对比MRI动态增强和超声在早期剖宫产瘢痕妊娠中的应用价值  

Comparing the Value of Dynamic Contrast-Enhanced MR Imaging Scan and Ultrasound in Early Cesarean Scar Pregnancy

作　　者：黄波涛[1] 区俊兴[1] 原仲晖[1] 陈伟[1] 陈莞春[2] 吕晓亮[3] 金新安[1] HUANG Botao;OU Junxing;YUAN Zhonghui(Department of Radiology, Dongguan Houjie Hospital, Dongguan, Guangdong Province 523945, P. R. Chin)

机构地区：[1]广东省东莞市厚街医院放射科,523945 [2]广东省东莞市厚街医院超声科,523945 [3]广东省东莞市厚街医院妇产科,523945

出　　处：《临床放射学杂志》2018年第5期781-785,共5页Journal of Clinical Radiology

基　　金：广东省医学科学技术研究基金项目(编号:2016113192543314)

摘　　要：目的探讨MRI动态增强扫描和超声在早期剖宫产瘢痕妊娠（CSP）中的应用价值。方法回顾性分析58例经临床证实的早期CSP患者的临床和影像资料,包括超声、MRI平扫、DWI及动态增强扫描,分析其影像学特点。结果 58例CSP患者中,超声诊断准确率91.3%（53/58）,MRI诊断准确率94.8%（55/58）。根据MRI分型,Ⅰ型12例,Ⅱ型33例,Ⅲ型10例。瘢痕部位常规序列呈低信号,增强后无强化,孕囊T1WI以等低信号为主,T2WI以高或混杂信号为主,DWI可为低信号、高信号或囊壁高信号,增强后环形强化25例,结节状或不均匀强化33例。其中合并绒毛或胎盘植入16例,超声诊断准确率50%（8/16）,MRI诊断准确率81.2%（13/16）,MRI表现为瘢痕及周围肌层内DWI高信号灶,花瓣样或结节状强化,血供丰富。超声与MRI诊断CSP的准确率比较,差异无统计学意义（χ^2=2.453,P=0.117）,两者判断绒毛植入的准确率比较,差异有统计学意义（χ^2=6.349,P=0.012）。结论超声和MRI对剖宫产CSP均有较高的诊断准确率,MRI可很好地显示CSP分型及与周围组织关系,对判断是否合并绒毛植入优于超声,为临床判断风险和制定治疗方案提供帮助。Objective to explore the application value of dynamic congtrast-enhanced MR imaging scan and ultrasound in early cesarean scar pregnancy（CSP）.Methods The clinical and imaging data of 58 clinically proven patients with early CSP were retrospectively analyzed,including ultrasonography,plain MRI scanning,DWI and dynamic contrast-enhanced scanning,and their imaging characteristics were analyzed.Results Among 58 CSP patients,the diagnostic accuracy of ultrasound was 91.3%（53/58）,and the accuracy of MRI diagnosis was 94.8%（55/58）.According to MRI classification,there were 12 cases of type I,33 cases of type Ⅱ,and 10 cases of type Ⅲ.The conventional sequence of the scar was hypointensity,no enhancement after enhancement,gestational sac T1 WI with predominantly low signal,T2 WI with high or confounding signal,DWI with low signal,high signal,or cystic hyperintense,enhanced circular enhancement In 25 cases,nodular or heterogeneous enhancement was observed in 33 cases.Among them 16 cases with combined villus or placenta accreta,the diagnostic accuracy of ultrasound is 50%（8/16）,the diagnostic accuracy of MRI is 81.2%（13/16）,MRI manifests as scars and DWI high signal lesions in surrounding muscle layer,petal-like Or nodular enhancement,rich blood supply.There was no significant difference between the accuracy of ultrasound and MRI in the diagnosis of scar pregnancy（χ^2= 2.453,P = 0.117）.The accuracy of the comparison of villi implantation was statistically significant（χ^2= 6.349,P =0.012）.Conclusion Both ultrasound and MRI have high accuracy in the diagnosis of CSP in cesarean section.MRI can well show the relationship between CSP classification and the surrounding tissue.It is better for judging whether or not combined villi implantation is better than ultrasound for clinical judgment of risk and development.Treatment options help.

关 键 词：瘢痕妊娠 胎盘植入 磁共振成像 动态增强 

分 类 号：R445.2[医药卫生—影像医学与核医学] R714.22[医药卫生—诊断学]