胎盘粘连与胎盘植入的MRI鉴别诊断  

Differential diagnosis of MRI between placenta adhesion and placenta increta

作　　者：王亚[1] 王忠[1] 王强[1] 郑晓林[2] 陈佩珊 WANG Ya;WANG Zhong;WANG Qiang;ZHENG Xiaolin;CHEN Peishan(Department of Radiology,Dongguan Maternal and Child Health Care Hospital,Dongguan 523000,China)

机构地区：[1]广东省东莞市妇幼保健院放射科,广东东莞523000 [2]广东省东莞市人民医院放射科,广东东莞523000

出　　处：《中国中西医结合影像学杂志》2022年第5期465-469,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：东莞市科技局立项课题(2014105101080)。

摘　　要：目的:探讨胎盘粘连与胎盘植入的MRI征象差别,以提高对两者的鉴别诊断水平。方法:对76例胎盘异常患者的MRI(以T_(2)WI、DWI为主)征象进行分析,按手术病理结果分为胎盘粘连组(50例)与胎盘植入组(26例),比较2组异常胎盘与子宫肌层交界面的形态特征、信号改变、蜕膜完整性及胎盘边缘类型。采用logistic回归分析胎盘植入的危险因素,并用诊断性试验检验2组的鉴别诊断效能。结果:胎盘粘连组检出病灶58处,胎盘植入组31处。2组矢状位DWI及T_(2)WI均表现为低信号蜕膜线连续性中断。胎盘植入组异常胎盘边缘类型以锯齿样(1类)为主,胎盘粘连组以条、面样膨隆(2类)和局限性膨隆(3类)为主,2组差异有统计学意义(P<0.05)。2组异常胎盘DWI均呈高信号,2组DWI信号强度比值差异有统计学意义(P<0.05)。2组T_(2)WI均呈稍高信号,2组T_(2)WI信号强度比值,差异无统计学意义(P>0.05)。logistic回归分析显示,异常胎盘边缘类型和DWI信号强度比值是诊断胎盘植入的危险因素。ROC曲线示异常胎盘边缘类型和DWI信号强度比值联合鉴别诊断胎盘粘连与胎盘植入的AUC为0.95,高于单项的鉴别诊断,差异有统计学意义(P<0.05)。结论:DWI信号强度比值与异常胎盘边缘类型联合鉴别诊断胎盘粘连与胎盘植入的敏感度、特异度较高,可为临床治疗提供可靠依据。Objective:To investigate the difference in MRI features between placenta adhesion and placenta increta and improve the level of differential diagnosis.Methods:MRI(mainly T_(2)WI and DWI)signs of 76 patients with placental abnormalities were analyzed.According to postoperative pathologic findings,the patients were classified into 2 groups,50 cases in the placenta adhesion group and 26 cases in the placenta increta group.The morphological characteristics,signal changes,the decidual integrity and the shape of placenta margin between two groups were compared.Logistic regression analysis was used to determine risk factors of placenta increta.The diagnostic test was used to test the efficiency in the differential diagnosis of the two groups.Results:There were 58 foci in the placenta adhesion group and 31 foci in the placenta increta group.All patients showed that the hypointensity decidua line was interrupted on sagittal DWI and T_(2)WI.The shapes of the placental margin were divided into 3 types,of which placenta increta was mainly serrated(type 1),placenta accrete was mainly strip and facial swelling(type 2)and localized swelling(type 3),with significant difference between the 2 groups(P<0.05).The abnormal placenta in the 2 groups demonstrated hyperintensity on DWI,and the signal intensity ratio was significantly different(P<0.05).The two groups demonstrated a slightly hyperintensity on T_(2)WI,and the signal intensity ratio had no significant difference(P>0.05).Logistic regression revealed that the shape of placental margin and DWI signal intensity ratio were risk factors for the diagnosis of placenta increta.The ROC curve showed that AUC of the abnormal placental margin combined with DWI signial intensity ratio in differential diagnosis of placental adhesion and placental increta was 0.95,which was higher than that of the single differential diagnosis,which showed significant differences(P<0.05).Conclusions:The signal intensity ratio of DWI combined with the morphological type of abnormal placental edge has a high

关 键 词：胎盘植入 胎盘粘连 形态 信号强度 诊断 鉴别 磁共振成像 

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