胎盘侵犯的MRI表现及诊断价值

发布时间：2018-03-20 01:34

本文选题：磁共振成像　切入点：胎盘　出处：《放射学实践》2017年01期 　论文类型：期刊论文

【摘要】：目的:探讨胎盘侵犯的MRI表现及诊断价值。方法:回顾性分析产前怀疑胎盘侵犯并行MRI检查的67例患者的病例资料,由两位医师判断胎盘侵犯的类型并记录其征象。以手术和/或病理诊断为金标准,分析穿透型和非穿透型胎盘侵犯、植入型和非植入型胎盘侵犯之间的影像学征象差异,并计算各征象诊断胎盘穿透和胎盘植入的敏感度和特异度。结果:膀胱壁毛糙、形态不规则或胎盘与邻近脏器分界不清在穿透型与非穿透型胎盘侵犯患者间的发生率差异有统计学意义(P0.05);T2WI图像可见粗大血管影、胎盘与子宫界面间低信号带中断或不清、子宫下段不规则隆起、宫颈内口区胎盘形态不规则在植入型和非植入型胎盘侵犯患者间的发生率差异有统计学意义(P值均0.05)。膀胱壁毛糙、形态不规则或胎盘与邻近脏器分界不清诊断穿透型胎盘侵犯的敏感度、特异度分别为75.0%(15/20)、98.2%(112/114);T2WI图像可见粗大血管影、胎盘与子宫界面间低信号带中断或不清、子宫下段不规则隆起、宫颈内口区胎盘形态不规则、胎盘信号不均诊断植入型胎盘侵犯的敏感度分别为82.4%(28/34)、70.6%(24/34)、73.5%(25/34)、52.9%(18/34)、67.6%(23/34),特异度分别为80.0%(80/100)、71.0%(71/100)、78.0%(78/100)、85.0%(85/100)、34.0%(34/100)。结论:膀胱壁毛糙、形态不规则或胎盘与邻近脏器分界不清提示胎盘穿透;T2WI图像可见粗大血管影、胎盘与子宫界面间低信号带中断或不清、子宫下段膨隆、宫颈内口区胎盘形态不规则等征象出现时,提示胎盘植入。MRI对诊断胎盘植入及胎盘穿透有一定的应用价值。
[Abstract]:Objective: to investigate the MRI manifestation and diagnostic value of placental invasion. Methods: the data of 67 patients with suspected placental invasion and MRI examination were analyzed retrospectively. The type of placental invasion was judged by two doctors and the signs were recorded. According to the gold standard of surgical and / or pathological diagnosis, the difference of imaging signs between penetrating and non-penetrating placental invasion, accreta type and non-accreta type placental invasion was analyzed. The sensitivity and specificity of each sign in the diagnosis of placenta penetration and placenta accreta were calculated. There were significant differences in the incidence of placental invasion between penetrating and non-penetrating placental invasion patients with irregular morphology or unclear boundary between placenta and adjacent viscera. There were significant differences in the incidence of placental invasion between penetrating type and non-penetrating type of placenta. There was a significant difference in the occurrence of large vessels on the images of P0.05 and T2WI, and the low signal band between placenta and uterus was interrupted or unclear. There were significant differences in the incidence of irregular placental morphology between the patients with placental invasion of accreta type and non-accreta type in the irregular protuberance of the lower segment of the uterus and the intraoral area of the cervix (P = 0.05). The sensitivity of irregular shape or unclear boundary between placenta and adjacent viscera to diagnose penetrating placental invasion was 75.00.The specificity was 75.00.15 / 20 / 20 / 98.2T _ 2WI images showed coarse vascular shadow, low signal band between placenta and uterine interface was interrupted or unclear, and the lower segment of uterus was irregular protuberance. The sensitivity of irregular placenta shape and uneven placental signal in cervix was 82.4and 28 / 34 / 70.6A = 73.535 / 73.535 / 25 / 52.99 / 52.94 / 2334, respectively, and the specificity was 80.080 / 100 / 71.0 / 78.0 / 78.0 / 78.0 / 78.0 / 78.0 / 100 / 78.0 / 85.00 / 85 / 100 / 34 / 100. Conclusion: bladder wall is rough, and the bladder wall is rough. Irregular morphology or unclear boundary between placenta and adjacent viscera suggests that placenta penetrating T2WI images show coarse vascular shadow, hypointensity band between placenta and uterine interface is interrupted or unclear, and the lower segment of uterus bulges. When the appearance of irregular placenta appearance in cervical internal orifice area, it is suggested that placenta accreta. MRI has certain application value in the diagnosis of placenta accreta and placenta penetration.
【作者单位】：郑州大学第二附属医院磁共振室;
【分类号】：R714.56;R445.2

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