多种影像方法检测早孕胎盘绒毛植入与临床分析  

Detection and clinical analysis of placental villus implantation in early pregnancy by various imaging methods

作　　者：孙多成[1] 栾峰[2] 李海军[3] 王小华[4] 钟守军[5] SUN Duocheng;LUAN Feng;LI Haijun;WANG Xiaohua;ZHONG Shoujun(Department of Medical Imaging,Zhongshan Boai Hospital,Zhongshan,Guangdong Province 528403,China;Department of Gynecology,Zhongshan Boai Hospital,Zhongshan,Guangdong Province 528403,China;Prenatal Diagnosis Center,Zhongshan Boai Hospital,Zhongshan,Guangdong Province 528403,China;Department of Ultrasound,Zhongshan Boai Hospital,Zhongshan,Guangdong Province 528403,China;Department of Pathology,Zhongshan Boai Hospital,Zhongshan,Guangdong Province 528403,China)

机构地区：[1]中山市博爱医院医学影像科,广东中山528403 [2]中山市博爱医院妇产科,广东中山528403 [3]中山市博爱医院产前诊断中心,广东中山528403 [4]中山市博爱医院超声科,广东中山528403 [5]中山市博爱医院病理科,广东中山528403

出　　处：《实用放射学杂志》2020年第9期1450-1453,共4页Journal of Practical Radiology

摘　　要：目的总结早孕胎盘绒毛植入的MRI、彩色多普勒超声表现.方法回顾性分析经手术、临床与病理证实的10例早孕胎盘绒毛植入的临床资料,10例均行阴道彩色多普勒超声、MRI检查.结果10例均表现为子宫增大,胎盘绒毛植入子宫肌层,呈圆形或类圆形,病灶局部子宫肌层明显变薄、子宫内膜面与包块分界模糊,彩色多普勒超声主要特点是病灶呈蜂窝状或筛孔状稍强不均匀回声,彩色多普勒超声血流成像(CDFI)见包块内部及周围血流信号异常丰富.MRI表现T1WI以等信号为主,T2WI高信号,T2压脂高信号,DWI、ADC以低等信号为主,仅3例见病灶内DWI呈点状高信号;病灶边缘明显强化,呈结节状、条状,似胎盘内血管走行,占100%(10/10);病灶周围血管明显增多、迂曲、分支紊乱8例,呈流空低信号,增强后明显强化,尤其以病灶侧子宫动脉增粗、迂曲明显.血管造影见病灶异常染色、见血池,子宫动脉及其分支明显增粗、增多,与MRI、彩色多普勒超声所见一致.伴随征象:盆腔少量积液8例.结论子宫肌层内特征性的MRI强化表现及邻近血管扩张迂曲特点,在早期胎盘绒毛植入的诊断中具有重要诊断价值,MRI诊断早孕绒毛植入的高灵敏度和特异性对早期临床治疗方案的选择、避免大出血、子宫穿孔等并发症发生具有重要参考价值与意义.Objective To summarize the MRI and color Doppler ultrasound findings of placental villus implantation in early pregnancy.Methods The clinical data of 10 patients were analyzed retrospectively,which were confirmed as placental villus implantation in early pregnancy by surgery and clinicaland pathology.All patients underwent color Doppler ultrasound and MRI examination.Results 10 cases showed uterine enlargement,placental villi implantation into the myometnum,local thinning of myometrial lesions and blurred endometrial surface and lesion boundary.Color Doppler ultrasound showed slightly thick and uneven echo of the lesion in the shape of a honeycomb or a mesh,and the CDFI showed an abnormally abundant blood flow signal inside and around the mass.MRI showed that the lesion was mainly isosignal on WI,high signal on T2WI,high signal on T2 fat suppression,and mainly low signal on DWI and ADC mapping but with dot-like high signal in 3 cases.The edge of the focus was enhanced obviously,which was nodular and strip-like,like the blood vessels in placentafaccounting for 100%(10/10).There were 8 cases with obvious increase of blood vessels around the focus,with tortuosity and disorder of branches.It was characterized by low flow empty signal and obvious contrast enhancement,especially with the thickening and tortuosity of uterine artery on the lesion side.The abnormal staining and blood pool of the focus,the thickening and increase of the uterine artery and its branches were found by angiography,which were consistent with the findings of MRI and color Doppler ultrasound.The complicated signs was small amount of fluid in pelvic cavity in 8 cases.Conclusion The characteristic MRI enhancement of the myometrium and the dilation and tortuosity of the adjacent vessels are of great value in the diagnosis of early placental villi implantation with higher sensitivity and specificity,which is helpful for the selection of early clinical treatment plan and the avoidance of complications such as massive hemorrhage and uterine perforation

关 键 词：早孕 绒毛植入 彩色多普勒超声 磁共振成像 

分 类 号：R714.15[医药卫生—妇产科学] R445.2[医药卫生—临床医学]