目的：对比分析超声、MRI在胎盘植入中的诊断价值；探讨胎盘植入在超声及MRI中的主要影像表现。方法：回顾性分析256例胎盘植入高风险晚期妊娠患者超声及MRI检查的影像资料，根据超声诊断结果及MRI阅片结果，分别与术中临床诊断结果进行比较，对比分析两者在胎盘植入中的诊断价值。结果：256例胎盘植入高风险晚期妊娠患者中共有50例经术中临床诊断为胎盘植入。超声准确诊断50例胎盘植入患者中的32例，敏感性64.0%，特异性99.5%，阳性预测值97.0%，阴性预测值91.9%，而MRI准确诊断50例胎盘植入中的39例，敏感性78.0%，特异性99.5%，阳性预测值97.5%，阴性预测值94.9%。超声及MRI在诊断胎盘植入的敏感性及特异性均无统计学差异（P>0.05）。胎盘植入在超声中的影像表现主要为胎盘后间隙不规则或消失，彩色多普勒示胎盘后或胎盘实质内有较大的血池及增粗的血管；在MRI中最常见的影像表现为胎盘与子宫肌层分界模糊，子宫局部膨出，SSFSE序列图像显示胎盘内和/或胎盘与子宫交界处可见条带状低信号影。结论：超声及MRI对胎盘植入均有较高的诊断价值。胎盘植入在超声及MRI中均存在较为特征性的影像表现。
Abstract
Objective: To compare the value of ultrasonography and MRI in the diagnosis of suspected abnormal placental implantation, and discuss ultrasonography and MRI features in patients with placental invasion. Methods: The sonographic and MRI scan of 256 patients at risk of placenta accreta was reviewed retrospectively. Finding patients of placenta accreta with ultrasound and MRI were compared with clinical findings with delivery, and then compared the value of ultrasonography and MRI in the diagnosis of suspected abnormal placental implantation. Results: Of the 256 patients at risk of placenta accreta, 50 patients were confirmed with abnormal placental implantation by the operative finding. Ultrasonography was correctly identified in 32 of 50 patients with placenta accreta, sensitivity 64.0%, specificity 99.5%, positive predictive value 97.0%, negative predictive value 91.9%. With MRI, abnormal placentations were correctly identified in 39 of 50 patients, with sensitivity 78.0%, specificity 99.5%, positive predictive value 97.5%, and negative predictive value 94.9%. Ultrasonography and MRI showed no statistically difference in identifying patients with abnormal placental implantation(P>0.05). The main features of placental implantation on ultrasonography were intraplacental lacunae and loss of the normal retroplacental clear space, bigger vascular lake and increased vascularization in placenta or uterine and serosa interface. At MRI, blurred of the interface placenta and uterine myometrium, uterine bulging and the presence of dark intraplacental bands on SSFSE images in intraplacental or uterine and serosa interface are of the main features of placental implantation. Conclusion: Both ultrasound and MRI have higher diagnostic value in placental implantation. There are both specific findings in placenta accreta on ultrasonography and MRI.
关键词
胎盘疾病 /
超声检查 /
多普勒 /
彩色 /
磁共振成像
Key words
Placenta diseases /
Ultrasonography, Doppler, color /
Magnetic resonance imaging
中图分类号：
Ｒ714.462
R445.1
Ｒ445.2
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Gielchinsky Y, Rojansky N, Fasouliotis SJ, et al. Placenta accreta—summary of 10 years: a survey of 310 cases[J]. Placenta, 2002, 23(2-3): 210-214.
[2]Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries[J]. Obstet Gynecol, 2006, 107(6): 1226-1232.
[3]Teo TH, Law YM, Tay KH, et al. Use of magnetic resonance imaging in evaluation of placental invasion[J]. Clin Radiol, 2009, 64(5): 511-516.
[4]俞峥，鲁红. 超声对胎盘植入的诊断价值[J]. 中华超声影像学杂志，2003，12（9）：562-563.
[5]Lax A, Prince MR, Mennitt KW, et al. The value of specific MRI features in the evaluation of suspected placental invasion[J]. Magn Reson Imaging, 2007, 25(1): 87-93.
[6]Dwyer BK, Belogolovkin V, Tran L, et al. Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging?[J]. J Ultrasound Med, 2008, 27(9): 1275-1281.
[7]Meng X, Xie L, Song W. Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: a systematic review and meta-analysis[J]. Ultrasound Med Biol, 2013, 39(11): 1958-1965.
[8]Levine D, Hulka CA, Ludmir J, et al. Placenta accreta: evaluation with color Doppler us, power Doppler us, and MR imaging[J]. Radiology, 1997, 205(3): 773-776.
[9]张力，李萍，何国琳，等. 经腹彩色超声多普勒在前置胎盘并发胎盘植入诊断中的价值[J]. 中华妇产科杂志，2006，41（12）：799-802.
[10]Riteau AS, Tassin M, Chambon G, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta[J]. PLoS One, 2014, 9(4): e94866.
[11]Derman AY, Nikac V, Haberman S, et al. MRI of placenta accreta: a new imaging perspective[J]. AJR, 2011, 197(6): 1514-1521.
[12]Lim PS, Greenberg M, Edelson MI, et al. Utility of ultrasound and MRI in prenatal diagnosis of placenta accreta: a pilot study[J]. AJR, 2011, 197(6): 1506-1513.
[13]Morita S, Ueno E, Fujimura M, et al. Feasibility of diffusion-weighted MRI for defining placental invasion[J]. J Magn Reson Imaging, 2009, 30(3): 666-671.
