经腹超声和MRI在产前胎盘植入诊断中的价值探讨

Value analysis of transabdominal ultrasonography and MRI for diagnosing prenatal placenta accreta

目的:探讨经腹超声和磁共振成像(MRI)在产前对胎盘植入诊断的临床价值。方法:回顾性分析2016年1月—2017年10月本院行经腹超声和MRI检查的79例疑似胎盘植入患者的临床资料,根据胎盘位置分为前壁组43例,后壁组36例,比较超声和MRI对胎盘植入诊断的特异性、敏感性等。结果:胎盘植入的超声表现为胎盘间隙不规则或消失等;MRI主要影像学表现为T2低信号、子宫局部变形膨出等。根据术后病理结果,后壁组术前MRI检查胎盘植入的敏感性、特异性、阳性预测值和阴性预测值均高于超声检查,而前壁组MRI仅在特异性和阴性预测高于超声检查(P<0.05)。结论:经腹超声和MRI在产前诊断中均具有较高价值,MRI对子宫后壁胎盘植入的诊断优势明显。

Objective： To explore the clinical value of transabdominal ultrasound and magnetic resonance imaging （MRI） for diagnosing prenatal placenta accreta. Methods： Clinical data of 79 pregnant women with suspected placenta accreta in people＇s hospital of three gorges university from January 2016 to October 2017 were retrospectively analyzed. According to placental location, the included women were divided in anterior wall group （43 cases） and posterior wall group （36 cases）. The specificity and sensitivity of ultrasound and MRI for diagnosing placenta accreta were compared. Results： The ultrasonographic manifestations of placental accreta were irregular or disappeared of placental spaces. The main imaging findings of MRI were T2 low signal and local deformation of the uterus. According to the postoperative pathological results, in posterior wall group, the sensitivity, specificity, positive predictive value and negative predictive value of the preoperative MRI examination were significantly higher than those of ultrasound examination. In anterior wall group, the specificity and negative predictive value of MRI were significantly higher than those of ultrasound examination （P〈 0.05）. Conclusion： Ultrasonography and MRI all have high value for diagnosing prenatal placental accrete, and MRI has obvious advantages for diagnosing uterine posterior wall placenta.