单次激发快速FSE序列在前置胎盘、胎盘植入诊断中的应用

Clinical value of single-short fast spin echo sequence in the diagnosis of placenta previa or placenta increta

目的探讨单次激发快速自旋回波序列在前置胎盘或伴胎盘植入临床诊断中的价值。方法回顾性分析50例前置胎盘及胎盘植入患者,其中26例前置胎盘伴有胎盘粘连或植入,产后胎盘残留植入2例。患者均行MR ss FSE序列作冠状位、矢状位及横断位扫描,影像结果与手术及病理结果进行综合比较。结果 50例前置胎盘及胎盘植入中:中央性前置胎盘21例;部分性前置胎盘14例;边缘性前置胎盘13例,伴有胎盘植入28例(粘连11例、植入或穿透15例,产后胎盘残留植入或穿透2例),子宫胎盘面中断在胎盘植入组与非胎盘植入组间有显著差异(P﹤0.05),有13例粗大血管贯穿胎盘发生在胎盘植入组,胎盘粘连组、非胎盘植入组均未见,此征象在胎盘植入组与胎盘粘连组、非胎盘植入组间有显著差异(P﹤0.05)。MR诊断前置胎盘的敏感度、特异度分别为:100%,90%,诊断胎盘植入的敏感度、特异度分别为:93%,82%。结论 MR ss FSE序列在前置胎盘伴胎盘植入的诊断中发挥着重要作用,术前可以指导临床治疗方案。

Objective To investigate the value of single-short fast spin echo sequence in patients with placenta previa or combining with placenta increta. Methods Retrospective analysis was conducted on 50 patients with placenta previa and/or placenta increta,in whom 26 patients also presented with placenta increta,2 cases with postpartum placenta increta. They all underwent single-short fast spin echo sequence by axial,coronal and sigital position and were also compared with surgical and pathological diagnosis. Results 21 cases were diagnosed with central placenta previa,14 cases of partial placenta previa,13 cases of marginial placenta previa. 28 cases with placenta increta were diagnosed by MRI（11 cases of placental adhesion,15 cases of placental increta or penetration,2 cases of postpartum placenta increta or penetration）. The differences were significant between placental increta and non-placental increta groups of the sign in the uteroplacental interface focal defect; 13 cases of placenta increta were found dialated tortuous vasculature entering into placenta,and the differences were significant between placental increta,placental adhesion and non-placental increta groups. The sensitivity of MRI in the diagnose of placenta previa was 100%,with the specificity of 90%. The sensitivity of MRI in the diagnosis of placenta increta was 93%,with the specificity of 82%. Conclusion Single-short fast spin echo sequence is an important method to diagnose placenta previa and placenta increta. It can provide instructions before clinical operation.