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(P＜0.05);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);T2 WI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;T2 WI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 features and the value in the diagnosis of placental invasion.Methods:The clinical and MRI materials of 67 patients with prenatally suspected placenta invasion were retrospectively analyzed.The type of placental invasion and their MRI manifestations were recorded by two experienced radiologists.Taking surgery and/or pathology as gold standard,the differences of MRI features between placenta percreta and non-placenta percreta,placenta increta and non-placenta increta were analyzed,also the sensitivity and specificity of the imaging features in diagnosing placenta percreta and placenta increta were calculated.Results:The features included irregular shape and blurring of bladder wall,indistinct margin between placenta and adjacent organs showed significant statistic difference in the incidence rates between placenta percreta and non-placenta percreta patients.The features included enlarged and tortuous blood vessels on T2WI,indistinct low signal band between placenta and uterus,irregular bulging of lower portion of uterus,and irregular shape of placenta around the inner orifice area of cervix showed significant difference between placenta increta and non-placenta increta patients (all P＜0.05).The sensitivity and specificity of features as irregular shape and blurring of bladder wall and indistinction of placenta and adjacent organs in the diagnose placenta percreta was 75.0％ (15/20) and 98.2％ (112/114) respectively.The sensitivity of enlarged and tortuous blood vessels on T2 WI,indistinct low signal band between placenta and uterus,irregular bulging of lower portion of uterus and irregular shape of placenta around the inner orifice area of cervix in the diagnosis of placenta increta was 82.4％ (28/34),70.6％ (24/34),73.5％ (25/34),52.9％ (18/34) and 67.6％ (23/34) respectively.The specificity of the above-mentioned 5 features in the diagnosis of placenta increta was 80.0％ (80/100),71.0％ (71/100),78.0％ (78/100),85.0％ (85/100)and 34.0％ (34/100) respectively.Conclusion:MRI features included irregular shape and blurring of bladder wall or indistinction of placenta with adjacent organs was useful in predicting placenta placenta percreta.The features included enlarged and tortuous blood vessels on T2WI,indistinct low signal band between placenta and uterus,irregular bulging of lower portion of uterus and irregular shape of placenta around the inner orifice area of cervix were useful for the diagnosis of placenta increta.MRI showed certain clinical application value for the diagnosis of placenta increta and placenta percreta.
NETL
NSTL
维普
万方数据