MRI检查对超声诊断前置胎盘并胎盘植入阴性的诊断价值

目的 探讨MRI对超声未提示植入的前置胎盘的确诊意义及指导治疗的作用.方法 回顾性分析本院收治的超声确诊前置胎盘而胎盘植入阴性患者的临床及影像学资料,并将其按不同诊疗程序分为A、B2组.A组直接行子宫下段剖宫产术.B组行MRI复查,对MRI诊断为胎盘植入患者行腹主动脉球囊暂时阻断术联合子宫下段剖宫产术及必要时双侧子宫动脉栓塞术,余患者行常规子宫下段剖宫产术.根据手术和(或)病理确诊胎盘植入.比较A、B2组中胎盘植入患者术中出血量及子宫切除率等.结果 MRI复查胎盘植入敏感性0.750,特异性0.916.A、B2组中胎盘植入患者术中出血量有统计学差异(P＜0.001),且A组＞B组,子宫切除率无统计学差异(P＞0.05).结论 当超声检查仅提示前置胎盘并胎盘植入阴性时,行MRI检查能够进一步筛选出胎盘植入患者;对于MRI诊断胎盘植入的产妇,妇产科联合介入干预能够有效减少术中出血量,或能减少胎盘植入患者子宫切除率.

The diagnostic value of MRI in patients with placenta previa and implantation presented negative in ultrasound

Objective To discuss the role of MRI in diagnosis and for the placenta previa and implantation presented negative in ultrasound.Methods Patients of placenta previa without placenta implantation confirmed by ultrasound were analyzed retrospectively.The patients were divided into A and B groups according to different treatment stages.A group underwent uterine segment cesarean section directly without MRI.B group underwent MRI scan first.And the MRI positive patients (B1 group) got abdominal aortic balloon temporarily block technique combined with the lower uterine segment cesarean section,if necessary,uterine artery embolization.The negative ones (B2 group) got uterine segment cesarean section directly.The placenta implantation was diagnosed by operation and (or) pathology.The maternal blood loss and hysterectomy rate between A and B group were compared.Results The sensitivity and specificity of MRI scan in placenta implantation was 0.75 and 0.916.The blood loss showed significant difference (P＜0.001).Hysterectomy rates presented no significant difference (P＞0.05).Conclusion When the ultrasound only showed placenta previa without implantation,the further test of MRI scan could detect the placenta implantation patients.After diagnosed by MRI,obstetrics and gynecology jointly intervene could effectively reduce the blood loss,or reduce the rate of hysterectomy.