MRI多征象联合在胎盘植入中的诊断价值  

Value of combination of multiple magnetic resonance imaging findings in the diagnosis of placenta accreta

作　　者：孔德会[1] 刘翠芳[2] 刘云[3] 杨柳[3] 付子文[1] 王凌[1] 杨华[2] 

机构地区：[1]重钢总医院放射科,重庆400080 [2]重庆市中医院放射科,重庆400021 [3]第三军医大学新桥医院放射科,重庆400037

出　　处：《放射学实践》2017年第3期271-274,共4页Radiologic Practice

摘　　要：目的:分析MRI多个征象及其联合应用在胎盘植入诊断中的应用价值。方法:对20例胎盘前置且临床高度怀疑胎盘植入的患者进行MRI检查,分别对拟诊胎盘植入的胎盘异质性、子宫肌层不连续、胎盘局部膨突、肌层变薄及结构模糊、宫外胎盘延伸等征象进行独立分析,以分娩术后是否有胎盘植入为标准,统计MRI各征象及联合应用多征象在诊断胎盘植入的敏感度、特异度、阳性预测值及阴性预测值。结果:肌层变薄及结构模糊的敏感度最高,为92.9%;子宫肌层不连续和宫外胎盘延伸诊断胎盘植入的特异度为100%,胎盘异质性和胎盘局部膨突的敏感度、特异度、阳性预测值及阴性预测值分别为85.7%、66.7%、85.7%、66.7%和71.4%、83.3%、90.9%、55.6%,两者联合应用后敏感度和阴性预测值为100%,特异度为83.3%,阳性预测值为93.3%。结论:MRI对胎盘植入具有很高的诊断效能,应当作为临床怀疑胎盘植入患者的常规检查方法,胎盘异质性和胎盘局部膨突两征象联合对胎盘植入的诊断具有很高的敏感度和特异度。Objective：To study the value of combination of multiple MRI findings in the diagnosis of placenta accreta. Methods：MR scanning was performed in 20 pregnant women with placenta previa and clinically highly suspected placenta accreta. Independent analysis was performed with the signs including heterogeneous signal intensity within the placenta, dis- continuous of myometrium, focal protrusion of placenta, thinning myometrium and blurring structure and placental tissue in- vaded outside of uterus. Taking whether placenta accrete was existed after cesarean section as standard,the sensitivity,spe- cificity,positive predictive value （PPV） and negative predictive value （NPV） of the MRI findings independently as well as in combination was analyzed. Results; Thinning myometrium and blurring structure had the highest sensitivity as 92.9 %, discontinuous myometrium and placental tissue invaded outside of uterus had the highest specificity as 100% respectively, The sensitivity, specificity,PPV and NPV was 85.7 % , 66.7 % , 85.7 % , 66.7 % respectively in heterogeneous signal intensi- ty within the placenta, and 71.4 %, 83.3 %, 90.9 %, 55.6% respectively in focal protrusion of placenta. As for the combina- tion of the two, the sensitivity and NPV was 100% respectively, the specificity was 83.3 %, and the PPV was 93.3 %. Conclusion： MRI could show the placenta accreta accurately, and should be routinely performed in the patient with suspected placenta accrete. MRI findings of heterogeneous signal intensity within the placenta in combination with focal protrusion of placenta showed high sensitivity and specificity in the diagnosis of placenta accrata.

关 键 词：胎盘植入 磁共振成像 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]