超声造影对产后胎盘植入分型诊断的探讨

Value of contrast-enhanced ultrasonography in diagnosis typing of placenta accrete

目的探讨超声造影在产后胎盘植入分型诊断中的作用。方法对临床诊断产后胎盘植入的31例产妇行超声造影检查，与二维彩色多普勒比较，并与术后结局作对照。结果二维彩色多普勒和超声造影均可显示31例残留胎盘大小，但超声造影能更清楚地显示胎盘与子宫的边界、胎盘内富血流区和乏血流区。二维彩色多普勒提示7例粘连型，23例植入型，1例穿通型。根据造影图像肌层厚度和造影剂灌注消退时间，造影提示11例粘连型，16例植入型，4例穿通型。手术结果：10例粘连型，21例植入型和穿通型。二维彩色多普勒的分型误判率为19．4％，造影的分型误判率为6．5％，造影分型诊断与术后结局一致性较高，Kappa系数0．859，Pd0．001。结论超声造影判别产后胎盘植入类型的准确率较二维彩色多普勒高，对临床怀疑产后胎盘植入者行超声造影检查能提高诊断的准确性和可靠性，为临床选择治疗方式提供参考依据。

Objective To assess the value of contrast-enhanced ultrasound （CEUS） in diagnosing subtypes of postpartum placenta accreta. Methods 31 puerperal clinically diagnosed of postpartum placenta accreta were collected. They were inspected by using CEUS and 2-dimensional color Doppler ultrasound, respectively. The operation was used as a reference. Results Both 2-dimensional color Doppler and CEUS could identify the sizes of residual placenta for the patients, but CEUS showed more explicit boundary for placenta and uterus and the rich/poor blood flow areas in the placenta. Among the 31 patients, 7,23 and 1 were classified of accreta, increta and percreta, respectively, by using 2-dimensional color Doppler ultrasound,while 11,16 and 4 were classified of accreta, increta and perereta, respectively, by using CEUS based on the myometrial thickness and contrast agent subsided time. With respect to operation, 10 patients were confirmed of accrete,with the other diagnosed of increta and percreta. The misclassification rate of 2- dimensional color Doppler ultrasound was 19.6%, while CEUS had only 6.5 %. CEUS had a good agreement with operation （Kappa = 0. 859, P 〈 0. 001 ）. Conclusions CEUS has higher accuracy in diagnosing subtypes of postpartum placenta accrete compared with 2-dimensional color Doppler ultrasound. CEUS can increase the accuracy and reliability for diagnosing those who were clinically considered of postpartum placenta accrete,and can provide helpful guidelines for clinical treatment.