DTI在产后盆底损伤早期诊断及后期恢复评价中的应用  

Application of magnetic resonance diffusion tensor imaging in early diagnosis and late recovery evaluation of postpartum pelvic floor injury

作　　者：刘郭坤 杨素君[1] 相世峰[1] 刘艳超 杨震 岳志领 LIU Guokun;XIANG Sujun;YANG Shifeng;LIU Yanchao;YANG Zhen;YUE Zhiling(Department of CT/room,Handan Central Hospital,Handan 056001,P.R.China;Department of Ultrasound Medicine,Handan Central Hospital,Handan 056001,P.R.China)

机构地区：[1]河北省邯郸市中心医院CT室,河北邯郸056001 [2]河北省邯郸市中心医院超声医学科,河北邯郸056001

出　　处：《医学影像学杂志》2021年第9期1565-1569,共5页Journal of Medical Imaging

摘　　要：目的探讨磁共振弥散张量成像(DTI)检查对不同分娩方式产后盆底损伤的早期诊断价值及后期恢复的评价效果。方法选取2019年1月~2019年12月经手术及病理证实的120例盆底器官脱垂(POP)患者,根据分娩方式的不同将患者分为顺产组(n=79)与剖宫产组(n=41),所有患者均于盆底康复治疗前后接受常规MRI扫描、DTI扫描和超声检查,比较DTI和超声检查结果,分析DTI检查的诊断价值。结果DTI检查的灵敏度、阴性预测率和准确率均高于超声检查(P<0.05);顺产组患者的宫颈下降距离、膀胱颈下降距离和肛管直肠连接下降距离均大于剖宫产组,肛提肌和闭孔内肌各向异性分数(FA)小于剖宫产组(P<0.05);行康复训练后,两组患者的子宫颈下降、膀胱颈下降和肛管直肠连接下降水平均低于康复前,肛提肌FA值高于康复前(P<0.05)。结论DTI诊断盆底功能损伤的灵敏度、阴性预测率和准确率均高于超声检查,可评价不同分娩方式对盆底结构和功能的影响,FA值可作为早期诊断产后盆底损伤和评价后期恢复的潜在指标。Objective To explore the value of magnetic resonance diffusion tensor imaging(DTI)in early diagnosis and late recovery evaluation of pelvic floor injury after different delivery modes.Methods 120 patients with pelvic organ prolapse(POP)confirmed by surgery and pathology in the hospital from January to December 2019 were selected as the subjects.According to the delivery mode,they were divided into the natural delivery group(n=79)and the cesarean section group(n=41).All patients completed conventional MRI scanning,DTI scanning and ultrasound examination before and after pelvic floor rehabilitation therapy.The results of DTI and ultrasound examination were compared,and the diagnostic value of DTI was analyzed.Results The sensitivity,negative predictive rate and accuracy rate of DTI were higher than those of ultrasound(P<0.05).The descending distances of uterine neck,vesical neck and anal-rectal junction in the natural delivery group were larger than those in the cesarean section group,while,fractional anisotropy(FA)of levator ani muscle and internal obturator muscle was lower than that in the cesarean section group(P<0.05).After rehabilitation training,the above descending distances of uterine neck,vesical neck and anal-rectal junction were decreased,while FA value of levator ani muscle was increased(P<0.05).Conclusion The sensitivity,negative predictive rate and accuracy of DTI in the diagnosis of pelvic floor injury are higher than those of ultrasound.It can be used to evaluate the effect of different delivery modes on pelvic floor structure and function,and FA value can be used as a potential index for early diagnosis and late recovery evaluation of postpartum pelvic floor injury.

关 键 词：盆底功能障碍性疾病 盆腔器官脱垂 分娩方式 磁共振成像 各向异性分数 

分 类 号：R681.6[医药卫生—骨科学] R445.2[医药卫生—外科学]