超声与MRI诊断粘连型胎盘植入的临床分析
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摘要
目的探讨超声与核磁共振成像(MRI)诊断粘连型胎盘植入(PIA)的临床价值。方法回顾性分析我院收治的60例PIA患者的临床资料,均行超声和MRI检查,以临床或术后病理结果为"金标准",分析粘连型PIA的超声和MRI图像特征,比较两种检查方法的诊断价值。结果 60例PIA患者中,粘连型38例(63.33%),非粘连型22例,其中植入型19例(31.67%),穿透型3例(5.00%);51例行剖宫产术终止妊娠,9例经阴道分娩,有7例行人工剥离胎盘术,2例行不完全子宫切除术,4例行子宫全切术,产后出血抢救4例;MRI诊断粘连型33例,非粘连型19例,误诊3例,漏诊5例,准确率为86.67%;超声诊断粘连型27例,非粘连型16例,误诊6例,漏诊16例,准确率为63.33%;MRI诊断粘连型PIA的灵敏度、准确率、阴性预测值均明显高于超声(P<0.05)。结论超声可作为粘连型PIA常规的筛查手段,但MRI的诊断效能优于超声,对于疑似粘连型PIA患者应结合MRI进行术前诊断。
Objective To explore the clinical value of ultrasound and magnetic resonance imaging(MRI) in the diagnosis of adhesive placenta accreta(PIA). Methods The clinical data of 60 PIA patients admitted to our hospital were retrospectively analyzed. All patients were given ultrasound and MRI examinations. The clinical or postoperative pathological results were evaluated as "gold standard", and the features of ultrasound and MRI images of adhesive PIA were analyzed, and the diagnostic value of the two inspection methods was compared. Results Among 60 patients with PIA, 38 cases(63.33%) were adhesive,and 22 cases were non-adhesive of which 19 cases(31.67%) were implanted and 3 cases(5.00%) were penetrating. 51 patients were terminated pregnancy by cesarean section, and 9 cases of vaginal delivery, 7 cases of manual removal of placenta, 2 cases of incomplete hysterectomy, 4 cases of hysterectomy and 4 cases of postpartum hemorrhage rescue.There were 33 adhesive cases, 19 non-adhesive cases, 3 cases of misdiagnosis and 5 cases of missed diagnosis by MRI diagnosis, and the accuracy in diagnosing adhesive PIA were 86.67%. There were 27 adhesive cases, 16 non-adhesive cases, 6 cases of misdiagnosis and 16 cases of missed diagnosis, and the accuracy in the diagnosis of adhesive PIA were63.33%. The sensitivity, accuracy and negative predictive value of MRI in the diagnosis of adhesive PIA were significantly higher than those of ultrasound(P<0.05). Conclusion Ultrasound can be used as a routine screening method for adhesive PIA, but MRI has better diagnostic efficacy than ultrasound. For patients with suspected adhesive PIA should be given preoperative diagnosis by combining with MRI.
Objective To explore the clinical value of ultrasound and magnetic resonance imaging(MRI) in the diagnosis of adhesive placenta accreta(PIA). Methods The clinical data of 60 PIA patients admitted to our hospital were retrospectively analyzed. All patients were given ultrasound and MRI examinations. The clinical or postoperative pathological results were evaluated as "gold standard", and the features of ultrasound and MRI images of adhesive PIA were analyzed, and the diagnostic value of the two inspection methods was compared. Results Among 60 patients with PIA, 38 cases(63.33%) were adhesive,and 22 cases were non-adhesive of which 19 cases(31.67%) were implanted and 3 cases(5.00%) were penetrating. 51 patients were terminated pregnancy by cesarean section, and 9 cases of vaginal delivery, 7 cases of manual removal of placenta, 2 cases of incomplete hysterectomy, 4 cases of hysterectomy and 4 cases of postpartum hemorrhage rescue.There were 33 adhesive cases, 19 non-adhesive cases, 3 cases of misdiagnosis and 5 cases of missed diagnosis by MRI diagnosis, and the accuracy in diagnosing adhesive PIA were 86.67%. There were 27 adhesive cases, 16 non-adhesive cases, 6 cases of misdiagnosis and 16 cases of missed diagnosis, and the accuracy in the diagnosis of adhesive PIA were63.33%. The sensitivity, accuracy and negative predictive value of MRI in the diagnosis of adhesive PIA were significantly higher than those of ultrasound(P<0.05). Conclusion Ultrasound can be used as a routine screening method for adhesive PIA, but MRI has better diagnostic efficacy than ultrasound. For patients with suspected adhesive PIA should be given preoperative diagnosis by combining with MRI.
引文
[1]周文明,何磊,付维东.磁共振对前置胎盘及胎盘植入的影像诊断价值[J].医学临床研究,2016,33(8):1659-1662.
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[5]汤敏,闵智乾,张鑫,等.MRI和经腹超声对产前胎盘植入的诊断价值[J].重庆医学,2017,46(4):456-458.
[6]Shahin Y,Pang C L.Endovascular interventional modalities for haemorrhage control in abnormal placental implantation deliveries:a systematic review and meta-analysis[J].European Radiology,2018,2(5):1-14.
[7]孙屹立.MRI鉴别前置胎盘不同分型及胎盘植入的敏感性观察[J].中国CT和MRI杂志,2017,15(2):70-72.
[8]左春洁,刘凯丽,刘艳梅,等.彩色多普勒超声与MRI在胎盘植入产前诊断中的对比研究[J].陕西医学杂志,2017,46(6):711-713.
[9]张勤,陆娴,印洪刚,等.MRI诊断胎盘植入的价值[J].中国CT和MRI杂志,2016,14(1):112-114.
[10]朱晓曼,张军.M R I诊断胎盘植入[J].中国医学影像技术,2016,32(3):416-420.
[2]Vahanian S A,Vintzileos AM.Placental implantation abnormalities:a modern approach[J].Current Opinion in Obstetrics&Gynecology,2016,28(6):1.
[3]韩鹏慧,江魁明,郭庆禄,等.超声及M R I在胎盘植入中的诊断价值[J].中国临床医学影像杂志,2016,27(3):194-197.
[4]中华医学会围产医学分会.胎盘植入诊治指南(2015)[J].中华妇产科杂志,2015,5(12):26-31.
[5]汤敏,闵智乾,张鑫,等.MRI和经腹超声对产前胎盘植入的诊断价值[J].重庆医学,2017,46(4):456-458.
[6]Shahin Y,Pang C L.Endovascular interventional modalities for haemorrhage control in abnormal placental implantation deliveries:a systematic review and meta-analysis[J].European Radiology,2018,2(5):1-14.
[7]孙屹立.MRI鉴别前置胎盘不同分型及胎盘植入的敏感性观察[J].中国CT和MRI杂志,2017,15(2):70-72.
[8]左春洁,刘凯丽,刘艳梅,等.彩色多普勒超声与MRI在胎盘植入产前诊断中的对比研究[J].陕西医学杂志,2017,46(6):711-713.
[9]张勤,陆娴,印洪刚,等.MRI诊断胎盘植入的价值[J].中国CT和MRI杂志,2016,14(1):112-114.
[10]朱晓曼,张军.M R I诊断胎盘植入[J].中国医学影像技术,2016,32(3):416-420.