彩超联合核磁共振检查在胎盘植入中的诊断价值研究

发布时间：2018-08-25 11:23

【摘要】：研究目的胎盘植入(placenta accrete PIA)是指蜕膜基底层发育不良从而导致胎盘绒毛的异常附着,是一种极其严重的妇产科急症,也是造成产妇产后大出血的一个重要原因。早期发现及术前充分评估是降低母胎并发症的重要因素。因此本文通过比较彩色多普勒超声检查、核磁共振成像检查以及两者联合应用诊断胎盘植入,旨在分析这些方法对胎盘植入孕期诊断及术前评估的价值。方法(1)本研究回顾性分析了天津市中心妇产科医院从2013年7月到2015年5月收治的62位临床可疑胎盘植入患者,涉及前置胎盘、多次剖宫产史及孕中晚期反复无痛性阴道出血者,均于孕28周后行彩色多普勒超声检查、核磁共振成像检查,两种检查相隔天数≤5天。胎盘植入最终确诊以手术发现或病理诊断或临床分析综合确定。(2)本研究中使用的彩超诊断仪是E8、GEV730以及SEQUIA-512,采用的核磁共振检查是Siemens Symophony 1.5T超导核磁共振扫描仪以及Siemens公司自有的LEONARDO图像处理工作站。(3)针对收集整理的数据资料通过SPSS 22.0软件进行统计分析,并将配对计数资料实施卡方检验,此即为McNemar检验与Kappa系数检验。其中,McNemar检验,α=0.05,如果p≤0.05则差异具备统计学意义;p0.05表示差异不具备统计学意义。Kappa系数检验所得到的值可划分成6个区段,所体现的是一致性程度。如果k0,则代表一致性程度极差;如果k=0.0~0.2,则代表一致性程度微弱;如果k=0.21~0.40,则代表一致性程度弱;如果k=0.41~0.60,则代表具有中度一致性;如果k=0.61~0.80,则代表具有高度一致性;如果k=0.81~1.00,则代表一致性程度极强。研究结果1.彩超可疑胎盘植入者49人,最终诊断胎盘植入者46人,彩超不诊断胎盘植入者13人,最终诊断非胎盘植入者9人,可以得出彩超检查的灵敏度92.00%,特异度75.00%,准确率88.70%,由此可见彩超检查具有较高的诊断准确率。2.核磁可疑胎盘植入者50人,最终诊断胎盘植入者46人,核磁不诊断胎盘植入者12人,最终诊断非胎盘植入者8人,可以得出核磁检查的灵敏度92.0%,特异度66.67%,准确率87.09%,由此可见核磁检查的也具有较高的诊断准确率。3.彩超和核磁联合诊断可疑胎盘植入者45人,最终诊断胎盘植入者43人,二者联合诊断不考虑胎盘植入者8人,最终诊断非胎盘植入者7人,可以得出联合检查的灵敏度97.73%,特异度77.78%,准确率94.33%,两者联合检查能够显著提升灵敏度、特异度及准确率,并能降低假阳性和假阴性率。研究结论1、彩色多普勒超声检查对于胎盘植入具有较高的诊断准确率,因而是首选的诊断方法。MRI作为辅助的影像诊断方式,结果的判读可与超声结果相结合。2、彩超和核磁都对胎盘植入都具备良好的诊断价值,二者联合检查可以明显提高诊断价值,有效降低误诊率及漏诊率。
[Abstract]:Objective placenta accreta (placenta accrete PIA) is an abnormal attachment of placental villi due to dysplasia of decidua basal layer. It is an extremely serious emergency of obstetrics and gynaecology and an important cause of postpartum hemorrhage. Early detection and full preoperative evaluation are important factors to reduce maternal and fetal complications. The purpose of this paper is to analyze the value of these methods in the diagnosis of placenta accreta during pregnancy and preoperative evaluation by comparing color Doppler ultrasonography, magnetic resonance imaging and combined application of the two methods in the diagnosis of placenta accreta. Methods (1) from July 2013 to May 2015, 62 patients with suspected placenta accreta, including placenta previa, history of cesarean section and recurrent painless vaginal bleeding, were retrospectively analyzed in Tianjin Obstetrics and Gynecology Hospital from July 2013 to May 2015. Color Doppler ultrasonography and magnetic resonance imaging were performed after 28 weeks of pregnancy. The interval between the two examinations was less than 5 days. The final diagnosis of placenta accreta is confirmed by surgical discovery or pathological diagnosis or clinical analysis. (2) the color ultrasound diagnostic instrument used in this study is E8G GE V730 and SEQUIA-512, MRI is Siemens Symophony 1.5T superconducting nuclear magnetic resonance scanner and Siemens. The company has its own LEONARDO image processing workstation. (3) to collect and organize the data through the SPSS 22.0 software for statistical analysis, The matched counting data are tested by chi-square test, which is called McNemar test and Kappa coefficient test. If p 鈮，

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