多体位、多序列MRI非增强检查诊断产前胎盘植入的方法初探

The preliminary exploration of prenatal placenta increta using unenhanced MR imaging under multi-positions and mult-sequences

目的探讨诊断胎盘植入的非增强MR的有效体位和序列。材料与方法将69例超声及临床可疑前置胎盘、胎盘植入患者纳入研究,通过3.0 T MRI两个体位、5个序列扫描,膀胱不同充盈状态成像。术前阅片观察图像质量并形成诊断,术中所见及术后病理结果与术前影像对比,总结成像质量的可靠性。采用SPSS 16.0统计软件进行统计分析。结果 69例中67例成像可以满足诊断需求,与术后结果对比,多种体位及序列结合胎盘植入诊断敏感性96.7%(58/60),特异性77.8%(7/9),准确性95.7%(66/69);对穿透性胎盘植入仰卧位结合侧卧位及膀胱不同充盈像敏感性66.7%,单一仰卧位成像敏感性33.7%,二者具有较明显差异。结论 MR非增强扫描成像两个体位、5个序列成像能提供关于胎盘状态的丰富信息,膀胱不同充盈像结合体位变动能有效减少伪影及容积效应,提高成像质量;进一步客观准确的诊断出产前胎盘植入,为临床提供重要的诊疗信息。

Objective： To summarize the effective scanning sequences of non enhanced MRI in the diagnosis of placenta accreta by performing multi- positional and multi-sequential non-enhanced MR scanning over 69 cases of prenatal placenta. Materials and Methods： A total of 69 suspicious cases with placenta previa by ultrasound and clinical symptoms were examined by 3.0 T magnetic resonance under 2 positions and 5 sequences. The image quality of different iflling bladder state were compared and the imaging findings of placenta increta were analyzed. Preoperative imaging were compared with intraoperative observation and postoperative pathologic results. SPSS16.0 statistical software was used for statistical analysis.Result：The image quality of 69 cases could meet the demand of diagnosis. The preoperative diagnosis was consistent with pathology and postoperative diagnosis. The quality of imaging were improved by two positions and patient discomfort was reduced, the artifact and volume effect was reduced by bladder different iflling state. Compared with postoperative pathologic results, the diagnosis sensitivity, speciifcity and accuracy of placenta increta under multi-positions and multi-sequences was respectively 96.7% （58/60）, 77.8% （7/9） and 95.7% （66/69）. The diagnosis sensitivity of penetrative placenta under combination of supine position and lateral position was 66.7% and was higher than that of the single supine position （33.7%）.Conclusions：Different bladder iflling state with position change can effectively reduce the artifact and volume effect and improve the imaging quality. The unenhanced MR scanning imaging under 2 positions and 5 sequences can provide abundant diagnostic information and treatment information for the placenta previa and provide a signiifcant role in the clinical diagnosis and treatment.