动态磁共振成像在女性盆腔器官脱垂诊断中的应用价值  

The role of dynamic magnetic resonance imaging in the diagnosis of female pelvic organ prolapse

作　　者：陈永康[1] 陆薇丹 韩劲松[1] 周延[2] 刘剑羽[2] 张坤[1] 

机构地区：[1]北京大学第三医院妇产科,北京100191 [2]北京大学第三医院放射科,北京100191

出　　处：《中国实用妇科与产科杂志》2015年第7期653-656,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨动态磁共振成像(MRI)在女性盆腔器官脱垂(POP)诊断中的应用价值。方法收集2012年2月至2014年3月在北京大学第三医院妇科门诊就诊的POP病人78例,对其临床检查并进行盆腔器官脱垂定量(POPQ)分期及HMO分度,与动态MRI的测量及诊断结果进行比较分析。结果临床检查与动态MRI的相关性:Aa与膀胱颈、Ba与膀胱底、C与宫颈或阴道穹窿最低点到H线的距离的Spearman相关系数分别为0.745、0.836、0.867,相关性好;Bp与子宫直肠陷凹最低点、Ap与直肠肛管连接处直肠前壁到H线的距离的相关系数分别为0.367、0.481,仅中度相关。两种分期在诊断前、中、后盆腔脱垂的Kappa检验结果分别为:K=0.313、0.794、0.385,前后盆腔一致性弱,中盆腔一致性强;χ2检验结果分别为:χ2=3.368(P=0.064)、5.143(P=0.016)、15.042(P<0.01),前盆腔两种检查的诊断率差异无统计学意义,中盆腔POP-Q的诊断率较高,后盆腔动态MRI的诊断率较高。两种分期在评价前、中、后盆腔脱垂程度的Kappa检验结果分别为K=0.063、0.328、0.167,一致性均差。结论动态MRI能够准确评估前、中盆腔器官脱垂,评估后盆腔器官脱垂比临床检查更具有优势。动态MRI可以作为临床检查的有效补充。Objective To investigate the value of dynamic MRI in diagnosing female POP. Methods Totally 78 women suffering with POP underwent dynamic MRI in Peking University Third Hospital from Feb. 2012 to Mar. 2014. Analyze the measurement results and diagnoses according to POP-Q and HMO classification. Results The correlations between measurement results of POP-Q and MRI were assessed by calculation of the Spearman correlation coefficients. The correlation coefficient of Aa-bladder neck was 0.745, Ba-bladder base 0.836, and C-cervix/vaginal vault 0.867. The correlation coefficient of Bp-eul-de-sac was 0.367 and Ap-posterior vaginal wall 0.481. There was very strong correla- tion between clinical examination and MRI in anterior and middle pelvic cavity but moderate correlation in posterior pelvic cavity. Comparisons between positive rate of POP-Q and HMO classification was performed with Kappa tests.The Kappa values were 0.313,0.794 and 0.385, and the X2 values were 3.368 （P=0.064）, 5.143 （P=0.016） and 15.042 （P〈 0.01 ） in anterior, middle and posterior compartment respectively. The positive rate of the two methods was of no significant difference in anterior compartment, but was higher of POP-Q in the middle and of MRI in the posterior. Consistency of grading POP between POP-Q and HMO classification was poor in anterior （K=0.063） , middle （K=0.328） or posterior compartment （K=0.167）. Conclusion There is excellent correlation in diagnosing POP between clinical examination and dynamic MRI in anterior and middle compartment. Dynamic MRI is more accurate than clinical diagnosis in posteri- or compartment. It can be an effective supplemental method to clinical examination.

关 键 词：盆腔器官脱垂 动态磁共振成像 POP-Q分期 

分 类 号：R711.5[医药卫生—妇产科学]