彩色多普勒超声和磁共振检查诊断在胎盘植入中的诊断价值

Value of Color Doppler Ultrasonography and MRI in the Diagnosis of Placental Implantation

【目的】探讨彩色多普勒超声（简称彩超）和核磁共振（MRI）在胎盘植入中的诊断价值。【方法】回顾性分析2012年7月至2017年6月菏泽市第二人民医院诊治的100例临床拟诊为胎盘植入产妇的彩超及MRI资料，其检查结果与临床及病理诊断结果对照，分析两种检查方法在胎盘植入中的诊断价值。【结果】临床及病理诊断结果为64例诊断为胎盘植入，其中后壁植入28例，前壁植入36例；36例为非胎盘植入。彩超确诊86例，误诊4例，漏诊10例；MRI检查确诊88例，误诊8例，漏诊4例。两种检查与I临床及病理结果比较的kappa值分别为0.707、0．733，均大于0.7，两种检查与病理诊断具有高度一致性。彩超灵敏度、特异度分别为84．38％（54／64）、88．89％（32／36），与MRI的93．75％（60／64）、77．78％（28／36）比较差异无统计学意义（P〉0．05）。在前壁胎盘植入中，彩超显示胎盘后有丰富血流信号比例为83．33％，显著多于MRI的61．11％，其差异有统计学意义（P〈0.05）；后壁胎盘植入中，MRI显示胎盘后间隙消失、胎盘与子宫交界显示不清比例分别为92．86％、85．71％，显著多于彩超的67．86％、60．71％，其差异均有统计学意义（P＜0．05）。【结论】彩超和MRI在胎盘植入中的诊断效能相当，彩超对前壁胎盘植入诊断有优势，MRI对后壁胎盘植入诊断优于彩超，故MRI检查可作为B超初筛、彩超复查后的重要补充。

[ObjectivelTo evaluate the diagnostic value of color Doppler ultrasound （CDUs） and magnetic resonance imaging （MRI） in placenta accreta.[MethodslFrom July 2012 to June 2017, the data of color Doppler ultrasound and MRI of 100 cases clinically diagnosed as placenta accreta in Heze second people＇s Hospital were ana- lyzed retrospectively. The results were compared with the clinical and pathological findings to analyze the diagnos- tic value of two methods in placenta accreta.[ResultslThe clinical and pathological findings showed 64 cases of pla- centa accreta, 28 cases of posterior wall implantation and 36 cases of anterior wall implantation ; 36 cases were non-placental accreta. 86 cases were diagnosed by color Doppler ultrasound （see figure la）, 4 cases were misdiag- nosed . The kappa values of the two kinds of examinations compared with the clinical and pathological results were 0.707 and 0.733 ,which were greater than 0.7, respectively. The two kinds of examinations were highly consistent with the pathological diagnosis. The sensitivity and specificity of color Doppler ultrasound were 84.38% （54/64） 88.89% （32/36） respectively, and there was no significant difference compared with MRI 93.75%（60/64） 77.78% （28/36） （ P〉0.05）. In the placenta accreta of anterior wall, color Doppler ultrasound showed abundant blood flow signal after placenta, the proportion was 83.33%, significantly more than 61.11%~ of MRI , the difference was statistically significant （ P〈0.05）.In the posterior wall placenta accreta, MRI showed that the posterior placental space disappeared, and undefined ratio of placenta to uterus was 92.86 %and 85.71%, which was signifi- cantly higher than that of 67.86% and 60.71 % of color Doppler ultrasound,the difference was statistically significant （ P〈0.05）.[ConclusionlThe diagnostic efficacy of color Doppler ultrasound and MRI in placenta accreta is the same. Color Doppler ultrasound has advantages in the diagnosis of anterior wall placenta accrete ,and MRI is superior to color ultrasound in the diagnosis of posterior wall placenta impiantation. Therefore, MRI can be used as an important supplement of B ultrasound screening and color ultrasound reexamination.