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 were 63.33%. 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.