磁共振成像与彩色三维多普勒超声在子宫发育畸形诊断中的价值

目的探讨磁共振成像（MRI）与彩色三维多普勒超声在子宫发育畸形诊断中的价值。方法回顾性分析2011年1月至2013年5月经手术确诊的子宫发育畸形患者98例的临床资料,其中65例术前经彩色三维多普勒超声诊断,33例经MRI诊断,24例同时行二维彩超和MRI检查,分析其诊断子宫发育畸形的准确度。结果 98例患者中,纵隔子宫39例,单角子宫17例,双角子宫16例,双子宫11例,无子宫9例,复杂畸形6例。三维彩超和MRI诊断子宫畸形的准确度分别为89.2%（58/65）和93.9%（31/33）,两者比较,差异无统计学意义（P〉0.05）。2例罗伯特子宫患者中,三维彩超和MRI术前均未明确诊断;4例子宫畸形合并阴道畸形患者中,仅1例术前确诊。24例患者二维彩超和MRI诊断的准确度分别为54.2%（13/24）和91.7%（22/24）,两者比较,差异有统计学意义（P〈0.05）。结论经阴道/直肠三维彩超和MRI对纵隔子宫、单角子宫、双角子宫、双子宫及无子宫或幼稚子宫的诊断率较高,三维彩超可作为子宫畸形的首选无创检查方法。但对于复杂的子宫畸形,二者的诊断准确度较低。

The value of MRI and three-dimensional color Doppler ultrasound in the diagnosis of congenital uterine malformations

Objective To confirm the value of MRI and three- dimensional color Doppler ultrasound in the diagnosis of congenital uterine malformations. Methods 98 hospitalized patients with congenital uterine malforma- tions from January 2011 to May 2013 in the First Affiliated Hospital of Zhengzhou University were investigated. 65 patients were classified by 3 -D ultrasound, 33 cases by MRI, and 24 cases were both by 2 -D ultrasound and MRI. The accuracy of the three examinations methods were compare. Results There were 39 cases of uterus septus, 17 cases of unicornuate uterus, 16 cases of bicornuate uterus, 11 cases of double uterus, 9 cases of anhysteria, and 6 cases of complex uterus malformation. The accuracy of threedimensional ultrasound and MRI were 89.2%（58/ 65） and 93.9% （31/33）, and there was no significant difference （P〉0.05）. But for some complex uterine malfor- mation （such as Robert uterus, uterine malformation combined with vaginal malformations） they got poor accuracy. 24 cases were diagnosed both with 2 - dimensional ultrasonography and MRI, the accuracy was 54.2% （13/24） and 91.7% （22/24）. The difference was statistically significant （P〈0.01）. Conclusions Transvaginal/rectum three- dimensional ultrasound and MRI can correctly identify uterus septus, unicornuate uterus, double uterus and congen- ital absence of the uterus or infantile uterus. As the 3 - dimensional ultrasound is economical and simple, it can be used as the preferred noninvasive uterine malformations. We need more experience accumulations on some complex uterine malformations because of the low diagnostic accuracy.