凶险型前置胎盘伴胎盘植入产前MRI诊断的影像特征及诊断价值
|
摘要
目的:分析凶险型前置胎盘(PPP)患者产前胎盘植入的磁共振成像(MRI)影像特征及诊断价值。方法:回顾性分析2015年12月—2017年12月本院妇产科收治的PPP患者71例临床资料。所有患者均于产前进行B超、MRI检查,分析MRI诊断胎盘植入的影像特征,以术后病理为准,对比B超、MRI诊断胎盘植入价值。结果:病理证实胎盘无植入25例,胎盘黏连23例,胎盘植入20例,胎盘穿透3例。胎盘植入MRI征象中50.7%为胎盘子宫分界不清,46.5%胎盘内信号不均一,32.4%胎盘内血管影增多、增粗,28.2%出现T2W1条带状低信号影,15.5%膀胱形态结构呈"帐篷样"或结节状改变,11.3%子宫呈现局部凸起。MRI诊断胎盘植入正确率84.0%,其中胎盘粘连正确率87.0%,胎盘植入90.0%,胎盘穿透100.0%。单独MRI征象诊断胎盘植入,T2W1低信号条带灵敏度最高(61.3%),子宫局部凸起特异度、阳性预测值最高(96.4%、100.0%),胎盘内血管影阴性预测值最高(61.5%),综合MRI诊断胎盘植入灵敏度、特异度、阳性预测值、阴性预测值分别为96.4%、98.2%、97.1%、98.0%。结论:MRI对植入型和穿透型胎盘植入诊断价值较高,T2W1低信号条带、子宫局部外凸、胎盘内血管影增多是诊断胎盘植入价值较高的MRI征象,临床应联合MRI影像诊断,提高胎盘植入的检出率。
Objective:To analyze the imaging characteristics of MRI used for diagnosing pregnant women with dangerous placenta previa(PPP)and placenta accreta,and to explore the clinical value of MRI examination.Methods:The data of 71 pregnant women with PPP admitted to li Huili east hospital from December 2015 to December 2017 were analyzed retrospectively.All patients were examined by prenatal B ultrasound and MRI before delivery.Imaging features of MRI examination of pregnant women with placenta accreta was analyzed.The diagnosing value of pregnant women with placenta accrete were compared between MRI examination and B ultrasound based on placenta pathology of women after delivery.Results:There were 25 women without placenta accreta,there were 23 women with placenta adhesion,there were 25 women with placenta accreta,and there were 3women with placenta penetrated who confirmed by placenta pathology.As for diagnosed by MRI,the signs of 50.7% women were unclear in the demarcation of placenta and uterus,46.5% women had intra-placental signal inhomogeneity,32.4% women had increasing and thickening of intra-placental vascular shadows,28.17% women had T2W1 banded low signal shadow,15.49% women had bladder shape with tent-like or nodular,and 11.27% women had partial bulge of uterus.The correct rate of diagnosing placenta accreta by MRI examination was 84.00%,in which,the correct rate of diagnosing placental adhesion,placenta accrete,and placenta penetration were 87.0%,90%,and 100.0%,respectively.When diagnosis of placenta accreta by MRI examination only,the sensitivity of T2W1 low signal band was the highest,which was 61.3%,the specificity and positive predictive value of uterine local protrusion were the highest(96.4%and 100.00%,respectively),and the negative predictive value of placenta vascular shadow was the highest(61.5%).The sensitivity,specificity,positive predictive value,and negative predictive value of several image features of MRI examination for diagnosing placenta accreta were 96.37%,98.15%,97.05%,and 98.02%,respectively.Conclusion:MRI examination is highly valuable for diagnosing pregnant women with placenta accreta and placenta transplacent.The low signal intensity of T2 W1,local uterine protrusion,and increased placental vascular shadow are important MRI image features for diagnosing placenta accreta.Several image features of MRI examination combined for diagnosing placenta accreta can increase the diagnostic accuracy.
Objective:To analyze the imaging characteristics of MRI used for diagnosing pregnant women with dangerous placenta previa(PPP)and placenta accreta,and to explore the clinical value of MRI examination.Methods:The data of 71 pregnant women with PPP admitted to li Huili east hospital from December 2015 to December 2017 were analyzed retrospectively.All patients were examined by prenatal B ultrasound and MRI before delivery.Imaging features of MRI examination of pregnant women with placenta accreta was analyzed.The diagnosing value of pregnant women with placenta accrete were compared between MRI examination and B ultrasound based on placenta pathology of women after delivery.Results:There were 25 women without placenta accreta,there were 23 women with placenta adhesion,there were 25 women with placenta accreta,and there were 3women with placenta penetrated who confirmed by placenta pathology.As for diagnosed by MRI,the signs of 50.7% women were unclear in the demarcation of placenta and uterus,46.5% women had intra-placental signal inhomogeneity,32.4% women had increasing and thickening of intra-placental vascular shadows,28.17% women had T2W1 banded low signal shadow,15.49% women had bladder shape with tent-like or nodular,and 11.27% women had partial bulge of uterus.The correct rate of diagnosing placenta accreta by MRI examination was 84.00%,in which,the correct rate of diagnosing placental adhesion,placenta accrete,and placenta penetration were 87.0%,90%,and 100.0%,respectively.When diagnosis of placenta accreta by MRI examination only,the sensitivity of T2W1 low signal band was the highest,which was 61.3%,the specificity and positive predictive value of uterine local protrusion were the highest(96.4%and 100.00%,respectively),and the negative predictive value of placenta vascular shadow was the highest(61.5%).The sensitivity,specificity,positive predictive value,and negative predictive value of several image features of MRI examination for diagnosing placenta accreta were 96.37%,98.15%,97.05%,and 98.02%,respectively.Conclusion:MRI examination is highly valuable for diagnosing pregnant women with placenta accreta and placenta transplacent.The low signal intensity of T2 W1,local uterine protrusion,and increased placental vascular shadow are important MRI image features for diagnosing placenta accreta.Several image features of MRI examination combined for diagnosing placenta accreta can increase the diagnostic accuracy.
