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MR不同序列在诊断 出血梗死性卵巢蒂 扭转的价值

作者:潘高升1 刘干辉1 程 英1 陈振松1 李雪梅2

所属单位:1.汕头大学医学院附属粤北人民医 院影像科 (广东 韶关 512026) 2.广东省韶关市中医院放射科 (广东 韶关 512026)

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摘要

目的 探讨出血梗死性卵巢蒂扭 转MR不同序列表现特点。方法 选取我院 经手术病理证实的出血梗死型卵巢蒂扭转 患者10例,回顾性分析其MR序列特征。结 果 10例卵巢蒂条状增粗,T2W低信号, T1W稍高信号,增强扫描T1W无强化;扭转 蒂周围脂肪间隙均见不同程度渗出;8例 病灶壁-蒂局部T2W低信号;6例病灶壁-蒂 局部T1W等或高信号,增强扫描T1W抑脂无 强化。结论 出血梗死型卵巢蒂扭转MR有 特殊表现,不同序列对诊断出血梗死性卵 巢蒂扭转有重要参考价值。

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.

【关键词】卵巢蒂;扭转;MR;出血;梗死

【中图分类号】R656.1;R445.2

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2019.06.034

前言

胎盘植入(placental implantation abnormality,PIA)是指胎 盘绒毛穿透底蜕膜抵达或侵入子宫肌层,通畅根据侵入肌层深度可分 为粘连型、植入型和穿透型,是产科急危重症之一,可引起产后大出 血、子宫穿孔、产褥感染等并发症,极大地威胁到母婴健康[1]。近年 来,PIA的发病率逐年上升,主要与高龄、多产、前置胎盘、人工流 产、剖宫产等高危因素有关,PIA产前症状无特异性,只能依靠产前影 像学检查得以发现[2]。既往对PIA的研究多集中在运用超声、核磁共振 成像(magnetic resonance imaging,MRI)等手段来提高诊断PIA的准 确性,但关于具体分型及粘连型PIA的研究较少[3]。本研究回顾性分析 我院60例PIA患者的临床资料,旨在为粘连型PIA的产前诊断提供临床 依据。