超声评分和MRI诊断植入性凶险型前置胎盘的价值分析

目的应用超声评分法和MRI对植入性凶险型前置胎盘(pernicious placenta previa,PPP)进行探讨,分析其影像学表现及超声评分法和MRI对诊断植入性凶险型前置胎盘的临床价值。方法选取96例疑诊为PPP并合并胎盘植入住院患者的临床资料,术前均根据超声评分法及MRI检查对PPP作出诊断,将二者诊断结果与术中所见及术后病理检测结果相对比,同时根据超声评分分组,对各组术中出血量进行对比分析。结果经手术及病理确诊,96例患者中,72例诊断为PPP合并胎盘植入,未合并植入者24例,超声评分法对PPP并植入诊断灵敏度为80.6%,特异度为83.3%,正确率为81.3%,MRI检查PPP并植入诊断灵敏度为86.1%,特异度为75.0%,正确率为83.3%,两种方法的灵敏度、特异度、正确率差异均无统计学意义(均P>0.05),胎盘植入评分不同组别间术中出血量的差异有统计学意义(P<0.05)。结论对于孕晚期高度怀疑为植入性PPP的患者,超声评分法及MRI均有重要的诊断价值,两者可互为补充,且超声评分高低对预估术中出血量有重要意义。

The value of ultrasound scoring and MRI in diagnosis of implanted pernicious placenta previa

Objective Ultrasound scoring and MRI were used to investigate the imaging features of implanted pernicious placenta previa,and to analyze the clinical value of ultrasound scoring and MRI in the diagnosis of implanted pernicious placenta previa.Methods The clinical data of 96 patients with suspected implanted pernicious placenta previa in the third trimester pregnancy were studied retrospectively.Preoperative diagnosis of implanted pernicious placenta previa was made according to ultrasound scoring and MRI,and the diagnostic results of the both methods were compared with the results of clinical and postoperative pathological examination.At the same time,the volume of intraoperative blood loss in each group was analyzed according to the ultrasonic scores.Results According to surgical operation and pathological examination,72 cases were diagnosed as pernicious placenta previa with implantation,24 cases without implantation.As for ultrasound scoring,the sensitivity was 80.6%,specificity was 83.3%and accuracy was 81.3%respectively.As for MRI,the sensitivity was 86.1%,specificity was 75.0%and accuracy rate was 83.3%respectively.The differences of sensitivity,specificity and accuracy between the US and MRI were not statistically significant(all P>0.05).The differences of the volume of intraoperative blood loss between different groups of ultrasound scoring were statistically significant(P<0.05).Conclusion For patients with suspected implanted pernicious placenta previa in the third trimester,both ultrasound scoring and MRI have important diagnostic significances,which can complement each other,and the ultrasonic scores are of great significance in predicting the volume of intraoperative blood loss.