胎盘植入MRI征象:出现两种或以上异常MRI征象时诊断准确性更高  

MRI signs of placenta accreta: the presence of at least two abnormal MRI signs has a high diagnostic value

作　　者：陈斐[1] 张盼盼[1] 王立晶[2] CHEN Fei;ZHANG Panpan;WANG Lijing(Department of Radiology,Binzhou People's Hospital,Binzhou 256600,China;Department of Obstetrics,Binzhou People's Hospital,Binzhou 256600,China)

机构地区：[1]山东省滨州市人民医院放射科,山东滨州256600 [2]山东省滨州市人民医院产科,山东滨州256600

出　　处：《分子影像学杂志》2022年第3期317-322,共6页Journal of Molecular Imaging

基　　金：山东省中医药科技项目(2021M045)。

摘　　要：目的评估产前MRI对胎盘植入诊断的准确性。方法回顾性分析2018年5月~2021年5月我院临床怀疑胎盘植入MRI图像,共47例孕妇图像符合标准纳入研究,分析2名医师对胎盘植入异常MRI征象检验的一致性,结合手术病理结果分析MRI胎盘植入诊断效能,比较评估胎盘植入的两种诊断方法:至少出现一种MRI征象(方法1)与至少出现两种MRI征象(方法2)。结果胎盘植入异常MRI图像中,2名医师对以下征象有较高一致性,T2WI序列低信号暗带(Kappa=0,874)、子宫肌层局部中断胎盘组织突入(Kappa=0.753)、胎盘内见异常增粗迂曲血管(Kappa=0.870)。MRI诊断胎盘植入总体准确度较高:Youden指数0.69,敏感度90.91%,特异性78.57%。诊断粘连性胎盘准确度低于植入性及穿透性胎盘。方法1诊断胎盘植入ROC曲线下面积为0.714,方法2诊断胎盘植入ROC曲线下面积为0.913,方法2的准确度高于方法1。结论MRI是评估胎盘植入的有效手段,至少出现两种异常MRI征象时诊断准确度最高。Objective To evaluate the accuracy of prenatal MRI for the diagnosis of placenta implantation.Methods MRI images of clinically suspected placenta implantation in our hospital from May 2018 to May 2021 were retrospectively analyzed.The images of 47 pregnant women were included in the study according to the criteria.The consistency of MRI signs of abnormal placenta implantation was analyzed.Combined with surgical pathological results,the diagnostic efficacy of MRI placenta implantation was analyzed.Two diagnostic methods were used to assess placenta implantation,with at least one MRI sign(method 1) and at least two MRI signs(method 2).Results Two physicians had high agreement with the following signs,hypointense band on T2 WI sequence(Kappa=0.874),local interruption of placental tissue protrusion in the uterus(Kappa=0.753),abnormal thickened tortuous vessels in placenta(Kappa=0.870).The overall accuracy of MRI in diagnosing placenta accreta was high:Youden index was 0.69,sensitivity was 90.91% and specificity was 78.57%.MRI diagnosis accuracy of adherent placenta is lower than that of implanted and penetrating placenta.The AUC area of method 1 was 0.714,and that of method 2 was 0.913.The accuracy of method 2 was higher than that of method 1.Conclusion MRI is an effective method to evaluate placenta implantation,and the diagnostic accuracy is highest when at least two abnormal MR signs occur.

关 键 词：胎盘植入 磁共振成像 前置胎盘 

分 类 号：R714.462[医药卫生—妇产科学] R445.2[医药卫生—临床医学]