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MRI鉴别前置胎盘不同分型及胎盘植入的敏感性观察

作者:孙屹立

所属单位:辽宁省本溪市中心医院放射科(辽宁 本溪 117000)

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摘要

目的 探讨MRI鉴别前置胎盘不 同分型及胎盘植入的敏感性。方法 回顾 性分析2012年8月-2014年8月经临床手术 和术后病理确诊为前置胎盘患者24例临 床资料,均行MRI常规,总结诊断结果及 MRI影像学表现。结果 以临床手术和术 后病理为准,MRI诊断完全性前置胎盘、 部分性前置胎盘、边缘性前置胎盘的符 合率分别为93.33%、75.0%、100.0%;影 像学表现为胎盘组织覆盖完全或部分子 宫颈内口,或位于宫颈内口边缘。MRI诊 断粘连型、植入型、穿透型胎盘植入的 符合率分别为100%、75.0%、66.67%。诊 断敏感性78.57%,特异性为80.0%,影像 表现为胎盘-子宫分界中断或连续,胎盘 增厚,形态异常,内部信号异常;胎盘子宫分界中断或模糊。结论 MRI能够明确 前置胎盘和胎盘植入的类型,具有较高 的应用价值。

Objective To investigate MRI in identifying different types of placenta previa and the sensitivity of placenta implantation. Methods The clinical data of 24 patients with placenta previa confirmed by clinical operation and postoperative pathology from August 2012 to August 2014 were retrospectively analyzed. All of the patients underwent MRI routine. The diagnostic results and MRI imaging findings were summarized. Results Subject to clinical operation and postoperative pathology, The coincidence rates of MRI in the diagnosis complete placenta previa, part placenta previa and marginal placenta previa were 93.33%, 75.0% and 100.0%, respectively. The imaging findings showed that the placenta tissues covered the entire or part internal opening of the cervix, or at the edge of the internal opening of the cervix. The coincidence rates of MRI in the diagnosis of adhesive type, implantable type and penetrating placenta implantation were 100%, 75.0% and 66.67%, respectively. The diagnostic sensitivity was 78.57% and the specificity was 80.0%. The imaging findings showed that the placenta-uterine boundaries were interrupted or continuous, the placenta was thickened, the morphology was abnormal and the internal signal was also abnormal. The placenta-uterine boundaries were interrupted or obscure. Conclusion MRI can define the type of placenta previa and placenta implantation and has high application value.

【关键词】前置胎盘;胎盘植入;磁共 振成像;前置状态,分型

【中图分类号】R714.46+2

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.02.022

前言

前置胎盘是妊娠期较为严重的并发症,根据胎盘和子宫颈口关 系,主要前置胎盘分为3种,即:完全性或中央性前置胎盘、部分性 前置胎盘、边缘性前置胎盘,是妊娠期晚期孕妇出血和死亡的重要因 素。有研究指出,前置胎盘是胎盘植入的高危影响因素,若治疗不及 时,会诱发严重产后出血,危机产妇生命[1-2]。因此,临床应提高对前 置胎盘和胎盘植入的早期诊断准确率。B超是诊断前置胎盘的重要辅 助方式,但受腹部长期、孕妇体型、胎盘附着位置的影响,易出现误 诊。MRI具有无创、软组织分辨率高、受肠气影响小等优势,在早期诊 断胎植入中具有独特优势[3]。本文回顾性分析24例前置胎盘影像学特 征,探讨其诊断前置胎盘中的应用价值,现报道如下。