胎盘下血管异常MRI分型预测胎盘植入疾病类型的价值  

The value of MRI-based classification of subplacental vascular abnormalities in predicting the type of placenta accreta disorders

作　　者：张夏 康立清[1] 郭素引 潘志斌 周英文 ZHANG Xia;KANG Li-qing;GUO Su-yin(Department of MRI,Cangzhou Central Hospital,Hebei 061000,China)

机构地区：[1]沧州市中心医院磁共振成像科,河北061000

出　　处：《放射学实践》2023年第5期598-603,共6页Radiologic Practice

摘　　要：目的:比较不同类型胎盘植入性疾病(PAS)的MRI征象,基于关键MRI征象对PAS类型进行预测。方法:回顾性分析经手术或病理证实的85例PAS患者的临床及MRI资料,比较粘连组(27例)、植入组(29例)与穿透组(29例)MRI征象的差异。采用多元Logistic回归分析胎盘下血管异常对PAS类型的预测价值。结果:粘连组、植入组、穿透组三组间胎盘膨出、前置胎盘、胎盘下血管异常、胎盘内暗带的发生率差异均有统计学意义(P<0.05)。植入组与穿透组比较,完全型前置胎盘(82.8%)、Ⅳ型胎盘下血管异常(75.9%)的发生率高于植入组(分别为51.7%、27.6%),差异具有统计学意义(P<0.05),其余征象的发生率差异无统计学意义(P>0.05);Ⅱ型胎盘下血管异常的发生率在三组间差异无统计学意义(P>0.05)。多元Logistic回归分析结果显示,植入组与穿透组比较时,Ⅲ型胎盘下血管异常提示胎盘植入的概率明显增高(P<0.05),而Ⅳ型血管异常提示胎盘穿透的概率明显增加(P<0.05);植入组与粘连组比较时,胎盘下血管异常不能预测其分型(P>0.05)。结论:不同PAS类型中前置胎盘、胎盘膨出、胎盘下血管异常及胎盘内暗带等四种MRI征象的发生率差异具有统计学意义,其中Ⅲ、Ⅳ型胎盘下血管异常能够预测PAS类型,胎盘下血管异常对术前预测PAS类型有一定价值。Objective:To investigate the value of MRI features to preoperatively predict the type of placenta accreta spectrum disorders(PAS).Methods:85 cases with PAS confirmed by cesarean section or pathology who underwent prenatal MRI examinations from February 2017 to December 2021 were retrospectively analyzed.Clinical data and MRI features were compared among the placenta accreta(27 patients),placenta increta(29 patients)and placenta percreta(29 patients)group.Multiple logistic regression analysis was performed to analyze the predictive value of subplacental vascular anomalies on PAS types.Results:Compared with increta and percreta group,the accreta group had significant different proportion of placenta bulge,placenta previa,subplacental vascular anomalies and intraplacental hypointense bands on T 2WI(P<0.05).Compared with percreta group,complete placenta previa(82.8%)and typeⅣof subplacental vascular anomalies(75.9%)were significantly more than those in increta group,but no significant differences existed in other MRI features.There were no significant difference of the inproportion of typeⅡof subplacental vascular anomalies among three groups.Multiple logistic regression analysis showed that subplacental vascular anomalies of typeⅢindicated high probability of placenta accreta(P<0.05),while the typeⅣindicated high probability of placenta percreta(P<0.05).The subplacental vascular anomalies did not significantly affect the classification of PAS when increta and accreta group were compared(P>0.05).Conclusion:The proportions of placenta bulge,placenta previa,subplacental vascular anomalies and intraplacental hypointense bands on T 2WI differ in three PAS types.TypeⅢandⅣsubplacental vascular anomalies can predicate the type of PAS.

关 键 词：磁共振成像 胎盘粘连 胎盘植入 胎盘穿透 胎盘下血管异常 

分 类 号：R714.2[医药卫生—妇产科学] R445.2[医药卫生—临床医学]