MRI影像联合超声图像特征对侵袭性胎盘植入的诊断及不良临床结局的预测价值  

The Value of MRI Image Combined with Ultrasound Image Features in the Diagnosis and Prediction of Adverse Clinical Outcomes of Invasive Placental Implantation

作　　者：汪姝妤 余兰[1] 罗俊莲 黄琪媚 周晓梅 冷媛媛[2] 黄燕涛[2] 钟丽萍 袁尉峰 WANG Shu-yu;YU Lan;LUO Jun-lian;HUANG Qi-mei;ZHOU Xiao-me;LENG Yuan-yuan;HUANG Yan-tao;ZHONG Li-ping;YUAN Wei-feng(Department of Ultrasound Medicine,Zigong First People's Hospital,Zigong 643000,Sichuan Province,China;Department of Radiology,Zigong First People's Hospital,Zigong 643000,Sichuan Province,China;The First Affiliated Hospital of Chengdu Medical College,Chengdu 610599,Sichuan Province,China)

机构地区：[1]自贡市第一人民医院超声医学科,四川自贡643000 [2]自贡市第一人民医院放射科,四川自贡643000 [3]成都医学院第一附属医院,四川成都610599

出　　处：《中国CT和MRI杂志》2024年第9期124-127,共4页Chinese Journal of CT and MRI

基　　金：2020年四川省医学(青年创新)科研课题项目(Q20059)。

摘　　要：目的探究核磁共振成像(MRI)影像联合超声图像特征对侵袭性胎盘植入的诊断,并分析对不良临床结局的预测价值。方法选取2021年8月~2023年2月我院收治的156例疑似胎盘植入孕产妇,进行超声检查、MRI检查,以手术或病理结果为“金标准”进行胎盘植入分型,分为侵袭组(植入型、穿透型)、非侵袭组(非胎盘植入、粘连性胎盘),比较两组MRI影像、超声图像特征,进行多变量Logistic回归分析,分析MRI影像、超声图像特征对侵袭性胎盘植入的诊断价值。根据侵袭性胎盘植入孕产妇的临床结局分为不良结局组、良好结局组,比较不同结局孕产妇的MRI影像、超声图像特征,并分析MRI、超声特征对不良结局的预测价值。结果经手术病理诊断,156例疑似胎盘植入孕产妇分为侵袭组(94例)、非侵袭组(62例)。经多变量Logistic回归分析显示,子宫肌层变薄、胎盘内T2WI低信号、子宫肌层-胎盘分界欠清、胎盘内异常增生血管、胎盘/子宫局限膨出、胎盘后方间隙消失、胎盘内虫蚀样改变、胎盘基底部血流紊乱、超声征象评分等MRI影像、超声图像特征均为侵袭性胎盘植入的影响因素(P<0.05);不良结局组、良好结局组上述各项MRI影像、超声图像特征比较,差异均有统计学意义(P<0.05);MRI影像、超声图像各项特征联合诊断侵袭性胎盘植入的AUC为0.928,联合预测侵袭性胎盘植入不良结局的AUC为0.936(P<0.05)。结论MRI影像、超声图像特征可用于侵袭性胎盘植入诊断,联合子宫肌层变薄、胎盘内T2WI低信号、子宫肌层胎盘分界欠清、胎盘内异常增生血管、胎盘/子宫局限膨出、胎盘后方间隙消失、胎盘内虫蚀样改变、胎盘基底部血流紊乱及超声征象评分诊断的效能更高,且各项特征联合预测侵袭性胎盘植入不良结局价值较高。Objective To explore the diagnostic value of magnetic resonance imaging(MRI)imaging combined with ultrasound image characteristics for invasive placental implantation,and analyze its predictive value for adverse clinical outcomes.Methods A total of 156 pregnant women with suspected placenta implantation admitted to our hospital from August 2021 to February 2023 were selected for ultrasound and MRI examinations,classification of placental implantation based on surgical or pathological results as the"gold standard",and the patients were divided into invasive group(implantation type,penetrating type)and non-invasive group(non-placenta implantation,adhesive placenta).The characteristics of MRI and ultrasound images were compared between the two groups,and multivariate Logistic regression analysis was performed to analyze the diagnostic value of MRI and ultrasound image characteristics for invasive placenta accreta.Based on the clinical outcomes of pregnant women with invasive placenta implantation,they were divided into adverse outcome group and good outcome group.The MRI and ultrasound image characteristics of pregnant women with different outcomes were compared,and the predictive value of MRI and ultrasound characteristics for adverse outcomes was analyzed.Results Based on surgical and pathological diagnosis,156 pregnant women with suspected placenta implantation were divided into an invasive group(94 cases)and a non-invasive group(62 cases).Multivariate Logistic regression analysis showed that the thinning of the myometrium,low signal intensity on T2WI in the placenta,unclear boundary between the myometrium and placenta,abnormal hyperplastic blood vessels in the placenta,localized bulging of the placenta/uterus,disappearance of the posterior interstitial space of the placenta,worm-like changes in the placenta,blood flow disorder in the basal part of the placenta,and ultrasound signs such as score of MRI imaging and ultrasound image characteristics were all factors affecting invasive placental implantation(P<0.05).

关 键 词：侵袭性胎盘植入 超声 MRI LOGISTIC 超声征象评分 ROC曲线 

分 类 号：R445.2[医药卫生—影像医学与核医学]