基于MRI征象预测凶险性前置胎盘患者子宫切除风险  

Prediction of Hysterectomy Risk in Patients with Pernicious Placenta Previa Based on MRI Signs

作　　者：陈永露[1] 刘照然[1] 李心怡 汤卓鹏 宋亭[1] 唐文艳[1] CHEN Yonglu;LIU Zhaoran;LI Xinyi;TANG Zhuopeng;SONG Ting;TANG Wenyan(Department of Radiology,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院放射科,广东广州510150

出　　处：《中国医学影像学杂志》2022年第8期821-825,827,共6页Chinese Journal of Medical Imaging

基　　金：广州市卫生健康科技西医类一般引导项目(20191A010060,20201A010058)。

摘　　要：目的探讨MRI征象评估凶险性前置胎盘患者子宫切除风险的价值。资料与方法回顾性分析2017年1月—2019年7月于广州医科大学附属第三医院行产前盆腔检查的96例凶险性前置胎盘患者的临床及MRI资料,依据手术结果分为子宫切除组42例及对照组54例,评估胎盘信号不均匀、胎盘内T2暗带、子宫下段膨隆、胎盘内血管异常、膀胱帐篷征、子宫肌层变薄、宫颈突出征、侵犯周围组织和器官等征象。两组以上征象行单因素分析,并依据独立危险因素的回归系数建立评分系统,使用受试者工作特征曲线进行评估。结果子宫切除组剖宫产次数(2比1;Z=-3.638,P=0.000)、术中出血量更多[(1744.19±1018.16)ml比(863.00±637.12)ml;t=-4.732,P=0.000],且胎盘植入性疾病发生率更高(100.00%比59.26%)。子宫切除组中子宫肌层变薄(95.24%比59.20%)、胎盘信号不均匀(100.00%比88.89%)、胎盘内T2暗带(97.61%比81.48%)、膀胱帐篷征(42.86%比7.41%)和胎盘内异常血管(95.24%比55.56%,χ^(2)=18.838)更常见(P均<0.05)。子宫切除术的独立危险因素为胎盘内血管异常、子宫肌层变薄和膀胱帐篷征,回归系数分别为2.264、2.401和1.683(P均<0.05)。依据其回归系数生成6分评分系统,对子宫切除术的预测能力良好,曲线下面积为0.829,当分值≥3.5,敏感度为95.20%,特异度为57.40%。结论基于MRI征象(胎盘内血管异常、子宫肌层变薄和膀胱帐篷征)的评分系统能有效预测凶险性前置胎盘患者的子宫切除风险。Purpose To investigate the risk value of hysterectomy in patients with pernicious placenta previa(PPP) based on MRI signs.Materials and Methods The clinical and MRI data of 96 patients with PPP in the Third Affiliated Hospital of Guangzhou Medical University from January 2017 to July 2019 were retrospectively analyzed. According to the surgical results, all patients were divided into two groups,including hysterectomy group(n=42 cases) and control group(n=54 cases). MRI features, including the uneven placental signal, T2 dark band in placenta, swelling of lower uterine segment, abnormal blood vessels in placenta, bladder tenting, thinning of myometrium, cervical protrusion sign, invasion of surrounding tissues and organs, were further evaluated. Univariate analyses were performed to analyze all MRI features between the two groups, establishing a scoring system according to the regression coefficient of independent risk factors. The receiver operating characteristic curves were drawn to analyze the area under the curve. Results The cesarean sections(2 vs. 1;Z=-3.638, P=0.000),the intraoperative blood loss[(1 744.19±1 018.16) ml vs.(863.00±637.12) ml;t=-4.732, P=0.000], and the incidence of placenta accreta spectrum disorder(100.00% vs. 59.26%) in the hysterectomy group was significantly higher than those in the control group. The incidence of myometrium thinning(95.24% vs. 59.20%), uneven placental signal(100.00% vs. 88.89%), T2 intra placental dark band(97.61% vs. 81.48%),bladder tenting(42.86% vs. 7.41%) and abnormal blood vessels(95.24% vs. 55.56%, χ^(2)=18.838) in placenta of hysterectomy group was significantly higher than those of control group(all P<0.05). The independent risk factors of hysterectomy were abnormal blood vessels in placenta, myometrium thinning and bladder tenting(regression coefficient 2.264, 2.401 and 1.683, all P<0.05). A 6-point scoring system was generated according to its regression coefficient, which had a good predictive ability for hysterectomy. The area under the curve was 0.829,

关 键 词：凶险性前置胎盘 子宫切除 磁共振成像 预测 

分 类 号：R445.2[医药卫生—影像医学与核医学] R714.56[医药卫生—诊断学] R713.42[医药卫生—临床医学]