剖宫产术后切口妊娠的MRI诊断价值

Diagnostic value of MRI in cesarean scar pregnancy

目的：探索剖宫产术后子宫切口妊娠（CSP）妊娠囊及子宫的MRI表现，并评估MRI在切口妊娠诊断及治疗中的价值。方法分析2010～2013年临床或B超怀疑切口妊娠，并取得手术及病理结果的16例病例，总结其MR影像特征、临床治疗方法及预后。结果16例病人中，2例排除CSP诊断，14例确诊为CSP，妊娠物均位于子宫下段峡部疤痕周围；14例CSP病人中8例病人妊娠物内部信号均匀，呈T1WI低、T2WI高信号，包膜呈T2WI略高、T1WI等信号，增强扫描仅有包膜轻度强化，另外6例病人妊娠物内部信号不均匀，T2WI呈高低混杂信号，T1WI可见高信号影，增强扫描呈不均匀强化，4例向宫腔内生长为主，10例向肌层内生长为主；14例CSP患者，6例为超声监测下高危负吸术，8例行子宫动脉栓塞术后高危负吸术，另外2例排除CSP的患者，分别行高危负吸术和药流术。结论 MRI能为临床治疗方案的选择提供重要的参考价值。

Objective To analyze the MRI feature of cesarean scar pregnancy（CSP）for treatment planning.Methods MRI of 16 patients with suspected CSP from 2010 to 2013 was retrospectively analyzed and compared with surgical findings.Results All gestational sacs were clearly demonstrated on MRI with 14 embedded in the anterior cervix and diagnosed as CSP.The gestational sacs were cystic（8/14）or heterogeneous（6/14）,located within the uterine cavity（4/14）or deeply implanted in the scar（10/14）.Suction and curettage were performed in 6/14 and uterine artery embolization in 8/14.Two patients were diagnosed as early abortion and treated by suction and curettage.Conclusion MRI is useful in the management of CSP.