对比经阴道超声与MRI检查对剖宫产术后瘢痕妊娠的诊断价值研究  

Comparison of Diagnostic Value Between Transvaginal Ultrasonography and MRI in the Diagnosis of Cesarean Scar Pregnancy

作　　者：胡晶晶 罗振凌[2] HU Jing-jing;LUO Zhen-ling(Department of Ultrasound,the first Maternal and Infant Health Care Hospital Affiliated to Tongji University,Shanghai 200042,China;Department of Gastrointestinal Surgery,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200438,China)

机构地区：[1]同济大学附属第一妇婴保健院超声科,上海200042 [2]上海中医药大学附属岳阳中西医结合医院胃肠外科,上海200438

出　　处：《中国CT和MRI杂志》2022年第3期111-112,125,共3页Chinese Journal of CT and MRI

基　　金：上海市科委资助项目(17401934812)。

摘　　要：目的探究经阴道超声和MRI检查对剖宫产术后子宫瘢痕妊娠的诊断价值。方法选取本院2018年9月至2019年12月收治的82例剖宫产后瘢痕妊娠患者,收集患者临床及影像学资料,观察分析经阴道超声检查和MRI检查剖宫产术后子宫瘢痕妊娠的影像学表现,以术后病理诊断为“金标准”,对比经阴道超声检查和MRI检查的准确性、敏感性、特异性。结果经阴道超声检查对剖宫产术后子宫瘢痕妊娠的诊断灵敏性、特异性和准确性分别为62.20%、64.63%、71.95%,低于MRI检查(89.02%、90.24%、86.59%)。MRI检查对剖宫产术后子宫瘢痕妊娠的诊断灵敏性、特异性和准确性明显高于经阴道超声检查(P<0.05)。纯妊娠囊型胎囊较大时超声可见胎囊丰富低阻血流,混合回声包块型内见无回声,子宫下段常见局部隆起,包块与膀胱间的子宫肌层常明显变薄。MRI检查妊娠囊黏附于子宫前下壁呈类圆形或卵圆形;T_(1)WI上呈低信号、混杂斑片状高信号,T_(2)WI呈混杂高信号,病灶周围可见低环形线状低信号包膜带。结论MRI检查对CSP的诊断灵敏性、特异性和准确性优于阴道超声检查,可提供更多有价值的影像学资料。Objective To investigate the diagnostic value of transvaginal ultrasonography and MRI in the diagnosis of cesarean scar pregnancy.Methods 82 patients with cesarean scar pregnancy who were admitted to our hospital from September 2018 to March 2019 were enrolled.Clinical and imaging data were collected.The imaging findings of cesarean scar pregnancy by transvaginal ultrasonography and MRI were observed and analyzed.The postoperative pathological diagnosis was the"gold standard"to compare the accuracy,sensitivity and specificity of transvaginal ultrasonography and MRI.Results The diagnostic sensitivity,specificity and accuracy of transvaginal ultrasonography for cesarean scar pregnancy were 62.20%,64.63%,and 71.95%,respectively,which were lower than those of MRI examinations(89.02%,90.24%,and 86.59%).The sensitivity,specificity and accuracy of MRI examination for cesarean scar pregnancy were significantly higher than those of transvaginal ultrasonography(P<0.05).When the pure gestational foetal sac was larger,the ultrasonography can be seen with rich and low-resistance bloodstream.There was no echo in the mass with mixed echo,and the local bulge was common in the lower uterine segment.The myometrium between the mass and the bladder became often thin.MRI examination showed that the gestational sac was adhered to the anterior wall of the uterus,which was round or oval,T_(1)WI showed low signal and mixed patchy high signal,T_(2)WI showed mixed high signal,and low-annular and linear envelope band with low signal can be seen around the lesion.Conclusion The sensitivity,specificity,and accuracy of MRI in the diagnosis of CSP are superior to transvaginal ultrasonography,and MRI can provide more valuable imaging data.

关 键 词：经阴道超声 剖宫产 核磁共振成像 瘢痕妊娠 

分 类 号：R713[医药卫生—妇产科学] R445[医药卫生—临床医学]