妊娠期胎盘植入MRI的诊断评价及植入范围分级的临床意义

发布时间：2018-02-26 21:25

本文关键词： 胎盘侵入性磁共振成像　出处：《中国临床医学影像杂志》2015年05期 　论文类型：期刊论文

【摘要】：目的:分析与妊娠期胎盘植入相关的磁共振特征,探讨植入范围MR分级对临床治疗的指导意义。方法:回顾性分析2009年12月—2014年5月期间在本院超声产检发现前置胎盘、怀疑胎盘植入并进一步行MRI检查的资料,以手术和病理结果为标准,对胎盘植入的MRI征象,包括子宫肌层变薄、胎盘-肌层交界面消失、胎盘内部带状T2WI低信号影、子宫轮廓外突以及最终诊断的灵敏度、特异度、阳性预测率以及阴性预测率。根据MRI横断图上最大植入面的范围,对确诊病例进行MR分级,植入面≤50%的为A级,植入面50%的为B级,出现浆膜外侵犯的为C级,通过χ2检验比较不同分级之间保守治疗成功率的差异。结果:69例怀疑胎盘植入的病例中有46例被最后确诊,其中43例被MRI正确诊断(灵敏度93.48%),21例被正确排除(特异度91.30%)。MRI征象中以胎盘-肌层交界面消失的灵敏度及阴性预测率最高(95.56%,90.0%),子宫肌层变薄次之。T2WI胎盘内低信号带的阳性预测率较高(90.01%),子宫轮廓外突的特异度及阳性预测率最高(100%)。植入范围MR分级保守治疗的成功率分别为100%(A级)、23.08%(B级)和12.5%(C级),统计学分析有明显差异(P0.05)。结论:MRI在胎盘植入的诊断方面有较大优势,以胎盘-肌层交界面消失为最佳诊断依据。根据植入范围的MR分级方法对治疗手段的选择有一定的指导意义。
[Abstract]:Objective: to analyze the MRI features of pregnancy associated with placenta implantation, to explore the significance of MR classification of implanting range for clinical treatment. Methods: a retrospective analysis from December 2009 to May 2014 in our hospital during the prenatal ultrasound found suspected placenta implantation and placenta previa, further MRI examination data, with surgical and pathological results as the standard MRI features of placenta implantation, including myometrial thinning, placental myometrial interface disappeared, placenta internal banded T2WI low signal intensity, sensitivity, uterine contour outside the process and final diagnosis specificity, positive predictive rate and negative predictive rate. According to the MRI diagram on the range maximum transverse implantation, MR classification of confirmed cases, implant surface is less than or equal to 50% for Grade A, 50% grade B implantation, appear subserous violations of the C level, the 2 test was the difference of the success rate of conservative treatment was compared among the different grade. Results: 69 Patients suspected of placenta implantation cases in 46 cases were finally diagnosed, 43 cases were diagnosed correctly by MRI (sensitivity 93.48%), 21 cases were correctly excluded (specificity 91.30%).MRI signs in placenta muscle layer and the disappearance of the highest sensitivity and negative predictive rate interface (95.56%, 90%), uterine muscle layer positive predictive with low signal.T2WI thin times within the placenta was higher (90.01%), uterine contour protrusion of the specificity and positive predictive rate was the highest (100%). The range of MR grade implantation success rate of conservative treatment was 100% (Grade A), 23.08% (B) and 12.5% (C), statistical analysis there was significant difference (P0.05). Conclusion: MRI has great advantages in diagnosis of placenta accreta, placenta myometrial interface disappeared as the best diagnostic basis. According to the classification method of MR implantation on the scope of treatment choice has certain guiding significance.

【作者单位】：广州市妇女儿童医疗中心;
【基金】：广东省医学科技研究基金,项目编号:WSTJJ20111220422827197206060013
【分类号】：R714.462;R445.2

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