阴道和直肠内填充耦合剂的动态MRI显示阴道后穹隆和直肠前突的价值

Clinical value of dynamic MRI of vaginal and rectal with coupling agent in the diagnosis of prolapse and rectocele

目的探讨阴道和直肠内填充耦合剂的动态MRI显示阴道后穹隆和直肠前突的价值。方法前瞻性收集经妇科门诊体检确诊为Ⅲ度以上盆腔脏器脱垂拟行手术治疗的33例患者，均行常规盆腔动态MRI（A组）以及经阴道和直肠内填充耦合剂的盆腔动态MRI检查（B组）。由2名放射科医师独立进行阴道后穹隆显示评分和直肠前突显示评分，并由妇产科医师根据影像医师共同商议出的A、B组图像结果制定手术方案。采用K印pa一致性检验评价2名放射科医师对阴道后穹隆和直肠前突显示评分的一致性，采用Fisher确切概率法比较A、B组图像对阴道后穹隆和直肠前突的显示以及对决定行高位骶韧带悬吊术的差异。结果2名医师对A、B组图像上阴道后穹隆显示评分和直肠前突显示评分的Kappa值分别为0．65、1．00，B组的一致性优于A组。B组对阴道后穹隆和直肠前突的显示均优于A组，差异均有统计学意义（P〈0．01）。依据A组图像，决定行高位骶韧带悬吊术者7例（21．2％，7／33）；依据B组图像，决定行高位骶韧带悬吊术者20例（60．6％，20／33），差异有统计学意义（P〈0．05）。结论采用经阴道和直肠内填充耦合剂的方法行盆腔动态MRI，更能清晰显示阴道后穹隆的位置和诊断直肠前突，为临床手术方式的制定提供重要的依据和参考。

Objective To investigate the diagnostic value of dynamic MRI with coupling agent filled vaginal and rectnmin the display of vaginal vault prolapse and rectocele. Methods Thirty three female patients, who were diagnosed with pelvic organ prolapse with III degrees and above by gynecologic outpatient clinic and prepared to be treated with surgery were prospectively collected. All of them underwent two types of dynamic MRI, one was routine dynamic MRI （Group A） and the other was dynamic MRI with vaginal and rectum filled with coupling agent （Group B）. Two radiologists evaluated and scored the display of vaginal vault and rectocele on these two groups of dynamic MRI images. According to the joint result of two radiologists, two gynecologists made surgical planning. Kappa test was used to compare the consistency of scores performedby two radiologists, and Fisher exact test was used to compare the differentiation fromboth groups, as well as the differentiation of probability of high uterosacral ligament suspension.Results The Kappa value of both groups was 0.65 and 1.00 respectively, where the consistency of Group B was superior than Group A. There were significant differencesbetween the two groups（P〈0.01）, where Group B was better than Group A. Based on the imaging results of Group A, 7 patients （21.2%, 7/33） were decided to make high uterosacral ligament suspension. Based on the imaging results of Group B, 20 patients （60.6%, 20/33） were decided to make high uterosacral ligament suspension, and differences were statistical significance between the two groups（P〈0.05）. Conclusions Fo purpose of the displaying vaginal vault and rectocele, the dynamic MR imaging with vaginal and rectum filled with coupling agent was better than routine method. The proposed method can provide important information and reference for the establishment of surgical planning.