引文
[1]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.
[2]王雅琴,张军,李燕娜.前置胎盘153例临床分析[J].中华实用诊断与治疗杂志,2016,30(7):672-674.
[3]Leyendecker JR,DuBose M,llosseinzadeh K,et al.MRl of pregnancy-related issues:abnormal placentation[J].AJR,2012,198(2):311-320.
[4]Alamo L,Anaye A,Rey J,et al.Detection of suspected placental invasion by MRI:Do the results depend on observer’s experience?[J].Eur J Radiol,2012,82(2):e51-e57.
[5]郑小丽,徐坚民,杨敏洁.晚孕期胎盘植入的诊断及分型[J].放射学实践,2015,30(3):264-268.
[6]Leyendecker JR,DuBose M,llosseinzadeh K,et al.MRl of pregnancy-related issues:abnormal placentation[J].AJR,2012,198(2):311-320.
[7]石慧,全显跃,孙希杰.产前胎盘植入的MRI诊断[J].中国医学影像学杂志,2015,23(6):474-477.
[8]Sinha P,Mishra M.Caesarean scar pregnancy:aprecursor of placenta percreta/accreta.J Obstet Gynaecol(Lahore),2012,32(7):621-623.
[9]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:126-127.2
[10]颜有霞,蔡淑芳,黄葵芳,等.早期胎盘植入的MRI表现[J].中国医学影像学杂志,2012,20(6):421-423.
[11]黄金瑞,陈琪瑛.凶险型前置胎盘合并胎盘植入的产前诊断及治疗进展[J].右江医学,2015,43(5):629-632.
[12]余琳,胡可佳,杨慧霞.2008-2014年凶险性前置胎盘的回顾性临床研究[J].中华妇产科杂志,2016,51(3):169-173.
[13]Miguel Palacios-Jaraquemada J,Hernan Bruno C,Martin E.MRI in the diagnosis and surgical management of abnormal placentation.Acta Obstet Gynecol Scand,2013,92(4):392-397.
[14]D'Antonio F,Iacovella C,PalaciosJaraquemada J,et al.Prenatal identification of invasive placentation using magnetic resonance imaging:Systematic review and meta-analysis[J].Ultrasound Obstet Gynecol,2014,44(1):8-16.
[2]王雅琴,张军,李燕娜.前置胎盘153例临床分析[J].中华实用诊断与治疗杂志,2016,30(7):672-674.
[3]Leyendecker JR,DuBose M,llosseinzadeh K,et al.MRl of pregnancy-related issues:abnormal placentation[J].AJR,2012,198(2):311-320.
[4]Alamo L,Anaye A,Rey J,et al.Detection of suspected placental invasion by MRI:Do the results depend on observer’s experience?[J].Eur J Radiol,2012,82(2):e51-e57.
[5]郑小丽,徐坚民,杨敏洁.晚孕期胎盘植入的诊断及分型[J].放射学实践,2015,30(3):264-268.
[6]Leyendecker JR,DuBose M,llosseinzadeh K,et al.MRl of pregnancy-related issues:abnormal placentation[J].AJR,2012,198(2):311-320.
[7]石慧,全显跃,孙希杰.产前胎盘植入的MRI诊断[J].中国医学影像学杂志,2015,23(6):474-477.
[8]Sinha P,Mishra M.Caesarean scar pregnancy:aprecursor of placenta percreta/accreta.J Obstet Gynaecol(Lahore),2012,32(7):621-623.
[9]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:126-127.2
[10]颜有霞,蔡淑芳,黄葵芳,等.早期胎盘植入的MRI表现[J].中国医学影像学杂志,2012,20(6):421-423.
[11]黄金瑞,陈琪瑛.凶险型前置胎盘合并胎盘植入的产前诊断及治疗进展[J].右江医学,2015,43(5):629-632.
[12]余琳,胡可佳,杨慧霞.2008-2014年凶险性前置胎盘的回顾性临床研究[J].中华妇产科杂志,2016,51(3):169-173.
[13]Miguel Palacios-Jaraquemada J,Hernan Bruno C,Martin E.MRI in the diagnosis and surgical management of abnormal placentation.Acta Obstet Gynecol Scand,2013,92(4):392-397.
[14]D'Antonio F,Iacovella C,PalaciosJaraquemada J,et al.Prenatal identification of invasive placentation using magnetic resonance imaging:Systematic review and meta-analysis[J].Ultrasound Obstet Gynecol,2014,44(1):8-16.