产后胎盘残留的MRI诊断与鉴别诊断  

MRI in the diagnosis and differential diagnosis of retained placental tissue postpartum

作　　者：苏峻[1] 蒋涛[1] 翟仁友[1] 

机构地区：[1]首都医科大学附属北京朝阳医院放射科,北京100020

出　　处：《医学影像学杂志》2015年第7期1256-1260,共5页Journal of Medical Imaging

摘　　要：目的探讨产后胎盘残留的MRI特征及诊断价值。方法回顾性分析16例临床拟诊为产后胎盘植入患者的MRI表现。结果临床或病理证实产后胎盘残留3例、胎盘粘连3例、胎盘植入9例,胎盘穿通1例。MRI确诊14例,2例胎盘粘连误诊为胎盘植入。MRI表现:子宫不同程度增大;结合带局部模糊甚至中断;胎盘附着处子宫肌层较对侧变薄。以子宫肌层为对照,T1WI序列:11例表现为等信号,4例表现为等-高信号,1例表现为高信号;T2WI序列:11例表现为不均匀高信号,内混有内散在的流空低信号血管和线条状低信号小叶间隔,3例表现为高信号,2例表现为低信号。16例均行增强MRI扫描,7例病灶呈不均匀明显强化,类似"花瓣"样、"结节"样,坏死区无强化。4例胎盘植入患者,植入部位伴多发迂曲、增粗流空血管影。结论 MRI能明确诊断产后残留胎盘的特征,判断胎盘植入的程度、位置及深度。Objective The objective of this study was to determine imaging features and diagnostic value of MRI in re- tained placental tissue （RPT） postpartum. Methods 16 patients with clinically suspected placenta increta were analyzed retrospectively. Results Clinical or pathological examination revealed 3 cases of normal retained placental tissue, 3 cases of placenta accrete, 9 cases of placenta increta, and one case of placenta percreta. 14 patients were correctly diagnosed with MRI, and 2 patients of placenta accrete were misdiagnosed of placenta increta. Uterus enlarged in various degrees and the junctional zone became thinner locally or discontinued. The myometrium was thinner at the attachment side than at the opposite side. Compared with the signal intensity of the outer layer of the myometrium, on Tl-weighted images, 11 cases showed isointense, 4 cases showed iso-hyperintense, and one case showed hyperintense. While, on T2-weighted images, 11 cases showed signi[icantly mixed heperintense with a Jew dark intraplacental spotted or linear bands, 3 cases showed hyperintense and 2 cases showed hypointense. All 16 cases received enhanced enhanced MRI scan. On Gadolinium- en- hanced T1 WI, 7 cases of placentas were heterogeneous enhancement significantly, appeared to be ＂rosette or petal-like＂, or ＂nodular＂ enhancement, the necrotic area was not enhanced. 4 cases of placenta inereta were hypervascular. Conclusion The feature of RPT can be clearly determined by MRI. The extent of placental accreta and the location and deepness of placental invasion can also be displayed.

关 键 词：胎盘 胎盘植入 磁共振成像 

分 类 号：R714.46[医药卫生—妇产科学] R445.2[医药卫生—临床医学]