磁共振成像和阴道超声诊断剖宫产后瘢痕妊娠的特点及比较

Comparison of characteristics and diagnostic accuracy between magnetic resonance imaging and transvaginal ultrasound in cesarean scar pregnancy

目的比较剖宫产后瘢痕妊娠(CSP)的磁共振成像(MRI)和阴道超声特点及二者诊断准确率。方法 2016年3月至2017年3月,对眉山市人民医院56例剖宫产后瘢痕妊娠的产妇进行回顾性分析,对其进行MRI和阴道超声检查,并对结果进行对比。结果 56例产妇中经MRI检出54例,诊断符合率为96.43%,其中20例不均质包块型均检出,单纯孕囊型检出34例,漏诊2例;而43例经阴道超声检查出,诊断符合率为76.79%,其中19例为不均质包块型,24例为单纯孕囊型,误诊13例,其中误诊为宫内妊娠8例,误诊为宫颈妊娠5例。统计结果显示,MRI对剖宫产后瘢痕妊娠的总体诊断准确率明显高于阴道超声(χ2=6.98,P<0.05),且MRI检出单纯孕囊型的准确率高于阴道超声检查(χ2=7.68,P<0.05),而不均质包块型检出率对比,并无明显差异(χ2=0.96,P>0.05)。结论 MRI对剖宫产后瘢痕妊娠诊断准确率较阴道超声检查高,可作为临床诊断的重要方法。

Objective To compare the characteristics and diagnostic accuracy between magnetic resonance imaging （MRI） and transvaginal ultrasound in cesarean scar pregnancy （CSP）. Methods Retrospective analysis was conducted among 56 cases of CSP selected in People Hospital of Meishan City during March 2016 and March 2017, and they accepted MRI and transvaginal uhrasonography for analysis. Results Fifty four cases were detected by MRI with diagnostic accordance rate of 96.43%, including 20 cases of heterogeneous mass type, 34 cases of simple gestational sac type. Two cases were missed diagnosed. There were 43 cases detected by transvaginai ultrasound, with diagnostic accordance rate of 76.79%, including 19 cases of heterogeneous mass type, 24 cases of simple gestational sac type. Thirteen eases were misdiagnosed, including 8 cases misdiagnosed as intrauterine pregnancy and 5 cases misdiagnosed as cervical pregnancy. The statistical results showed that the overall accurate rate of MRI in diagnosis of CSP was significantly higher than that of transvaginal ultrasound （χ2 = 6.98,P〈0.05）, and the accuracy rate of MRI in detecting simple gestational sac was higher than that of transvaginal uhrasound （χ2 =7.68,P〈0.05）. There was no significant difference between two methods in detection rate of heterogeneous mass （χ2 = 0.96, P〉0.05）. Conclusion The accuracy of MRI in diagnosis of CSP is higher than that of transvaginal ultrasonnd, and MRI can be used as an important method for clinical diagnosis.