胎盘植入的MRI诊断

The MRI Diagnosis of Placenta Accreta

目的:探导胎盘植入的MRI特征,有助于在产前MRI扫描明确诊断胎盘植入。方法:本文回顾性分析了32例拟诊前置胎盘患者的磁共振检查影像,22例经手术证实胎盘植入,总结胎盘植入MRI影像特征。并将MRI检查结果与术后病理证实结果进行比较。结果:32例前置胎盘的患者中行磁共振检查,10例经手术证实无胎盘植入,有22例经手术证实胎盘植入。32例拟诊前置胎盘的患者行磁共振检查诊断为胎盘植入23例,非胎盘植入9例。32例术后病理确诊22例胎盘植入,10例无胎盘植入。MRI有3例诊断为胎盘植入,术后证实为非胎盘植入;MRI有2例诊断为非胎盘植入,术后证实为胎盘植入。MRI误诊3例,漏诊2例。22例胎盘植入患者,其中粘连17例,18例植入,13例既有粘连又有植入,MRI表现为:22例有子宫体积的不规则增大、变形,其中15例见子宫壁局部隆起;胎盘信号不均匀16例;胎盘内T2WI条状低信号条带影15例;胎盘下血管影16例。结论:胎盘植入的MRI的表现为有子宫体积的不规则增大、变形,子宫壁局部隆起;胎盘信号不均匀;胎盘内T2WI条状低信号条带影;胎盘下血管影增多。MRI能够明确诊断胎盘植入。MRI检查胎盘植入的敏感性、特异性分别为90.91%、70.00%。统计学处理显示MRI产前检查结果与临床术后最终确诊结果之间差异无统计学意义(P>0.05)。

Purpose： To explore the MRIfeatures of placenta accreta. Methods： MRI images of 32 patients with placenta previa were retrospectively analyzed, of which 22 cases were confirmed by operation results. We compared MRIresults with postoperative pathology results. Results： Thirty-two cases of patients with suspected placenta previa underwent MRI examination. Of them, 10 cases were confirmed with no placenta accreta, 22 cases were confirmed with placenta accreta by operation; 23 cases were diagnosed as with placenta increta, and 9 cases with no placenta increta by MRI examination. Three cases were diagnosed as with placenta implants by MRI, but postoperative results showed them without placenta implants; 2 cases were diagnosed as with no placenta implants by MRI, the postoperative results showed them with placenta implants. Three cases were misdiagnosed by MRI, and 2 cases were miss diagnosed. Of the 22 cases with placenta accrete, 17 cases were with adhesion, 18 cases with implantation, 13 cases with both adhesion and implantation. MRIshowed that 22 cases were with irregular increase of uterine size and with shape deformation. Of these 22 cases, 15 cases were with local uplift of the uterine wall, 16 cases with inhomogeneous placenta signal intensity, 15 cases with dark intraplacental bands on T2-weighted images, and 16 cases with increased subplacental vascularity. Conclusion： The main MRIfeatures of placenta accreta were irregular increase of uterine size and with shape deformation, local uplift of the uterine wall, inhomogeneous placenta signal intensity, dark intraplacental bands on T2-weighted images and increase of subplacental vascularity. MRIhas an important value for the preoperative diagnosis of placenta accreta. The sensitivity and specificity of MRIin diagnosis of placenta increta were 90.91% and 70.00%.Statistical results showed that there was no statistical significant difference between the results of MRI and clinica postoperative results （P 〉0.05）.