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MRI在胎盘植入中应用研究*

作者:李 红

所属单位:郑州大学第三附属医院 妇产科(河南 郑州 450052)

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摘要

目的 研究磁共振成像(MRI) 在胎盘植入中的应用价值。方法 回顾 性分析本院2014年1月-2016年6月行超 声、MRI检查的100例可疑胎盘植入患者 临床资料,以术后病理结果为金标准, 比较超声、MRI诊断敏感度、特异度及 准确度,并以50例无胎盘植入孕妇为正 常对照组,比较两组MRI征象。结果 术 后病理确诊为胎盘植入60例,MRI诊断敏 感度、特异度、准确度分别为83.33%、 95.00%、88.00%,较超声的75.00%、 90.00%、81.00%差异无统计学意义(P> 0.05);胎盘植入与无胎盘植入正常对照 组在胎盘与子宫交界面波浪状改变、胎 盘附着处肌层变薄或缺失、子宫梨形消 失、胎盘内条状低信号、胎盘内血管影 增多、子宫壁或宫旁血管增多、子宫浆 膜层信号中断或缺失MRI征象上比较差异 显著(P<0.05)。结论 超声、MRI对胎盘 植入诊断效果类似,胎盘附着处肌层变 薄或缺失、子宫壁或宫旁血管增多等可 作为胎盘植入与无胎盘植入判断重要MRI 征象。

Objective To study the application value of magnetic resonance imaging (MRI) in placenta implantation. Methods The clinical data of 100 patients with suspected placenta implantation who underwent ultrasound examination and MRI in our hospital between January 2014 and June 2016 were analyzed retrospectively. With postoperative pathological results as the golden standard, the diagnostic sensitivity, specificity and accuracy were compared between ultrasound and MRI. Another 50 pregnant women without placenta implantation were included into normal control group, and MRI signs were compared between the two groups. Results Postoperative pathology diagnosed 60 cases with placenta implantation. The diagnostic sensitivity, specificity and accuracy of MRI were 83.33%, 95.00% and 88.00%, respectively. Compared with those of ultrasound (75.00%, 90.00% and 81.00%), there were no significant differences (P>0.05); The wave like changes at interface of placenta and uterus, muscle layer becoming thinner or absent at placenta attachment sites, uterine pyriform disappearance, striped low signal in placenta, placental vascular shadow increasing, uterine wall or vessels around uterus increasing, perimetrium signal interruption or loss and other MRI signs showed no significant differences between the two groups (P<0.05). Conclusion The effects of ultrasound and MRI are similar in the diagnosis of placenta implantation. Muscle layer becoming thinner or absent at placenta attachment sites and increase of uterine wall or uterine blood vessels can be used as an important MRI sign for diagnosis of placenta implantation.

【关键词】胎盘植入;磁共振成像;超 声;诊断价值;征象

【中图分类号】R714.4

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.06.039

前言

胎盘植入指的是胎盘绒毛侵入子宫肌层或浆膜层,近年来其发生 率在人流、剖宫产等比例增长下不断上升,易引发产后出血、弥散 性血管内凝血相关并发症[1],威胁产妇及其胎儿性命。目前临床诊断 胎盘常见手段为超声,操作简单、价格实惠,但其易受孕妇体重(肥 胖)、胎儿躁动等影响,可能导致误诊或漏诊,而磁共振成像(MRI)不 受上述因素的影响,能有效弥补超声诊断缺点,对胎盘可多方位显 示,对孕妇产前胎盘植入诊断有重要作用[2],但当下国内尚无MRI诊 断统一标准。基于此,本研究一方面以术后病理结果为金标准,比较 MRI、超声对胎盘植入诊断效果,另一方面通过与正常对照组比较,总 结胎盘植入MRI征象。报道如下。