目的分析完全性前置胎盘合并 胎盘植入MRI影像学表现及诊断价值。方 法 选择2017年1月至2018年10月我院收 治的完全性前置胎盘合并胎盘植入患者60 例，均以剖宫产手术和病理确诊，所有患 者术前均进行超声和MRI检查，分析其影 像学表现及诊断价值。结果 完全性前置 胎盘合并胎盘植入超声影像学表现为胎 盘漩涡接近子宫肌层部血流异常丰富，中 部无明显血流信号，胎盘实质间隙血流广 泛形成，胎盘增厚，血池明显增多，胎盘 后方间隙消失且其子宫肌层低回声带消失 或明显变薄。MRI影像学表现为子宫多呈 冬瓜形，T2WI显示子宫肌壁局部发生不同 程度变薄或缺失，受胎盘入侵的子宫壁边 缘呈结节状或锯齿状，部分患者T2WI呈不 均匀低信号，内可见丰富流空血管影。以 手术病理结果为标准，完全性前置胎盘合 并胎盘植入超声检出率80.00%与MRI检出 率的88.33%无显著差异(P>0.05)。MRI后 下壁检出率显著高于超声(P<0.05)。结论 MRI对完全性前置胎盘合并胎盘植入检出 率与超声相近，且对子宫后壁胎盘植入检 出效果优于超声，可作为临床诊断完全性 前置胎盘合并胎盘植入的重要方法。

Objective To analyze MRI imaging findings and diagnostic value of total placenta praevia with placenta accreta. Methods 60 cases of patients with total placenta praevia with placenta accreta who were admitted to our hospital from January 2017 to October 2018 were selected, and all patients were given cesarean section and diagnosed by pathology. All patients were examined by ultrasound and MRI before operation. Imaging findings and diagnostic value were analyzed. Results Ultrasound imaging of total placenta praevia with placenta accreta showed that the blood flow was abnormally abundant from the placental eddy close to the myometrium, and there was no obvious blood flow signal in the middle, and the blood flow was extensively formed in the placental interspace, and there were thickened placenta, obviously increased blood pool, and disappeared space behind the placenta and the disappeared or significantly thinned hypoechoic band in myometrium. The MRI findings showed that the uterus was mostly melon-shaped, and T2WI showed there was local thinning or loss of uterine muscle wall, and the edge of uterine wall invaded by placenta was nodular or jagged, and uneven signal on the T2WI was shown in some patients with visible rich signal voids of vessel. Based on the results of surgical pathology, there was no significant difference in the detection rate of total placenta praevia with placenta accreta between by ultrasound and by MRI (80.00% vs 88.33%) (P>0.05). The detection rate of posterior inferior wall of MRI was significantly higher than that of ultrasound (P<0.05). Conclusion The detection rate of total placenta praevia with placenta accreta of MRI is similar to that of ultrasound, and the detection effect of posterior uterine placenta accreta is superior to that of ultrasound. MRI can be used as an important method for clinical diagnosis of total placenta praevia with placenta accreta.