产后胎盘植入的影像学表现及病理对照  

Correlation of imaging features and histop athoiogy in postpartum placental accrete

作　　者：颜志平[1] 邝菲[1] 苏素联[1] 罗万能[1] 冯浩[1] 郑顺荣[1] 周子俊[1] 

机构地区：[1]解放军第174医院医学影像科,厦门361003

出　　处：《磁共振成像》2015年第6期450-454,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：南京军区医学科技创新课题(编号:12MA059)

摘　　要：目的探讨产后胎盘植入的影像学表现特征及其病理表现的关系。材料与方法回顾性分析14例经临床及病理证实的产后胎盘植入患者,年龄24~39岁,平均（30.6±2.5）岁。14例中10例行MRI检查,另4例行CT检查,总结其MRI及CT影像特点及诊断价值。结果 14例均确诊,子宫体积不同程度增大,MRI表现为子宫内见混杂信号团块影,局部内膜及结合带不完整,边缘模糊甚至中断。孕龄短的胎盘表现为单纯的团块状结构,孕龄长的胎盘具有特征性的叶状、结节状结构。以子宫肌层为对照,T1WI病灶表现为等低信号,与宫壁分界欠清,T2WI表现为以高信号为主的混杂信号影,内散在条状及点状低信号,病灶侵入肌层,肌层局部明显变薄,3例累及浆膜层;CT病灶则呈稍低密度,边界不清;增强扫描病灶呈不均匀明显强化类似＂花瓣＂样,其强化程度高于子宫肌层,坏死区无强化表现为＂裂隙＂状。结论 MRI较CT能更清晰显示植入胎盘的形态、位置及深度,对病变程度的判断与病理分型基本一致,是诊断产后胎盘植入的重要手段。Objective： To investigate the features and diagnostic value of MRI and CT in postpartum placenta accreta（PA）. Materials and Methods： Fourteen cases PA comfirmed clinically or pathologically were retrospectively analyzed（aged 24—39 years old, with an average of 30.6±2.5 years old）. Ten cases were examined by MRI scans, four cases by conventional and contrast-enhanced CT scans, their imaging appearances were analysed. Results： Fourteen cases were correctly diagnosed with MRI and CT. Uterus enlarged in various degrees, the mixed signal intensity mass was showed in it. The integrity of endometrium and junctional zone of myometrium was destructed. Placentas of shorter gestational age appeared to be a mixed simple mass, the longer ones to be lobulated structure distinctively. Compared with the signal intensity of the outer layer of the myometrium, the signal intensity of implanted placenta showed isointense or hypointense and its boundary with uterus was not clear on T1 WI. On T2 WI, it showed significantly mixed hyperintense, and spread strip and punctate low signal shadows. The lesions invaded myometrium, and made the myometrium thinning locally. The lesions invaded close to perimetrium in 3 cases. By CT scan, they showed a ill-defi ned low density, by enhancement scan, placentas were heterogeneous enhancement significantly, appeared to be＂petal shaped＂, similar to enriched degree of myometrium. The necrotic area were not enhanced, depicted as＂crack shaped＂. Conclusion： Compared with CT, MRI can make correct diagnosis of PA and judge the general degree of placental invasion, as similar with pathologic types. It is a kind of auxiliary diagnostic tool ideally.

关 键 词：产后期 胎盘植入 电子计算机断层扫描 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R714.43[医药卫生—诊断学]