超声造影在产后胎盘植入诊断中的临床应用

目的：探讨胎盘植入超声造影图像特征及其在产后胎盘植入诊断中的临床价值。方法采用造影剂SonoVue对2009年4月至2013年5月湖北省妇幼保健院临床疑诊为胎盘植入的12例患者行超声造影检查，观察患者子宫内病灶部位、范围及造影剂灌注特点，结合临床及手术病理诊断结果，总结胎盘植入超声造影分型表现及图像特征。结果12例患者子宫超声造影增强表现：11例胎盘植入病灶造影表现呈高增强，1例呈无增强（术后病理诊断为胎盘组织变性及钙化）。12例患者子宫超声造影分型表现及术后病理诊断结果：1例（粘连型）造影表现为宫腔内高增强病灶与周边子宫肌层间界限清楚，术后病理诊断为胎盘粘连。6例（植入型）造影表现为残留胎盘附着处子宫浆膜层菲薄，子宫浆膜层部分连续性不好，呈毛刺样改变，术后病理诊断为胎盘植入。5例（穿透型）造影表现为残留胎盘穿透子宫浆膜层，子宫浆膜层连续性中断，造影剂外溢，术中或术后病理诊断为子宫胎盘植入，穿透浆膜层、子宫破裂。超声造影诊断并经临床手术诊治12例患者均治愈。结论超声造影通过组织灌注成像之间的差异诊断胎盘植入，注射造影剂后胎盘植入病灶呈高增强，子宫浆膜层呈毛糙锯齿样改变，造影剂外溢时应考虑胎盘穿透子宫浆膜层。超声造影对产后胎盘植入诊断及子宫破裂术后治疗修复的观察均有重要临床应用价值。

The value of clinical in diagnosis of implanted placenta postpartum by contrast-enhanced ultrasonography

ObjectiveTo explore the contrast-enhanced ultrasonography features of postpartum placenta implantation and its clinical value in diagnosis of postpartum placenta implantation.MethodsBetween April 2009 and May 2013, twelve patients with clinically suspected placenta implantation underwent contrast-enhanced ultrasonography in Hubei Maternal and Child Health Hospital. The location and extent of intrauterine lesions and perfusion features of contrast agent were observed. The contrast-enhanced ultrasonography features of postpartum placenta implantation were analyzed and compared with postoperative pathological diagnosis.ResultsIn twelve patients with placenta implantation, eleven showed enhancement. Only one lesion showed no enhancement, which was diagnosed as placental degeneration and calcification on postoperative pathology. One case was placenta adhesions conifrmed by postoperative pathological diagnosis, which presented with a hyperenhanced lesion in uterine cavity with a clear boundary to myometrium. Six cases were placenta implantation confirmed by postoperative pathological diagnosis, which presented with a residual placenta surrounded with extremely thin or evendiscontinuous uterine serosa. Five cases were placenta penetration confirmed by postoperative pathological diagnosis, which presented with a residual placenta penetrating the uterine serosa and contrast agent spilling out. All cases in this study were cured by operation.ConclusionsContrast-enhanced ultrasound could diagnose placenta implantation via the difference of tissue perfusion. The lesion of placenta implantation showed enhancement after injection of contrast agent. If discontinuous uterine serosa and contrast agent spilling was observed, placenta penetrating uterine serosa should be considered. Contrast-enhanced ultrasound has important clinical value in diagnosing postpartum placenta implantation and observing postoperative recovery processes of uterine rupture.