超声造影诊断胎盘植入的应用价值

目的 探讨超声造影在胎盘粘连植入及胎盘穿透中的临床诊断价值.方法 对20例临床怀疑胎盘粘连或植入的患者常规超声检查后采用造影剂SonoVue行超声造影,观察实时超声造影过程,分析各组的造影剂灌注特征.结果 15例超声造影与清官术结果对照显示:8例造影显示官腔内残留病灶与子宫肌壁关系清楚,7例残留病灶与子宫浆膜层之间厚度仅2～4 mm.5例超声造影与手术结果对照,3例造影示胎盘附着处子宫浆膜层菲薄,连续不完整,毛糙呈锯齿样,手术结果为胎盘植入穿透;1例合并子宫破裂病例造影表现子宫肌层与浆膜层造影剂灌注缺失;1例超声造影怀疑滋养细胞疾病,术后病理诊断为胎盘植入.结论 超声造影表现子宫浆膜层毛糙呈锯齿样,造影剂外溢,对诊断胎盘植入与穿透提供了重要的信息.

Value of contrast-enhanced ultrasound in diagnosis of placental acerete

Objective To explore the value of contrast-enhanced ultrasound(CEUS) in diagnosis of placental accrete,placental increta and placental percreta. Methods Twenty suspected patients of placental accrete, placental increta and placental percreta were examined with CEUS after routine ultrasound examination. Sono Vue was injected intravenously as bolus and a real time CEUS was performed to observe the characteristics. Results Comparison of 15 CEUS cases with uterine curettage, 8 cases had a clear relationship between the residual disease of the uterine cavity and uterine wall,7 cases had a thin thickness (2-4 mm) between the residual disease of the uterine cavity and uterine wall. Five of the 20 cases performed cesarean cesion,3 cases of the uterine serosa of placenta affixing part were very thin,incomplete and rough, demonstrating placenta increta and placenta percreta, 1 case of uterine rupture showed non-invasiveness between uterine wall and uterine serosa,and 1 case of placenta increta pathologically proven, initially suspected gestational trophoblastic disease by the CEUS. Conclusions CEUS provides an important diagnostic message for placental accrete, placental increta and placental percreta by showing the different characteristics of the perfusion image.