MRI对剖宫产术后瘢痕妊娠绒毛植入的应用价值  

The application value of MRI for cesarean scar pregnancy with implantation of villi

作　　者：汤为 邓旭嵘 袁海英[2] 李少怀 庾汉华 TANG Wei;DENG Xurong;YUAN Haiying;LI Shaohuai;YU Hanhua(Department of Radiology,Dongguan Huangjiang Hospital,Guangdong,Dongguan 523750,China;Department of Pharmacy,Dongguan Huangjiang Hospital,Guangdong,Dongguan 523750,China)

机构地区：[1]广东省东莞市黄江医院放射科,广东东莞523750 [2]广东省东莞市黄江医院药剂科,广东东莞523750

出　　处：《中国医药科学》2021年第19期176-179,共4页China Medicine And Pharmacy

基　　金：广东省东莞市社会科技发展(一般)项目(202050715041897)。

摘　　要：目的探究磁共振(MRI)对剖宫产术后瘢痕妊娠(CSP)绒毛植入的临床应用价值及影像特征。方法回顾性分析东莞市黄江医院2018年1月至2020年11月90例剖宫产术后瘢痕妊娠患者临床资料及影像学资料,观察MRI特征,并将手术结果与MRI分型比较。结果病理证实有CSPⅠ型50例,CSPⅡ型25例,CSPⅢ型15例。MRI图像显示Ⅰ型患者轴位T1WI显示为低信号,孕囊边缘低信号环与肌层分界清晰。Ⅱ型患者中,存在宫腔内类圆形稍高信号妊娠囊,与剖宫产切口紧密,瘢痕信号不均匀。Ⅲ型患者中,轴位T1WI显示宫腔内类圆形高信号妊娠囊,瘢痕信号中断。MRI术前分型包括CSPⅠ型45例,CSPⅡ型30例,CSPⅢ15例,有5例CSPⅠ型患者被过度诊断为CSPⅡ型。MRI对CSPⅠ型患者诊断准确率为90%(45/50),对Ⅱ型、Ⅲ型患者诊断准确率为100%。MRI测得Ⅱ型、Ⅲ型患者瘢痕肌层厚度低于Ⅰ型患者(P<0.05)。MRI测得Ⅰ型患者子宫壁瘢痕多无突出、无植入,Ⅱ型、Ⅲ型患者子宫壁瘢痕多向宫腔外生长,出现绒毛植入肌层。结论MRI图像对CSP分型诊断有一定特异性,可较好反映出患者瘢痕肌层厚度、子宫壁瘢痕突出与绒毛植入情况,有利于治疗方案的选择。Objective To explore the clinical application value and imaging characteristics of magnetic resonance imaging(MRI)for cesarean scar pregnancy(CSP)with implantation of villi.Methods The clinical data and imaging data of 90 CSP patients in Dongguan Huangjiang Hospital from January 2018 to November 2020 were retrospectively analyzed,MRI characteristics were observed,and the surgical results were compared with MRI classification.Results There were 50 pathologically confirmed cases of CSP typeⅠ,25 cases of CSP typeⅡ,and 15 cases of CSP typeⅢ.According to the MRI images,typeⅠpatients showed low signal on axial T1WI,and the boundary between the low signal ring at the edge of the gestational sac and the muscle layer was clear.In typeⅡpatients,there was a round-shaped gestational sac of slightly high signal in the uterine cavity,which was close to the cesarean section scar,and the scar signal was uneven.In typeⅢpatients,axial T1WI showed a round-shaped gestation sac of high signal in the uterine cavity,and the scar signal was interrupted.According to the preoperative MRI classification,there were 45 cases of CSP typeⅠ,30 cases of CSP typeⅡand 15 cases of CSP typeⅢ,and 5 cases of CSP typeⅠpatients were overdiagnosed as CSP typeⅡ.The diagnostic accuracy rate of MRI for CSP typeⅠpatients was 90%(45/50),and for typeⅡand typeⅢpatients was 100%.MRI showed that the muscle layer thickness of the scar in typeⅡand typeⅢpatients was lower than that in typeⅠpatients(P<0.05);MRI showed that the scars on the uterine wall of typeⅠpatients were mostly non-protruding without implantation,and the scars on the uterine wall of typeⅡand typeⅢpatients mostly grew out of the uterine cavity with implantation of villi into the muscle layer.Conclusion MRI images have certain specificity for the diagnosis of CSP classification,and can better reflect the muscle layer thickness of the patient's scar,uterine wall scar prominence and implantation of villi,which is conducive to choosing treatment options.

关 键 词：剖宫产 磁共振 瘢痕妊娠 绒毛植入 

分 类 号：R714.2[医药卫生—妇产科学]