经阴道超声联合磁共振对剖宫产术后子宫瘢痕妊娠的诊断价值

Value of MRI Combined with Transvaginal Ultrasonography in the Diagnosis of Caesarean Scar Pregnancy

目的探讨经阴道超声联合MRI在剖宫产术后子宫瘢痕妊娠诊断中的价值。方法回顾性分析2008年1月~2014年12月在温州市中医院经临床或病理证实为子宫瘢痕妊娠的80例患者的临床资料。所有患者均行经阴道超声检查,对经阴道超声难以诊断的患者再行MRI检查。总结分析经阴道超声与MRI对子宫瘢痕妊娠的诊断的准确性及各自的图像特点。结果经阴道超声检查检出率为83.8%(67/80),按声像特点,进一步分为单纯胚囊型(48例)和不均质包块型(32例),二者的检出率分别为90.5%(43/48)、75.0%(24/32),差异无统计学意义(P>0.05)。行MRI检查13例,检出率100%,与经阴道超声的检出率比较,差异无统计学意义(P>0.05)。结论经阴道超声检查对子宫瘢痕妊娠有较高的准确性,但仍有一定的误诊率,尤其是不均质包块型子宫瘢痕妊娠;MRI检查准确有效,可作为经阴道超声难以确诊或为进一步明确诊断时的补充手段。

Objective To explore the value of MRI combined with transvaginal ultrasonography in the diagnosis of cesarean scar pregnancy. Methods The clinical data of 80 patients with uterine scar pregnancy confirmed by clinical or pathology in Wenzhou Hospital of Traditional Chinese Medicine from January 2008-December 2014 were retrospectively analyzed.All patients underwent transvaginal ultrasound, and MRI was performed in patients who were difficult to diagnose.To summarize and analyze the accurate diagnostic rate of ultrasound and MRI in uterine scar pregnancy and the characteristics of each examination. Results The diagnostic accuracy of transvaginal ultrasonography was 83.8%（67/80）, according to the characteristics of the image, gestational cystic type were 48 cases and heterogeneous mass type were 32 cases, the diagnostic accuracy was 90.5%（43/48） and 75.0%（24/32） respectively, the difference was not statistically significant（P〉0.05）.MRI was carried out in 13 cases, he diagnostic accuracy was 100%.the difference in diagnostic efficiency between MRI and transvaginal ultrasound was not statistically significant（P〉0.05）. Conclusion The diagnoses of cesarean scar pregnancy by transvaginal ultrasonography is highly consistent with pathological results.,but there is still a certain rate of misdiagnosis,and gestational cystic type is more serious.MRI is accurate and effective, and can be used as an effective complement to the transvaginal ultrasound.