MRI在胎盘侵犯术前诊断中的价值

发布时间：2018-03-08 22:38

本文选题：胎盘　切入点：磁共振成像　出处：《放射学实践》2015年06期 　论文类型：期刊论文

【摘要】：目的:研究MRI在胎盘侵犯术前诊断中的价值。方法:回顾性分析产前疑似胎盘侵犯的46例孕妇MRI图像,两位阅片者分别记录最佳MRI序列、方位、图像质量、诊断信心、有无侵犯、侵犯深度以及特异性MRI征象;并对两者的结果进行一致性检验。以术后病理或手术记录作为金标准,分别计算MRI诊断胎盘侵犯、侵犯深度以及各个MRI征象的敏感性、特异性、阳性预测值和阴性预测值。结果:两者术前诊断达到中度至高度的一致性(κ值为0.478~0.739)。单次激发闭气序列(SSFSE)及矢状面是最佳的MRI序列和观察方位。MRI诊断胎盘侵犯的敏感度和特异度为79.4%和66.7%;诊断胎盘粘连、植入和穿透的敏感度分别为28.4%,70.6%和33.3%。胎盘与肌层间低信号带缺失在胎盘侵犯中的出现率明显高于无胎盘侵犯(P=0.027),其胎盘侵犯的阳性预测值为83.95%,敏感度为76.5%。胎盘与肌层间低信号带缺失和T2WI上结节状低信号带同时出现的阳性预测值达到92.3%,但敏感度仅为35.3%。胎盘与肌层间低信号带缺失和子宫下段膨隆同时出现的阳性预测值是100%,但敏感性仅为23.5%。结论:MRI判断有无胎盘侵犯具有较高的敏感性和特异性。判断侵犯深度(粘连、植入和穿透)时敏感性偏低。MRI征象判断胎盘植入具有较高的阳性预测值,但是敏感性偏低。
[Abstract]:Objective: to study the value of MRI in the preoperative diagnosis of placental invasion. Methods: the MRI images of 46 pregnant women suspected of placental invasion were analyzed retrospectively. The optimal MRI sequence, location, image quality and diagnostic confidence were recorded by two radiographers. The diagnostic sensitivity of MRI for placental invasion, depth of invasion and MRI signs was calculated by using postoperative pathological or surgical records as the golden standard. Specificity, Positive predictive value and negative predictive value. Results: the preoperative diagnosis of both had a moderate to high consistency (魏 value was 0.4780.7339) and sagittal plane was the best MRI sequence for diagnosing placental invasion, and sagittal plane was the best. The sensitivity and specificity were 79.4% and 66.7 respectively. The sensitivity of implantation and penetration were 70.6% and 33.3%, respectively. The incidence of loss of low signal band between placenta and myometrium in placental invasion was significantly higher than that in non-placental invasion. The positive predictive value of placental invasion was 83.95, and the sensitivity was 76.5.The placenta and myometrium were found in the placenta and myometrium. The positive predictive value of the simultaneous occurrence of hypointense band loss and nodular hypointensity band on T _ 2WI was 92.3, but the sensitivity was only 35.3.The positive predictive value of the loss of hypointense band and the distention of the lower uterine segment of the placenta and muscle layer was 100, but sensitive. ConclusionThe sensitivity and specificity of detecting placental invasion with or without the presence of the placenta are higher than that of MRI, and the depth of the invasion (adhesion, adhesion, adhesion, adhesion, adhesion, adhesion, etc.). MRI findings showed that placenta accreta had a high positive predictive value, but the sensitivity was low.
【作者单位】：南京医科大学第一附属医院放射科;
【分类号】：R714.56;R445.2

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