超声造影与彩色多普勒超声在产后胎盘植入诊断中的应用价值比较

目的 探讨产后胎盘植入及胎盘残留的超声造影和二维彩超的影像学特点,比较两种方法诊断产后胎盘植入的价值.方法 本院产科住院的临床疑诊产后或引产后胎盘植入的产妇43例,常规进行灰阶、彩色多普勒超声检查和超声造影检查.超声造影观察宫腔内异常回声团、子宫肌层、浆膜层的造影剂增强特点.并与病理或临床综合诊断结果比较,分析超声造影与灰阶结合彩色多普勒超声鉴别胎盘残留和植入的敏感性、特异性.结果 病理及临床诊断34例为胎盘植入,9例胎盘残留.超声造影正确诊断胎盘植入32例,正确诊断胎盘残留9例,2例胎盘植入误诊为胎盘残留.二维彩超诊断胎盘植入29例,诊断胎盘残留14例,其中25例胎盘植入与5例胎盘残留与临床病理诊断标准结果相符,胎盘植入误诊为胎盘残留9例.胎盘残留误诊为胎盘植入4例.超声造影及二维彩超诊断胎盘植入的敏感性分别是94.1％、73.5％,差异有统计学意义(P＜0.05);超声造影及彩色多普勒超声诊断胎盘植入的特异性分别为100.0％、55.5％,差异有统计学意义(P＜0.05).结论 超声造影在胎盘植入的诊断方面较彩色多普勒超声能够提供更准确的血流灌注信息,较后者更有优势.

The comparison of the diagnosis value of contrast-enhanced ultrasound and color Doppler ultrasound in morbidly adherent placenta

Objective To compare the diagnosis value of contrast-enhanced ultrasound (CEUS) and color Doppler ultrasound in morbidly adherent placenta.Methods Forty-three patients suspected morbidly adherent placenta after delivery or labor induction hospitalized in our hospital were examined by gray-scales ultrasound,color Doppler ultrasound,and CEUS.The microvascular perfusion of the abnormal mass was evaluated,and the enhanced features of the abnormal mass,the myometrium,and the serous layer were observed.The diagnostic sensitivity and specificity by CEUS and color Doppler ultrasound were compared according to clinical and histological results.Results 34 cases of morbidly adherent placenta were confirmed and 9 cases of placenta remnants were confirmed by clinical or histological diagnosis.32 cases of morbidly adherent placenta and 9 cases of placenta remnants which were diagnosed by CEUS coincided with our diagnosis criterion,2 cases of morbidly adherent placenta were misdiagnosed as placenta remnants.29 cases of morbidly adherent placenta and 14 cases of placenta remnants were diagnosed by color Doppler ultrasound,25 cases of morbidly adherent placenta and 5 cases of placenta remnants which were diagnosed by Color Doppler ulttasound coincided with our diagnosis criterion.9 cases of morbidly adherent placenta were misdiagnosed as placenta remnants and 4 cases of placenta remnants were misdiagnosed as morbidly adherent placenta by color Doppler ultrasound.The diagnostic sensitivity of morbidly adherent placenta by CEUS and color Doppler ultrasound were 94.1％ and 73.5％,respectively (P＜0.05).The diagnostic specificity of morbidly adherent placenta by CEUS and color Doppler ultrasound were 100.0％ and 55.5％,respectively (P＜0.05).Conclusion CEUS can provide more perfusion information and has more advantages than color Doppler ultrasound in the diagnosis of morbidly adherent placenta.