前置胎盘合并植入患者MRI与彩色多普勒超声图像特征及漏诊的因素分析  

Analysis of MRI and color Doppler ultrasound features and missed diagnosis factors in patients with placenta previa combined with placenta accreta

作　　者：李晓丽[1] 刘光虹[1] 刘向蕊[1] LI Xiaoli;LIU Guanghong;LIU Xiangrui(Department of Obstetrics and Gynecology,Zhengzhou People's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州人民医院妇产科,河南郑州450000

出　　处：《实用放射学杂志》2023年第8期1297-1300,共4页Journal of Practical Radiology

摘　　要：目的探讨前置胎盘合并植入患者MRI与彩色多普勒超声图像特征及漏诊影响因素。方法选取60例前置胎盘患者,均行彩色多普勒超声、MRI检查和术中探查,分析超声和MRI检查的图像特征。结果51例患者被诊断为胎盘植入,其中粘连性前置胎盘5例(9.80%)、植入性前置胎盘33例(64.71%)、穿透性前置胎盘13例(25.49%)。彩色多普勒超声诊断48例为胎盘植入,检出率90.20%,漏诊3例(5.88%),漏诊原因分别为肠道内气体干扰、胎盘位置及解剖结构复杂和肥胖。MRI诊断胎盘植入49例,检出率96.08%,漏诊2例(1.96%),漏诊原因为胎盘周围解剖学结构复杂、内部血窦不丰富。Kappa值检验结果表明MRI与超声检查前置胎盘合并植入的一致性较高(Kappa≥0.75)。MRI诊断前置胎盘合并植入的敏感度、特异度、准确率及曲线下面积(AUC)均高于彩色多普勒超声检查,但差异无统计学意义(P>0.05)。结论前置胎盘合并植入彩色多普勒超声表现为胎盘绒毛穿入子宫肌层,胎盘增厚,胎盘侵入膀胱壁;MRI表现为胎盘内信号不均匀,T2WI呈低信号,胎盘和子宫肌层交界不清。漏诊的影响因素包括肠道内气体干扰、胎盘解剖结构复杂、肥胖和胎盘内血窦不丰富。Objective To analyse the characteristics of MRI and color Doppler ultrasound in patients with placenta previa combined with placenta accreta,and to explore the influencing factors of missed diagnosis.Methods Sixty patients with placenta previa were selected,all patients underwent color Doppler ultrasound examination,MRI examination and intraoperative exploration,and the image characteristics of ultrasound and MRI were analyzed.Results Fifty-one cases were diagnosed as placenta accreta,including 5 cases of adhesion placenta previa(9.80%),33 cases of implantation placenta previa(64.71%),and 13 cases of penetrating placenta previa(25.49%).48 cases of placenta accreta were diagnosed by color Doppler ultrasound,the detection rate was 90.20%,and 3 cases(5.88%)were missed.The reasons for missed diagnosis were intestinal gas interference,complex placental location and anatomical structure,and obesity.MRI diagnosed 49 cases of placenta accreta,the detection rate was 96.08%,missed diagnosis in 2 cases(1.96%).The reasons for missed diagnosis were the complex anatomical structure around the placenta and insufficient internal blood sinuses.The Kappa value test results showed that MRI and ultrasound were highly consistent with placenta previa combined with placenta accreta(Kappa≥0.75).The sensitivity,specificity,accuracy and area under the curve(AUC)of MRI in the diagnosis of placenta previa with placenta accreta were higher than those of color Doppler ultrasound,but there was no significant difference(P>0.05).Conclusion Color Doppler ultrasound of placenta previa combined with placenta accreta showed that the placental villi invaded the myometrium,the placenta thickened,and the placenta invaded the bladder wall,while MRI showed uneven signal in placenta,low signal on T,WI,and unclear interface between placenta and myometrium.The influencing factors of missed diagnosis including intestinal gas interference,complex placental anatomy,obesity and poor blood sinuses in placenta.

关 键 词：前置胎盘 胎盘植入 磁共振成像 彩色多普勒超声 漏诊 

分 类 号：R714.56[医药卫生—妇产科学] R714.462[医药卫生—临床医学] R445.2R445.1