子宫切口早期妊娠的MRI表现

目的探讨剖宫产术后早期子宫切口瘢痕妊娠(CSP)的MRI表现。方法回顾性分析13例经手术病理证实为早期CSP患者的MRI特征,比较影像特征与病理结果,分析其MRI特点。结果 13例早期CSP于MRI均清楚显示妊娠囊位于子宫下段前壁切口瘢痕处,瘢痕于MR平扫T1WI和T2WI呈低信号。9例妊娠囊呈类圆形囊性病灶,T1WI呈低信号、T2WI呈高信号。4例呈不规则团块状病灶,其中3例T1WI呈混杂高、稍高信号,T2WI呈高信号,1例T1WI呈等信号、T2WI呈混杂低信号。7例DWI中,5例妊娠囊DWI呈均匀或不均匀高信号,ADC呈稍低信号;2例妊娠囊DWI呈不均匀低信号,ADC呈高信号。2例增强扫描均可见妊娠囊囊壁呈环形强化。13例病理检查镜下均可见滋养叶细胞、绒毛及蜕膜组织。结论 CSP的MRI具有一定的特征,对临床明确诊断及治疗方法的选择有重要价值。

MRI features of caesarean scar pregnancy during the first-trimester

Objective To investigate MRI features of caesarean scar pregnancy (CSP) during the first-trimester. Methods The MRI features and pathologic manifestations of 13 CSP patients during the first-trimester confirmed by surgery and pathology were retrospectively analyzed. Results All gestational sacs located at the caesarean scars in lower anterior uterus were display by MRI clearly. The incision scars showed low signal on T1WI and T2WI. In the 9 of 13 cases, gestational sacs presented as circular or ovoid, which showed homogeneous low signal on T1WI and high signal on T2WI. In the remaining 4 cases, gestational sac showed as irregular mass, 3 cases of which showed heterogeneous high signal on T1WI and high signal on T2WI, the other one showed isointensity on T1WI and heterogeneous low signal on T2WI. There were 7 patients underwent DWI examination, the gestational sac presented homogeneous or heterogeneous high signal on DWI and slightly low signal on ADC in 5 cases, the gestational sac of other 2 cases presented heterogeneous low signal on DWI and ADC showed high signal intensity. In the 2 of 13 cases performed enhanced MRI, the cyst wall of gestational sac was enhanced with annular enhancement. All the cases were found trophoblast cells, villi and decidua tissue on pathology after operation. Conclusion MRI features of CSP has its specific characteristics. It has unique value in early diagnosis of CSP and the choice of treatment.