剖宫产切口妊娠患者MRI影像特点及临床结局分析

MRI Image Features and Clinical Outcomes of Cesarean Delivery Scar Pregnancy

目的分析剖宫产切口妊娠(CSP)患者磁共振成像(MRI)影像特点及临床结局。方法回顾性收集2015年1月-2017年6月我院收治的34例CSP患者临床资料,分析其MRI影像特点,并比较不同分型CSP的影像特征参数及临床结局。结果 CSP的MRI影像特点为妊娠物于子宫前壁疤痕处种植。囊状孕囊13例,MRI表现为T1WI呈低信号,T2WI呈高信号,增强扫描显示环形薄壁强化。包块状孕囊21例,MRI表现为T1WI呈等低信号,T2WI呈混杂信号,增强扫描显示环形厚壁强化。孕囊着床位置的疤痕最小厚度为(3.61±1.12)mm,孕囊、疤痕相交处长度(19.46±9.74)mm,孕囊面积大小为(643.36±197.65)mm2。血供丰富20例,血供缺乏14例。外生型20例,内生型14例;相比于内生型,外生型具有更小的疤痕厚度及孕囊面积、更大的孕囊与疤痕相交处长度(P<0.05),且孕囊周边血供丰富的比例更高(P<0.05)。相比于内生型,外生型行子宫动脉化疗栓塞比例及清宫术出血量更大,β-HCG转阴时间更长,差异有统计学意义(P<0.05)。结论CSP的MRI影像表现具有特征性,且外生型与内生型影像特征参数及临床结局存在差异,MRI检查对临床治疗有重要指导意义。

Objective To analyze the magnetic resonance imaging（MRI） image features and clinical outcomes of patients with cesarean scar pregnancy（CSP）. Methods The clinical data of 34 patients with CSP who were admitted to the hospital from January 2015 to June2017 were retrospectively analyzed, and their MRI image features were analyzed. The image features and clinical outcomes of different types of CSP were compared. Results The MRI image characteristic of CSP was that the pregnancy matter was planted at the scar of the anterior wall of the uterus. There were 13 cases of cystic gestational sacs. MRI showed low signal on T1 WI and high signal on T2 WI, and enhanced scan showed circular thin-walled enhancement. There were 21 cases of massive gestational sacs. MRI showed low signal on T1 WI and mixed signal on T2 WI, and enhanced scan showed ring-shaped thick-wall enhancement. The minimum thickness of scar at implantation site was（3.61±1.12） mm, the length of pregnancy sac and scar intersection was（19.46±9.74） mm, and the size of gestational sac was（643.36±197.65） mm2. The blood supply was rich in 20 cases and lacking in 14 cases. There were 20 cases of exogenic type and 14 cases of endogenous type. Compared with endophytic type, exogenic type had smaller scar thickness and gestational sac area, larger intersect length of gestational sac and scar（P〈0.05）, and the proportion of rich peripheral blood supply of gestational sac was relatively higher（P〈0.05）. Compared with the endogenous type, the proportion of uterine artery chemoembolization for exogenic type and the bleeding volume in uterus curettage were higher/more, and the negative conversion time of β-HCGwas longer（P〈0.05）. Conclusion The MRI image features of CSP are characteristic, and there are differences between extrinsic and endogenous image features and clinical outcomes. MRI examination is of great guiding significance for clinical treatment.