94(36):1-6.
[5]Comstock CH,Bronsteen RA.The antenatal diagnosis of placenta accrete[J].BJOG,2014,121(2):171-181.
[6]朱玲玲,解丽梅.胎盘植入的产前超声诊断价值[J].中国医学影像技术,2017,33(10):1575-1578.
[7]中华医学会围产医学分会,中华医学会妇产科学分会产科学组.胎盘植入诊治指南(2015)[J].中华产科急救电子杂志,2016,5(1):26-31.
[8]Okumura M,Francisco RP,Kondo MM,et al.Ultrasound diagnosis and evaluation of the number of prior caesarean deliveries as risk factor for placenta accreta in placenta previa cases[J].Ultrasound Obstet Gynecol,2016,48(1):323.
[9]李宁宁,叶玉泉,陈丽娜,等.超微血流成像早子痫前期患者胎盘微循环检测中的临床应用价值[J].现代妇产科进展,2018,27(5):339-342.
[10]Kumar I,Verma A,Ojha R,et al,Invasive placental disorders:a prospective US and MRI comparative analysis[J].Acta Radiol,2017,58(1):121-128.
[11]Machado P,Segal S,Lyshchik A,et al.A novel microvascular flow technique:initial results in thyroids[J].Ultrasound Q,2016,32(1):67-74.2019-03-11
[2]Kayem G,Deneux-Tharaux C,Sentilhes L,et al.PACCRETA:clinical situations at high risk of placenta ACCRETA/percreta:impact of diagnostic methods and management on maternal morbidity[J].Obstet Gynecol Scand,2013,92(4):476-482.
[3]Gabriel M,Tomczak J,Snoch-ziólkiewicz M,et al.Comparison of superb micro-vascular ultrasound imaging(SMI)and contrast enhanced ultrasound(CEUS)for detection of endoleaks after endovascular aneurysm repair(EVAR)[J].Am J Case Rep,2016,25(17):43-46.
[4]Ma Y,Li G,Li J,et al.The diagnostic value of superb microvascular imaging(SMI)in detecting blood flow signals of breast lesions:a preliminary study comparing SMI to color Doppler flow imaging.Medicine(Baltimore),2015,94(36):1-6.
[5]Comstock CH,Bronsteen RA.The antenatal diagnosis of placenta accrete[J].BJOG,2014,121(2):171-181.
[6]朱玲玲,解丽梅.胎盘植入的产前超声诊断价值[J].中国医学影像技术,2017,33(10):1575-1578.
[7]中华医学会围产医学分会,中华医学会妇产科学分会产科学组.胎盘植入诊治指南(2015)[J].中华产科急救电子杂志,2016,5(1):26-31.
[8]Okumura M,Francisco RP,Kondo MM,et al.Ultrasound diagnosis and evaluation of the number of prior caesarean deliveries as risk factor for placenta accreta in placenta previa cases[J].Ultrasound Obstet Gynecol,2016,48(1):323.
[9]李宁宁,叶玉泉,陈丽娜,等.超微血流成像早子痫前期患者胎盘微循环检测中的临床应用价值[J].现代妇产科进展,2018,27(5):339-342.
[10]Kumar I,Verma A,Ojha R,et al,Invasive placental disorders:a prospective US and MRI comparative analysis[J].Acta Radiol,2017,58(1):121-128.
[11]Machado P,Segal S,Lyshchik A,et al.A novel microvascular flow technique:initial results in thyroids[J].Ultrasound Q,2016,32(1):67-74.2019-03-11