超声与MRI诊断剖宫产术后早期子宫瘢痕妊娠的临床价值分析

目的分析超声与核磁共振(MRI)诊断剖宫产术后早期子宫瘢痕妊娠(CSP)的临床价值。方法选取2013年1月至2018年1月于双流区第一人民医院就诊治疗的70例CSP患者作为研究对象,以手术病理学检查结果为标准,收集其临床、影像学资料,比较不同检查方法对CSP的诊断符合率,并分析不同检查方式中CSP的影像图像特征表现。结果超声联合MRI检查对CSP的诊断符合率(98.57%)均显著高于超声(84.29%)和MRI(85.71%)单独检查对CSP的诊断符合率(P<0.05);超声检查示36例单纯孕囊型宫腔下段"双环征"孕囊声像,且孕囊与膀胱壁之间子宫肌层非常薄,孕囊附近血流较为丰富;23例不均质包块型可于子宫下段显示混合团块状,团块内表现明显暗液区,病灶伸入至子宫肌层。MRI检查示平扫40例单纯孕囊型CSP显示子宫切口下段可见卵圆形或类圆形孕囊,T1WI表现为低信号、T2WI为高信号,呈环状表现,进一步增强扫描示孕囊囊壁明显强化。20例不均质包块MRI平扫示下示子宫下段内呈现不规则团块影,在T1WI上呈等信号,T2WI上呈低信号,进一步增强扫描示T1WI序列可见明显强化,且呈树突状和斑片状呈现。结论超声和MRI对CSP的检出和诊断符合率相类似,但超声联合MRI检查检出和诊断符合率明显提高,有望在早期CSP诊断中发挥重要作用。

Clinical Value of Ultrasound and MRI in the Diagnosis of Early Caesarean Scar Pregnancy

Objective To analyze the clinical value of ultrasound and magnetic resonance imaging(MRI)in the diagnosis of early caesarean scar pregnancy(CSP).Methods A total of 70 patients with CSP who were treated at the First People's Hospital in Shuangliu District from January 2013 to January 2018 were selected as subjects.The results of surgical pathology were used as the standard,the clinical and imaging data were collected,the diagnostic accuracy of different examinations for CSP was compared,and the image characteristics of CSP in different examinations were analyzed.Results The diagnostic coincidence rate(98.57%)of ultrasound combined with MRI for CSP was significantly higher than that of ultrasound(84.29%)and MRI(85.71%)for CSP alone(P<0.05).Ultrasound examination showed lower uterine cavity of simple pregnancy cystic type showed image of gestational sac with"double ring sign"in 36 cases,the myometrium between the gestational sac and the bladder wall was very thin,and the blood stream near the gestational sac was relatively abundant.The lower part of the uterus showed mixed mass in heterogeneous clump type of 23 cases.The masses showed clear and dark fluid area,and the lesion extended into the myometrium.MRI examined the CSP of 40 cases with simple gestational sac,showing that an oval or round-shaped gestational sac can be seen in the lower part of the incision of uterus,T1WI showed a low signal and T2WI showed a high signal with shape like a ring.Further enhanced scanning indicated that the sac wall was significantly enhanced.MRI scan of 20 cases with heterogeneous mass showed irregular mass in the lower uterus and showed equal signal in T1WI and low signal in T2WI.Further enhanced scanning showed that the T1WI sequence was clearly enhanced and presented in dendritic and patchy appearance.Conclusion The detection rate of CSP by ultrasound and MRI is similar.However,the detection rate of CSP by ultrasound combined with MRI is significantly improved,which is expected to play an important role in the early diagnosis of CSP.