三维能量多普勒超声产前诊断胎盘植入性疾病

目的 评价三维能量多普勒超声（3D-PDUS）产前诊断胎盘植入性疾病（PAS）的价值。方法 纳入116例经超声诊断为前置胎盘孕妇，采用二维超声观察胎盘及周边结构，以3D-PDUS测量相关血流参数。根据产后临床及病理诊断将孕妇分为PAS组（n=32）及无PAS组（n=84）；根据胎盘绒毛侵袭子宫肌层深度将PAS组分为粘连性胎盘（PA）亚组（n=12）及异常侵袭性胎盘（AIP）亚组（n=20）。比较组间及亚组间3D-PDUS参数的差异。绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），评价3D-PDUS参数诊断PAS的效能。采用Cochran Q检验比较3D-PDUS参数与二维超声诊断PAS效能的差异。结果 PAS组血管化指数（VI）、流量指数（FI）及血管流量指数（VFI）均显著高于无PAS组（P均<0.05）；AIP亚组VI及VFI均显著高于PA亚组（P均<0.05）；亚组间FI差异无统计学意义（P>0.05）。VI、FI及VFI诊断PAS的效能均较高，VI与VFI的敏感度、特异度及准确率均无明显统计学差异（P均>0.05）；FI与二维超声诊断效能差异无统计学意义（P均>0.05）；VI及VFI诊断效能明显高于FI及二维超声（P均<0.05）。结论 3D-PDUS定量检测胎盘及周边结构血流参数可用于产前诊断PAS。

Three-dimensional power Doppler ultrasound for prenatal diagnosis of placenta accrete spectrum

Objective To observe the value of three-dimensional power Doppler ultrasound (3D-PDUS) for prenatal diagnosis of placenta accrete spectrum (PAS). Methods A total of 116 patients with placenta previa diagnosed with ultrasound were enrolled. The placenta and peripheral structures were observed with two-dimensional ultrasound, and the blood flow parameters were measured by using 3D-PDUS. According to postpartum clinical diagnosis and pathological diagnosis, the patients were divided into PAS group (n=32) and non-PAS group (n=84), and those in PAS group were further divided into placenta accrete (PA) subgroup (n=12) and abnormal invasive placenta (AIP) subgroup (n=20) according to the depth of placental villi invading the myometrium. Then 3D-PDUS parameters were compared between groups and subgroups. Receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the efficacy of 3D-PDUS for diagnosing PAS. Cochran Q test was used to compare the diagnostic efficiency of PAS between 3D-PDUS and two-dimensional ultrasound. Results Vascular index (VI), flow index (FI) and vessel flow index (VFI) in PAS group were all significantly higher than those in non-PAS group (all P<0.05). VI and VFI in AIP subgroup were significantly higher than those in PA subgroup (both P<0.05). There was no statistically difference of FI between 2 subgroups of PAS (P>0.05). VI, FI and VFI had high diagnostic efficiency of prenatal diagnosis of PAS. No statistically difference of the sensitivity, specificity nor accuracy was found between VI and VFI (all P>0.05),nor of diagnostic efficiencies between FI and two-dimensional ultrasound (all P>0.05). The diagnostic efficiencies of VI and VFI were significantly higher than those of FI and two-dimensional ultrasound (all P<0.05). Conclusion Blood flow parameters of placental and peripheral structural measured with 3D-PDUS could be used for prenatal diagnosis of PAS.