MRI在孕晚期胎盘植入中的诊断价值

The value of MRI in the diagnosis of placenta accreta at the late stage of pregnancy

目的分析MRI对孕晚期胎盘植入诊断价值。方法回顾性分析本院行MRI检查孕晚期患者98例,以手术及病理诊断为金标准,分析各MRI征象及各征象联合应用对胎盘植入的诊断价值。结果 98例患者以手术及病理诊断为标准,诊断胎盘植入36例,其中胎盘粘连13例、胎盘植入19例及胎盘穿透4例。子宫肌层中断、胎盘肌层界面模糊、植入膀胱、胎盘内信号不均匀、胎盘血管增多、子宫异常膨隆诊断胎盘植入的诊断价值分别为87.8%、86.7%、66.0%、87.7%、86.7%、84.7%。子宫肌层中断结合子宫异常膨隆诊断准确率为92.6%,敏感度和阴性预测值达100.0%。子宫肌层中断、胎盘内信号不均匀、子宫异常膨隆的联合应用诊断准确率达98.4%,敏感度和阴性预测值达100.0%。结论MRI各征象对胎盘植入具有较高的诊断价值,三个征象联合应用对胎盘植入诊断价值明显提高,子宫肌层中断、胎盘内信号不均匀、子宫异常膨隆的联合应用诊断准确率最高。

Objective To analyze the value of MRI in the diagnosis of placenta implantation at the late stage of pregnancy.Methods 98 patients with the late stage of pregnancy were included in the study.To analyze the diagnostic value of MRI signs for placental implantation with surgical and pathological diagnosis as gold standard.Results 36 cases of placental implantation were diagnosed by surgical and pathological criteria in 98 cases,including 13 cases of placental adhesion,19 placental implantation and 4 cases of placental penetration.The diagnostic value of myometrial interruption,placental muscularis interface blurring,implantation of bladder,placental heterogeneity,placental blood vessels and abnormal uterine expansion were 87.8%,86.7%,66%,87.7%,86.7%,84.7%respectively.The diagnostic value of combination of focal disruption of myometrium and abnormal uterine bulging were 92.6%.The diagnostic value of combination of focal disruption of myometrium,heterogeneous placenta and abnormal uterine bulging were 98.4%.Conclusion There was high value in the diagnosis of placental implantation abnormality with MRI.The diagnostic value of combination of focal disruption of myometrium,heterogeneous placenta and abnormal uterine bulging is highest.