三维能量多普勒定量超声对产前胎盘植入的诊断价值

目的采用三维能量多普勒超声结合VOCAL技术对胎盘血管指数进行定量分析,评价胎盘血管化指数对产前胎盘植入的诊断价值。方法随机选择56例中央型前置胎盘孕妇,产前行二维超声及彩色多普勒超声检查,对感兴趣区行三维能量多普勒超声检查,最后用VOCAL技术对获得的三维能量图像进行分析,计算胎盘血管化指数(VI、FI及VFI)。待孕妇分娩后,将产前超声的声像图特征及诊断与临床表现、手术所见和(或)病理结果对照。依据临床和(或)病理结果,将病例分成植入组和无植入组,其中植入组包括轻度植入组、中度植入组和重度植入组。结果 1植入组的VI、FI及VFI值均高于无植入组,差异有统计学意义(P=0.000);2无植入组、轻度植入组、中度植入组及重度植入组进行比较,VI、FI及VFI差异具有统计学意义(P<0.05);3通过ROC曲线推断VI、FI及VFI的曲线下面积分别是0.858、0.736及0.809,其截断值分别为15.837、34.030及5.948。结论三维能量超声结合VOCAL技术对胎盘血管化指数进行定量分析能够为超声产前评价胎盘植入其侵入肌层的深度和范围提供更为客观的诊断依据,可作为胎盘植入产前诊断方法的重要补充。

Value of the Quantitative Analysis of Placental Vasculature by Means of Three-dimensional Power Doppler in Placenta Accrete

Objective To assess the value of placental vascular index for diagnosis of placenta accrete prenatally by means of three-dimensional power Doppler ultrasound and Virtual Organ Computer-aided Analysis (VOCAL) technique. Methods Fifty-six pregnancies with complete placenta previa were examined with two-dimensional ultrasonography and Color Doppler ultrasonography. Finally we obtained the vascularization index (VI), flow index (FI) and vascularization flow index (VFI) by means of 3D power Doppler targeted to region of interest (ROI)and VOCAL technique. After childbirth, prenatal ultrasonic diagnosis and clinical surgery or (and) pathological results were compared for these pregnancies. Based on clinical surgery or (and) pathological results,all of cases were divided into placenta accreta group and placenta previa group,the former including placenta accrete group,placenta increta group and placenta percreta group. Results A comparative analysis of VI, FI and VFI revealed statistically significant differences between placenta previa group and placenta accreta group(P=0.000).It was statistically significantly different about analysis of placenta previa group,placenta accreta group,placenta increta group and placenta percreta group (P<0.05). Area under the curve VI, FI and VFI inferred by the ROC curves were 0.858, 0.736 and 0.809, with the cut-off values of 15.837, 34.030, and 5.948, respectively. Conclusion The analysis of quantification of placental vasculature can provide more Objective diagnostic basis for prenatal ultrasound evaluation of placenta increta depth and scope of the invading muscularis prenatally with 3D-PD and VOCAL technique, which can be used as important supplement method of the prenatal diagnosis of placenta increta.