磁共振与超声对胎盘植入诊断价值的对比研究

目的探讨胎盘植入的磁共振和超声影像学特点,比较两种方法诊断胎盘植入的价值。方法回顾性分析临床拟诊胎盘植入的28例产妇MRI及超声影像学资料特征,并与手术和(或)临床综合诊断结果比较,分析MRI与超声鉴别胎盘粘连和种植的敏感性、特异性和准确性。结果胎盘植入的超声表现为胎盘与子宫肌层间交界的低回声带中断、胎盘内及与肌层交界处可见较多的血流、胎盘植入处肌层不完整及变薄,超声造影可见残留病灶缓慢增强。磁共振表现为蜕膜层低强度信号发生局部缺失,子宫肌层变薄,动态增强种植胎盘与子宫基层一致性强化,部分胎盘边缘强化明显,少数可见滋养血管。MRI鉴别胎盘植入(含穿透)与粘连敏感性、特异性和准确性分别为85%、80%和82%,超声检查分别为62%、80%和71%。结论 MRI结合增强能明确胎盘植入并判断肌层受侵的情况,超声结合造影亦能鉴别胎盘植入与粘连,从临床诊断价值的角度来看,磁共振检查比超声具有更多的优势。

Comparison of Magnetic Resonance Imagine and Ultrasonograpy in the Diagnosis of Placenta Accrete

Objective To investigate the MRI and ultrasound features in placenta accrete,and to compare the value of ultrasound in placenta retention and placenta accrete with that of MRI.Methods The ultrasound and MRI data of 28 patients with placenta accrete were retrospectively analyzed and compared with the findings of surgery or/and clinical diagnosis.The sensitivity,specificity and accuracy of MRI and ultrasound in the differential diagnosis of placenta adherence between placenta accrete were evaluated.Results On ultrasound,placenta accrete was represented disruption of the placenta-myometrium interface,appeared vessels in the placenta and placenta-myometrium interface,was half-baked and thinner than surrounding of myometrium.The nidus was enhanced slowly on contrast-enhanced ultrasonography.While the main MRI findings were partly deletion of deciduum,myometrial thinness.On contrast enhanced,accreted placenta and uterine grassroots were enhanced significantly.The edge was enhanced obviously and vasa vasorum was visible on some lesions.The sensitivity,specificity and accuracy of MRI differential diagnosis of placenta adherence between placenta accrete were 85%,80% and 82% respectively and the data of ultrasound were 62%,80% and 71% respectively.Conclusion Placenta accrete could be clearly determined by MRI combined with the contrast enhanced.And myometrial invasions could also be clear-cut.Though placenta accrete could be differentiated from placenta adherence on ultrasound,MRI examination has more superiorities than ultrasound examination from the view of the clinical diagnosis value.