3．0TMRI对早期剖宫产术后子宫切口瘢痕妊娠的诊断价值  

Diagnostic value of 3. 0 T magnetic resonance imaging for early cesarean scar pregnancy

作　　者：刘倩[1] 张瑞方[1] 王雪[1] 刘锟[1] 白光辉[1] 黄雅南[1] 朱欢乐[1] 严志汉[1] 

机构地区：[1]温州医科大学附属第二医院放射科,325027

出　　处：《中华医学杂志》2014年第45期3589-3592,共4页National Medical Journal of China

基　　金：温州市科技局对外合作科研项目（H20090073）

摘　　要：目的探讨剖宫产术后子宫瘢痕妊娠（CSP）的MRI影像学特点，分析其对CSP的早期诊断价值。方法回顾分析2012年8月至2014年6月在温州医科大学附属第二医院临床拟诊CSP，并行盆腔3．0TMRI和超声检查的早孕患者81例，观察其MRI和超声影像学特点，计算MRI和超声诊断CSP的敏感度、特异度、准确度，绘制ROC曲线。结果8l例患者中，经病理证实68例为CSP，13例为宫内早孕。68例CSP，超声正确诊断52例，诊断错误16例；13例宫内早孕，超声正确诊断11例，误诊2例。其诊断CSP的敏感度、特异度、准确度分别为76．5％（52／68）、11／13、77．8％（63／81），阳性预测值为96．3％（52／54），阴性预测值为40．7％（11／27）。68例CSP，MRI正确诊断64例，诊断错误4例；13例宫内早孕，MRI正确诊断10例，误诊3例。其诊断CSP的敏感度、特异度、准确度分别为94．1％（64／68）、10／13、91．4％（74／81），阳性预测值为95．5％（64／67），阴性预测值为10／14。ROC曲线分析结果，MRI和超声检查的曲线下面积（AUC）分别为0．941（P=0．000）、0．867（P=0．000）。结论MRI诊断CSP的敏感度和准确度均高于超声，MRI对于临床早期选择治疗方案可提供更多信息。Objective To explore the magnatic resonance imaging （MRI） features of cesarean scar pregnancy （CSP） and analyze the diagnostic value of MRI for early CSP. Methods The 3.0 T MRI and ultrasonic findings of 81 patients with CSP were analyzed. The sensitivity, specificity and accuracy of two methods was calculated respectively for the diagnosis of CSP. The diagnostic value of each method was evaluated with receiver-operating-characteristics （ROC） analysis. Results Among them, the final pathological diagnoses were CSP （ n = 68 ） and early uterine pregnancy （ n = 13 ）. Among 68 cases of CSP,52 cases were detected and 16 cases incorrectly diagnosed by ultrasound. Among 13 cases of early uterine pregnancy, 11 cases were correctly diagnosed and 2 cases misdiagnosed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasound for diagnosing CSP were 76. 5% （52/ 68 ）, 11/13,77.8% （63/81 ） ,96. 3 % （ 52/54 ） and 40.7% （ 11/27 ） respectively. Among 68 cases of C SP, 64 cases were detected and 4 cases incorrectly diagnosed by MRI. Among 13 cases of uterine pregnancy, 10 cases were diagnosed correctly and 3 cases misdiagnosed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI for diagnosis of CSP were 94. 1% （64/68）, 10/13, 91.4% （74/81）,95.5% （64/67） and 10/14 respectively. The ROC analysis yield the area under curve （AUC） of MRI and uhrasonography were 0.941 （P = 0.000） and 0.867 （P = 0.000） respectively. Conclusion The sensitivity and accuracy of MRI are better than those of ultrasound in the diagnosis of CSP. And MRI is quite important for choosing appropiate therapeutic protocols.

关 键 词：剖宫产术 妊娠 磁共振成像 超声检查 

分 类 号：R714.22[医药卫生—妇产科学]