体素内不相干运动成像诊断胎盘植入谱系疾病及预测术中大量失血的价值  

The value of intravoxel incoherent motion imaging in diagnosing placenta accreta spectrum disorders and predicting massive intraoperative bleeding

作　　者：郑潇涵 陈欣 王光彬 Zheng Xiaohan;Chen Xin;Wang Guangbin(Department of Medical Imaging,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院医学影像科,济南250021

出　　处：《中华放射学杂志》2024年第12期1417-1423,共7页Chinese Journal of Radiology

基　　金：山东省自然科学基金(ZR2020QH268)。

摘　　要：目的探讨体素内不相干运动(IVIM)成像定量参数诊断胎盘植入谱系疾病(PASDs)及预测术中大量失血的效能。方法该研究为病例对照研究,前瞻性收集2017年1月至2022年12月于山东第一医科大学附属省立医院就诊的怀疑PASDs的孕妇,对其进行IVIM序列扫描。共106例入组研究,根据剖宫产手术和病理结果,分为PASDs组(69例)和对照组(37例)。根据胎盘植入深度,将PASDs组分为浅植入亚组(29例)和深植入亚组(40例);根据术中失血量分为大量失血亚组(48例)和非大量失血亚组(21例)。测量IVIM参数扩散系数(D)、假性扩散系数(D*)和灌注分数(f)。采用Mann-Whitney U检验比较2组间IVIM参数的差异,采用Kruskal-Wallis检验比较3组间的差异,两两比较用Bonferroni校正。采用受试者操作特征曲线评价IVIM参数诊断PASDs和预测术中大量失血的效能。结果PASDs组f值[0.330(0.302,0.361)]高于对照组的f值[0.287(0.269,0.318)],差异有统计学意义(Z=-5.25,P<0.001);D、D*值差异无统计学意义(P>0.05)。对照组、浅植入亚组和深植入亚组间D、f值总体差异有统计学意义(H=7.73,P=0.021;H=46.19,P<0.001),D*值总体差异无统计学意义(H=2.20,P=0.353)。深植入亚组D值高于对照组D值(P=0.029),深植入亚组f值高于浅植入亚组和对照组f值(P均<0.001),余两两比较组间差异无统计学意义(P>0.05)。f值诊断PASDs的曲线下面积(AUC)为0.910(95%CI 0.847~0.973),区别胎盘浅植入与深植入的AUC为0.870(95%CI 0.789~0.951),D值区别正常与胎盘深植入的AUC为0.670(95%CI 0.544~0.796)。大量失血亚组与非大量失血亚组间f值差异有统计学意义(Z=-3.47,P<0.001),预测术中大量失血的AUC为0.851(95%CI 0.764~0.938)。结论PASDs患者的胎盘表现为高灌注,f值可用于诊断PASDs、评价胎盘深植入和预测术中大量失血。Objective To investigate the efficacy of intravoxel incoherent motion(IVIM)imaging parameters for the diagnosis of placenta accreta spectrum disorders(PASDs)and the prediction of massive intraoperative blood loss.Methods The pregnant women with suspected PASDs were prospectively collected in this case-control study at the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2022.The participants were scanned using the IVIM sequence and were divided into two groups,the PASDs group(69 cases)and the control group(37 cases),based on cesarean section and pathological findings.The PASDs group was further stratified into superficial implantation subgroup(29 cases)and deep implantation subgroup(40 cases)according to the depth of placental implantation,and into massive blood loss subgroup(48 cases)and non-massive blood loss subgroup(21 cases)based on intraoperative blood loss.The IVIM parameters,including the diffusion coefficient(D),pseudo-diffusion coefficient(D^(*)),and perfusion fraction(f),were measured.The Mann-Whitney U test was employed to compare IVIM parameters between the two groups,while the Kruskal-Wallis test was assessed among the three groups,with post-hoc Bonferroni corrections for multiple comparisons.The receiver operating characteristic curves were utilized to assess the diagnostic efficacy of IVIM parameters for PASDs and their predictive value for massive intraoperative blood loss.Results The f value in the PASDs group[0.330(0.302,0.361)]was significantly higher than that in the control group[0.287(0.269,0.318)](Z=-5.25,P<0.001),while the differences in D and D*values were not statistically significant(both P>0.05).The overall differences in D and f values among the control,superficial implantation subgroup,and deep implantation subgroup were statistically significant(H=7.73,P=0.021;H=46.19,P<0.001),whereas the difference in D*values was not(H=2.20,P=0.353).The deep implantation subgroup exhibited a higher D value than that in the control group(P=

关 键 词：胎盘 侵入性 磁共振成像 体素内不相干运动 

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