盆底动态MRI对子宫脱垂的临床诊断价值  

Clinical diagnostic value of dynamic MRI of pelvic floor in uterine prolapse

作　　者：王娟 刘晓云 杨龙 何青 马学进 李仕广 WANG Juan;LIU Xiaoyun;YANG Long;HE Qing;MA Xuejin;LI Shiguang(Department of Imaging,the Third Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou Province 563002,China;Department of Gynaecology and Obstetrics,the Third Affiliated Hospital of Zunyi Medical University,Zuiyi,Guizhou Province 563002,China;Department of Imaging,Guiyang Second People's Hospital,Guiyang 550000,China)

机构地区：[1]遵义医科大学第三附属医院影像科,贵州遵义563002 [2]遵义医科大学第三附属医院妇产科,贵州遵义5630022 [3]贵阳市第二人民医院影像科,贵州贵阳550000

出　　处：《实用放射学杂志》2022年第6期948-951,共4页Journal of Practical Radiology

基　　金：遵义市创新人才团队培养项目[遵义人才(2020)6号]。

摘　　要：目的评价盆底动态MRI对子宫脱垂(UP)的诊断价值及分析误诊原因.方法回顾性分析UP患者67例和非UP患者17例的盆底动态MRI图像与临床诊断及分度情况.以临床诊断及传统分度作为金标准,对力排相MRI判断和分度UP分别进行诊断试验.采用Pearson相关分析判断力排相MRI宫颈前下缘与耻骨尾骨线(PCL)距离和UP传统分度间是否相关.分析MRI漏诊假阴性病例的可能原因.结果UP组67例,非UP组17例,2组之间年龄[(60.76±12.11)岁vs(61.24±11.08)岁]、孕次[(4.71±2.42)次vs(4.28±1.91)次]和产次[(3.94±2.11)次vs(3.24±1.77)次]均无统计学差异.以临床诊断及传统分度作为金标准,力排相MRI诊断和分度UP的诊断准确率、灵敏度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率分别为0.73和0.46、0.75和0.54、0.65和0.34、0.89和0.57、0.39和0.31、0.35和0.66、0.25和0.46.考虑UP严重程度的情况下,真阳性与假阴性相比,2组间PCL倾斜角差异有统计学意义(t=-2.542,P=0.014),而组间骶尾椎曲率、后位子宫占比、骨盆出口前后径和骨盆出口面积差异无统计学意义.宫颈前下缘至PCL距离与传统分度呈正相关(r=0.562,P=0.000).结论盆底动态MRI对UP检出率较高,与传统分度标准评估UP的严重程度一致性较差,MRI检查技术及临床对UP检查方式均需改进.Objective To evaluate the diagnostic value of pelvic floor dynamic MRI for uterine prolapse(UP),to analyze the causes of misdiagnosis.Methods The dynamic MRI of pelvic floor,clinical diagnoses and grading of 67 patients with UP and 17 patients without UP were analyzed retrospectively.Taking clinical diagnosis and traditional grading as the gold standard,the diagnostic tests were carried out on the ability of defecation phase MRI diagnosis and UP grading.Pearson correlation analysis was used to determine the correlation between the distance from anterior and inferior cervix margin to pubococcygeal line(PCL)at defecation phase MRI and UP traditional grading.The possible causes of missed diagnosis of false negative cases in MRI diagnosis were analyzed.Results There were 67 cases in UP group and 17 cases in non UP group.There was no significant difference in age[(60.76±12.11)years vs(61.24±11.08)years],times of pregnancy[(4.71±2.42)times vs(4.28±1.91)times],parity[(3.94±2.11)times vs(3.24±1.77)times]between the two groups.Taking clinical diagnosis and traditional grading as the gold standard,the diagnostic accuracy,sensitivity,specificity,positive predictive value,nega-tive predictive value,false positive rate and false negative rate of defecation phase MRI diagnosis and UP grading were 0.73 and 0.46,0.75 and 0.54,0.65 and 0.34,0.89 and 0.57,0.39 and 0.31,0.35 and 0.66,0.25 and 0.46,respectively.Consider the severity of UP,compared with true positive and false negative,the difference in PCL inclination(t=-2.542,P=0.014)between two groups was statistically significant,while there were no statistically significant differences in sacrococcygeal vertebral curvature,proportion of retroposition of uterus,anteroposterior diameter of pelvic floor outlet and pelvic outlet area between the two groups.The distance from anterior and inferior cervix margin to PCL was positively correlated with traditional grading(r=0.562,P=0.000).Conclusion The dynamic MRI of pelvic floor has a high detection rate of UP,it has a poor consis

关 键 词：磁共振成像 子宫脱垂 诊断试验 

分 类 号：R445.2[医药卫生—影像医学与核医学] R711.74[医药卫生—诊断学]