彩色多普勒超声与磁共振成像鉴别穿透型、植入型和粘连型胎盘植入的价值  

The value of color Doppler ultrasound and MRI in identifying penetration type,implantable type and adhesive type of placenta implantations

作　　者：王琼芳[1] 吴晓莉[1] 郑秀[1] 唐媛[1] 王淑颖 郑红[2] WANG Qiong-fang;WU Xiao-li;ZHENG Xiu(Department of Ultrasound,Panzhihua Central Hospital,Panzhihua 617067,China;不详)

机构地区：[1]攀枝花市中心医院超声科,四川攀枝花617067 [2]德阳市人民医院超声科,四川德阳618000

出　　处：《中国医学装备》2021年第8期68-72,共5页China Medical Equipment

基　　金：四川省卫生厅科研项目(180417)“彩色多普勒超声与核磁共振鉴别穿透型、植入型和粘连型胎盘植入的价值研究”。

摘　　要：目的:研究彩色多普勒超声与磁共振成像(MRI)鉴别穿透型、植入型和粘连型胎盘植入的价值。方法:选取医院收治的89例疑似胎盘植入患者,其中粘连型胎盘植入59例,穿透性胎盘植入25例,植入型胎盘植入5例。所有患者均行彩色多普勒超声及MRI检查,采用Kappa检验分析比较超声、MRI检查单独和联合诊断结果与病理检查结果一致性,绘制受试者工作特征(ROC)曲线分析两种方法单独及联合诊断胎盘植入的价值。结果:超声显示,粘连型胎盘植入患者胎盘异常增厚、子宫肌层变薄;穿透型胎盘植入患者子宫浆膜层与膀胱壁间血管丰富;植入型胎盘植入患者胎盘间隙不规则或消失等。MRI显示,粘连型胎盘植入患者可见胎盘信号不均匀等症状;植入型胎盘植入患者表现为胎盘与肌层的交界面毛糙等;穿透性胎盘植入患者可见胎盘聚拢并呈驼峰状改变等表现。89例患者一致性检验中,超声Kappa值为0.410,符合率为71.91%,一致性尚可;MRI Kappa值为0.376,符合率为68.91%,一致性一般;联合诊断Kappa值为0.609,符合率为80.90%,一致性较好。ROC曲线中,两者联合诊断胎盘植入的灵敏度为91.75%,特异度为89.26%。结论:彩色多普勒超声在评估胎盘植入的面积、深度及血管走行等具有一定优势。MRI对血流信号敏感,组织分辨率较高,可作为彩色多普勒超声诊断胎盘植入的重要补充。Objective:To explore the value of color Doppler ultrasound and magnetic resonance imaging(MRI)in identifying penetration type,implantable type and adhesive type of placenta implantation.Methods:89 patients with suspected placenta implantation who admitted to hospital were selected.Among of them,59 patients were adhesive type of placenta implantation,25 patients were penetration type of placenta implantation and 5 patients were implantable type of placenta implantation.All of patients underwent color Doppler ultrasound and MRI examination.The Kappa test was adopted to analyze and compare the coincidences between single examination of ultrasound and MRI,the combined examination of them and pathological examination.And the receiver operating characteristics(ROC)curve was drawn to analyze the values of any single method and the combined method in diagnosing placenta implantation.Results:The results of ultrasound showed abnormal thickening of placenta and thinning of myometrium occurred in patients with adhesive type of placenta implantation,and there were abundant vessels between serous layer of the uterus and bladder wall in patients with penetration type of placenta implantation,and the placental gap was irregular or disappears in patients with implantable type of placenta implantation.The results of MRI showed that there were unevenly placental signals in patients with adhesive type of placenta implantation,and there were coarse interfaces between placenta and muscular layer in patients with implantable type of placenta implantation,and there were changes that placenta gathered together and appeared hump shape in patients with penetration type of placenta implantation.The Kappa value of ultrasound was 0.410 and its coincidence rate was 71.91%,and its coincidence was favorable.And the Kappa value of MRI was 0.376 and its coincidence rate was 68.91%,and its coincidence was ordinary.The Kappa value of combined diagnosis was 0.609 and its coincidence rate was 80.90%,and its consistency was ideal.In ROC curve,the sensi

关 键 词：彩色多普勒超声 磁共振成像(MRI) 穿透型 植入型 粘连型 胎盘植入 

分 类 号：R445.1[医药卫生—影像医学与核医学]