高龄产妇不同部位异位妊娠的MRI影像特点及诊断准确度分析

Analysis of MRI image characteristics and diagnostic accuracy of heterotopic pregnancy in different parts of the elderly parturients

目的:探讨高龄产妇不同部位异位妊娠的MRI影像特点,并观察MRI临床诊断的准确度.方法:选取我院2016年2月~2018年2月收治的35例高龄异位妊娠患者,年龄34~39岁.所有患者均在我院接受治疗且手术病理证实为异位妊娠.结合临床病例资料和常规超声/MRI影像检查资料,回顾性分析MRI对本组异位妊娠的诊断效果,并对不同部位异位妊娠进行影像分析.结果:本组病例手术病理证实:输卵管妊娠29例,子宫瘢痕妊娠3例,宫角妊娠2例,卵巢妊娠1例;MRI对异位妊娠定性定位正确诊断32例,漏诊0例,误诊3例,诊断准确度为91.43%(32/35);常规超声正确检出24例,漏诊6例,5例,诊断准确度为68.57%(24/35).统计学分析显示MRI对异位妊娠的定性定位诊断准确度较常规超声高,差异具有统计学意义,MRI诊断结果和病理金标准Kappa检验显示两者具有较好一致性(Kappa值=0.774,95%CI=0.681~0.804).MRI影像显示子宫内未见异常信号,可见盆腔积液、输卵管扩张和胎囊结构情况,不同部位异位妊娠病灶主要呈圆形、椭圆形或类椭圆形,且多在T1WI、T2WI、SPIR上多呈高低混杂信号,行增强扫描可见病灶信号边缘强化或不均匀强化.结论:不同部位异位妊娠在MRI上均较具特征性,MRI检查异位妊娠能达到满意的定性定位诊断效果,可作为临床早期诊断的重要补充优化手段.

Objective To investigate the MRI features of heterotopic pregnancy in different parts of the older women and to observe the accuracy of the clinical diagnosis of MRI.Methods 35 elderly patients with ectopic pregnancy,aged 34~39 years,were treated in our hospital in February^2018 February 2016.All patients were treated in our hospital and the surgical pathology proved to be ectopic pregnancy.Combined with clinical data and conventional ultrasound/MRI imaging data,we retrospectively analyzed the diagnostic effect of MRI on ectopic pregnancy in our group,and analyzed the ectopic pregnancy in different locations.Results The cases of surgical pathology:29 cases of tubal pregnancy,3 cases of uterine scar pregnancy and cornual pregnancy in 2 cases,1 cases of ovarian pregnancy;ectopic pregnancy MRI on qualitative positioning correct diagnosis of 32 cases,0 cases of misdiagnosis,3 cases of misdiagnosis,the diagnostic accuracy was 91.43%(32/35);conventional ultrasound is correct there were 24 cases of misdiagnosis in 6 cases,5 cases,the diagnostic accuracy was 68.57%(24/35).The statistical analysis showed that the accuracy of MRI in the qualitative diagnosis of localization of ectopic pregnancy than conventional ultrasound,the difference was statistically significant,MRI diagnosis and pathological gold standard Kappa test showed that both have good consistency(Kappa=0.774,95%CI=0.681~0.804).MRI imaging showed no abnormal signal in the uterus,pelvic effusion,visible fallopian tube expansion and embryo sac structure,different parts of the main foci of ectopic pregnancy were round,oval or oval,and in T1WI,T2WI,SPIR more showed mixed signal,enhanced scan can see lesion signal edge enhancement or inhomogeneous enhancement.Conclusion Ectopic pregnancy in different locations is more characteristic on MRI.MRI can achieve satisfactory qualitative location diagnosis effect in ectopic pregnancy.It can be used as an important supplementary means for early diagnosis in clinic.