特异性MRI征象评估胎盘植入的诊断价值  

The diagnostic value of specific MRI signs in evaluating placenta implantation

作　　者：朱婉秋 赵雪梅[1] 方旖骅 侯唯姝[1] ZHU Wanqiu;ZHAO Xuemei;FANG Yihua;HOU Weishu(Department of Radiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Obstetrics,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院放射科,安徽合肥230022 [2]安徽医科大学第一附属医院妇产科,安徽合肥230022

出　　处：《实用放射学杂志》2022年第6期940-944,共5页Journal of Practical Radiology

基　　金：安徽省自然科学基金项目(2008085QH381)。

摘　　要：目的探讨MRI征象在各分型胎盘植入中的诊断价值,确定可能预测各型胎盘植入最相关的MRI征象.方法以临床手术或病理为依据,回顾性分析胎盘粘连(19例)、胎盘植入(10例)、穿透性胎盘植入(43例)和无胎盘植入患者(9例)产前MRI图.比较胎盘及其相邻结构相关的8个MRI征象在各型胎盘植入与无植入组间差异.评价各征象对各分型胎盘植入的诊断效能.结果T_(2)WI胎盘低信号带在各型胎盘植入和无植入组间差异有统计学意义(P<0.01);子宫膨隆在胎盘植入和无植入组间有统计学差异(P<0.01);穿透性胎盘植入和无植入组间除胎盘信号不均匀、膀胱"帐篷征",余征象均有统计学差异(P<0.05).评估胎盘粘连,T_(2)WI胎盘低信号带阳性预测值(PPV)100%;评估胎盘植入,T_(2)WI胎盘低信号带与子宫膨隆联合诊断阴性预测值(NPV)提高到90%;评估穿透性胎盘植入,T_(2)WI胎盘低信号带与子宫胎盘交界面波浪状改变和(或)子宫膀胱交界面局部缺损联合诊断PPV 100%,NPV 90%.结论选择特定MRI征象有利于胎盘植入分型.T_(2)WI胎盘内低信号带是鉴别有无胎盘植入的关键征象,与子宫胎盘交界面波浪状改变和子宫膀胱交界面局部缺损相结合对穿透性胎盘植入具有较高诊断价值.Objective To investigate the diagnostic value of MRI signs in the diagnosis of different types of placenta implantation and identify the most relevant MRI signs that may predict different types of placenta implantation.Methods According to the clinical operation and pathology,the prenatal MRI of patients with placenta adhesion(19 cases),placenta increta(10 cases),placenta percreta(43 cases)and patients without placenta implantation(9 cases)were analyzed retrospectively.The differences of the 8 MRI signs associated with the placenta and adjacent structures between different types of placenta implantation groups and without placenta implantation group were analyzed.The diagnostic value of each MRI sign in different types of placenta implantation was evaluated.Results Dark intraplacental bands on T_(2)WI showed statistically significant difference between different types of placenta implantation groups and without placenta implantation group(P<0.01).Between the placenta increta group and without placenta implantation group,significant difference was also found in uterine wall bulging(P<0.01).Except for the heterogeneous intraplacenta signal intensity and tenting of the bladder,there were statistically significant differences in the other MRI signs between the placenta percreta group and without placenta implantation group(P<0.05).The dark intraplacental bands on T_(2)WI in the detection of placenta adhesion showed a positive predictive value(PPV)of 100%.Evaluating placenta increta,the combination of dark intraplacental bands on T_(2)WI and uterine wall bulging improved the negative predictive value(NPV)to 90%.For the detection of placenta percreta,the combination of the dark intraplacental bands on T_(2)WI,the wavy uterine placental wall interface and disappearance of local uterine-bladder wall interface showed a PPV of 100%,and NPV of 90%.Conclusion The specific MRI signs are useful for the classification of placenta implantation.Dark intraplacental bands on T_(2)WI is the key sign for the diagnosis of placenta imp

关 键 词：磁共振成像 胎盘粘连 胎盘植入 穿透性胎盘植入 

分 类 号：R445.2[医药卫生—影像医学与核医学] R714.462[医药卫生—诊断学]