不同类型剖宫产切口妊娠MRI特征及比较

Study and comparison of the MRI features in different types of cesarean scar pregnancy

目的:探讨剖宫产切口妊娠(CSP)的MRI表现并比较CSP两种类型的影像特征、治疗手段及临床结局。方法:经临床确诊CSP 27例,回顾性分析MRI影像及临床资料,比较CSP两种类型的影像特征、治疗手段及临床结局。结果:CSP的MRI表现为妊娠物种植在瘢痕处。孕囊着床处瘢痕最薄厚度为(3.2±1.7)mm。孕囊与疤痕接触面的长度为(21.4±10.0)mm。孕囊大小为(567.1±261.4)mm2。孕囊周围血供丰富16例。外生型16例,内生型11例。外生型及内生型在孕囊着床处疤痕最薄厚度、孕囊与疤痕接触面的长度、孕囊大小、孕囊周围血供方面,差异有统计学意义(P<0.05)。两种类型在行子宫动脉化疗栓塞例数及清宫术中出血量方面,差异有统计学意义(P<0.05)。结论:CSP有特征性MRI表现。外生型及内生型影像特征、治疗手段及临床结局不同,MRI能指导临床个体化治疗。

Objective：To study the MRI features of different types of cesarean scar pregnancy （CSP） and to compare their MRI features,treatment and clinical outcome. Methods：The MRI and clinical materials of 27 women with clinically di- agnosed CSP were analyzed retrospectively. The MRI features, treatment and clinical outcome of two types of CSP were compared. Results：The MRI feature of CSP was gestational sac （GS） embedded in cesarean section scar （CSS）. The mini- mum thickness of the CSS of nidation was （3.2 ±1.7）mm. The length of CSS in contact with GS was （21.4 ± 10.0）mm. The size of GS was （567.1±261.4）mm2. 16 cases had rich blood supply in the surrounding of GS. There were exogenous type （16 cases） and endogenous type （11 cases）. Significant statistical difference between exogenous type and endogenous type were existed in the minimum thickness of the nidation at CSS, the maximum length of CSS in contact with GS, the size of GS and the surrounding blood supply （all P〈0. 05）. The number of patients performing uterine artery chemo-emboliza tion and the volume of hemorrhage during curettage in these two types of CSP also showed statistical difference （P〈0.05）. Conclusion：Characteristic MRI findings of CSP could be assessed. The imaging features,treatment and clinical outcome of exogeneous and endogeneous type of CSP varied, MRI provides helpful guidance for individual treatment.