MRI在高强度聚焦超声消融治疗产后胎盘植入中的应用价值  

Application value of MRI in high intensity focused ultrasound ablation of postpartum placental accrete

作　　者：冯敏清[1] 张婧[2] 陈向东[1] 徐智立[3] 冯婉琴 崔运能[2] FENG Minqing;ZHANG Jing;CHEN Xiangdong;XU Zhili;FENG Wanqin;CUI Yunneng(Department of Gynecology,Foshan Women and Children Hospital,Foshan,Guangdong Province 528000,China;Department of Radiology,Foshan Women and Children Hospital,Foshan,Guangdong Province 528000,China;Women Health Care,Foshan Women and Children Hospital,Foshan,Guangdong Province 528000,China)

机构地区：[1]佛山市妇幼保健院妇科,广东佛山528000 [2]佛山市妇幼保健院放射科,广东佛山528000 [3]佛山市妇幼保健院妇女保健科,广东佛山528000

出　　处：《实用放射学杂志》2023年第2期255-258,共4页Journal of Practical Radiology

基　　金：广东省医学科研基金项目(B2019161);佛山市医学影像精准诊断工程技术研究中心(FS0AA-KJ819-4901-0049)。

摘　　要：目的探讨MRI在高强度聚焦超声(HIFU)消融治疗产后胎盘植入中的应用价值。方法回顾性分析经HIFU消融治疗的18例胎盘植入患者资料,观察其治疗前后MRI图像,了解胎盘植入位置、信号特点、侵犯子宫肌层深度及HIFU消融术后MRI表现等。结果术前MRI检查显示18例子宫体积均不同程度增大,病变区子宫肌层变薄,子宫结合带消失,病灶均累及子宫深肌层;T2WI大部分呈高、低混杂信号,其中10例可见多发粗大流空样血管信号从病灶内延伸至子宫肌层甚至直达浆膜层;增强扫描显示大部分病灶呈明显不均匀强化。HIFU消融治疗后增强扫描显示10例病灶大部分或基本无强化;5例病灶见部分小斑片状无强化影;3例病灶仍见强化,但强化程度及范围较前有所减低。结论MRI术前检查能明确胎盘植入位置及肌层受侵情况,有助于HIFU消融术前定位;术后增强扫描可判断HIFU消融治疗疗效。Objective To investigate application value of MRI in high intensity focused ultrasound(HIFU)ablation of postpartum placental accrete.Methods The data of 18 patients with placental accrete treated by HIFU ablation were analyzed retrospectively.The size of the uterine,the location and signal intensity characteristics and the invasion of placental accrete,were analyzed on preoperative and postoperative MRI images.Results Preoperative MRI examination showed that the uterine of 18 cases enlarged in various degrees,the layer of the myometrium in the lesion area became thinner,and the uterine junctional zone disappeared.Lesions invaded the deep uterine layer.At T2WI,the placenta appeared as a mixed of high and low signals.Of these,10 cases showed multiple large,hollow-like vascular signal extending into the myometrium and even to the perimetrium.By contrast enhanced,placental accrete were most heterogeneous enhancement significantly.After HIFU ablation treatment,10 cases showed most or basically area with no enhancement,5 cases showed small patches with no enhancement,3 cases still showed enhancement,but the degree of enhancement were reduced.Conclusion Preoperative MRI examination can determine the location of placenta accrete and the general degree of placental invasion,which is conducive to the preoperative localization of HIFU ablation.Postoperative dynamic enhanced scanning is helpful to judge the efficacy of HIFU ablation treatment.

关 键 词：高强度聚焦超声消融 产后胎盘植入 磁共振成像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.462[医药卫生—诊断学] R445.2[医药卫生—临床医学]