超声造影技术在产科临床应用初探

发布时间：2018-03-05 15:34

本文选题：超声微泡　切入点：胎盘　出处：《重庆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过比较微泡造影剂造影前后胎盘二维图像上的细微变化，从而为评估胎盘的结构、大小、位置、是否存在发育异常等提供更为准确的超声图像。期待寻找一种可以进一步提高胎盘植入、前置胎盘、胎盘早剥等疾病的超声诊断准确率的影像学诊断方法，评估超声造影技术在胎盘疾病诊断中的应用价值。方法：随机选择12名需要引产的孕妇参与研究，所有参加者均自愿并签署知情同意书。其中8名孕妇因为胎儿器官发育异常或胎儿染色体异常需要医学引产，1名孕妇因合并严重甲状腺功能异常需要引产，其余3名孕妇因为无生育指标要求引产，另外1例术中发现胎盘植入的产妇也参与了该项试验。试验选用声诺维（SonoVue）作为超声影像学示踪剂。试验开始前，通过静脉通道快速注入超声造影剂，，然后立即在超声诊断仪（PHILIPS IU-22）二维造影模式下观察声诺维在胎盘组织中的显影情况，对比判断造影前后超声图像异同，从而判断造影剂的使用能否提高胎盘疾病超声诊断的准确性。结果：造影剂推入后，胎盘部位出现了明显的回声增强，呈现高回声区，而子宫肌层回声较胎盘回声稍低，胎儿部位呈现无回声区。对比造影前图像，造影后胎盘小叶结构、位置、大小及附着部位界限显示更清晰。胎盘植入病人造影图像中发现子宫肌层近内膜线部位出现一个明显三角形异常信号部位，其内回声强弱不等，边缘为明显高回声并与内膜线连续，其余部分的子宫肌层依旧呈现稍高回声区，肌层与宫腔回声强度差异明显,而造影前图像未提示子宫肌层回声强弱不等,并且子宫肌层与宫腔的回声强度也无明显差异。结论：我们的研究结果一方面证明超声微泡造影剂的使用，能提高胎盘部位的超声图像显示效果，较普通二维图像更清晰识别胎盘小叶，胎盘与肌层附着关系；另一方面说明胎儿部位无造影剂显影，可能提示造影剂未通过胎盘屏障进入胎儿体内，造影剂可能对胎儿无有害影响。
[Abstract]:Objective: to evaluate the structure, size and location of placenta by comparing the subtle changes in two-dimensional placenta images before and after microbubble contrast medium angiography. Looking forward to finding an imaging diagnostic method that can further improve the diagnostic accuracy of placenta accreta, placenta previa, placental abruption and other diseases. To evaluate the value of contrast-enhanced ultrasonography in the diagnosis of placental diseases. Methods: twelve pregnant women who needed induced labor were randomly selected to participate in the study. All participants volunteered and signed informed consent. Among them, 8 pregnant women needed medical induction of labor due to fetal organ dysplasia or fetal chromosomal abnormalities. One pregnant woman needed to induce labor due to severe thyroid dysfunction. The remaining three pregnant women required induction of labor because they had no fertility indicators. Another woman who had found placenta accreta during the operation also participated in the trial. Sono Vue was selected as an ultrasound imaging tracer. Before the trial began, The ultrasound contrast agent was injected quickly through the vein channel, and then the development of sonovir in placental tissue was observed immediately under the mode of ultrasound diagnostic instrument PHILIPS IU-22), and the difference and similarities of ultrasound images before and after contrast were judged. So as to determine whether the use of contrast media can improve the accuracy of ultrasound diagnosis of placental diseases. Results: after the contrast agent was pushed into the placenta, there was obvious echo enhancement in placenta, which appeared hyperechoic area, while the echo in myometrium was a little lower than that in placenta, and the fetal area was anechoic. Compared with the pre-contrast image, the structure of placental lobules appeared after contrast. The location, size and boundary of the attachment site were more clear. In the placenta accreta patients, an obvious triangular abnormal signal was found in the myometrium near the endometrial line, and the echo intensity was different. The edge of uterine myometrium was hyperechoic and continuous with the endometrial line. The myometrium of the rest of uterus still showed a slightly hyperechoic area, and the intensity of the myometrium was significantly different from that of the uterine cavity. There was no significant difference in echo intensity between myometrium and uterine cavity. Conclusion: on the one hand, our results show that the use of ultrasound microbubble contrast agent can improve the display effect of placenta, and identify the placental lobules and the relationship between placenta and myometrium more clearly than ordinary two-dimensional images. On the other hand, there is no contrast agent in the fetus, which may indicate that the contrast agent does not enter the fetus through the placental barrier, and the contrast agent may have no harmful effect on the fetus.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R71

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