MRI与超声联合检查对胎盘置入的诊断意义

Study on the diagnostic significance of combined MRI scanning and ultrasonography for placenta accrete

目的探讨MRI与超声联合检查对胎盘置入的诊断意义。方法依据整群随机抽样的方法回顾性选取2016年2月至2018年2月海口市第三人民医院妇产科收治的疑诊胎盘置入孕妇94例,所有孕妇均接受MRI与超声检查,统计分析MRI、超声、MRI与超声联合检查对胎盘置入的诊断价值。结果 94例孕妇中,病理诊断胎盘置入62例,其中14例为胎盘置入,12例为胎盘粘连,5例为胎盘穿透;未发生胎盘置入32例。MRI检查对胎盘置入的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值、误诊率、漏诊率分别为71. 0%(44/62)、62. 5%(20/32)、68. 1%(64/94)、78.6%(44/56)、52. 6%(20/38)、37. 5%(12/32)、29. 0%(18/62)。超声检查对胎盘置入的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值、误诊率、漏诊率分别为80. 6%(50/62)、68. 8%(22/32)、76. 6%(72/94)、83. 3%(50/60)、64. 7%(22/34)、31. 3%(10/32)、19. 4%(12/62)。MRI与超声联合检查对胎盘置入的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值、误诊率、漏诊率分别为96. 8%(60/62)、87. 5%(28/32)、93. 6%(88/94)、93. 8%(60/64)、93. 3%(28/30)、12. 5%(4/32)、3. 2%(2/62)。MRI与超声联合检查对胎盘置入的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值均显著高于MRI、超声检查(P <0. 05),误诊率、漏诊率均显著低于MRI、超声检查(P <0. 05);而MRI、超声检查对胎盘置入的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值、误诊率、漏诊率之间的差异均无统计学意义(P> 0. 05)。结论 MRI与超声联合检查对胎盘置入的诊断意义较MRI、超声检查单独诊断大。

Objective To explore the diagnostic significance of combined MRI scanning and ultrasound examination for placenta accreta. Methods 94 pregnant women with suspected placenta accreta during February 2016 to February 2018 admitted to the Department of Obstetrics and Gynecology, in the Third People's Hospital of Haikou were retrospectively selected by method of cluster random sampling. All pregnant women were examined by MRI scanning and ultrasonography. The diagnostic significance of MRI, ultrasound, MRI and ultrasound combined examination on placenta implantation were statistically analyzed. Results Among 94 pregnant women, 62 cases with placental implantation were diagnosed by pathological examination, including 14 cases with placental implantation, 12 cases with placental adhesion, 5 cases with placental penetration and 32 cases without placental implantation. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, misdiagnostic rate and missed diagnostic rate of placenta implantation were 71.0%(44/62), 62.5%(20/32), 68.1%(64/94), 78.6%(44/56), 52.6%(20/38), 37.5%(12/32) and 29.0%(18/62) respectively. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, misdiagnostic rate and missed diagnostic rate were 80.6%(50/62), 68.8%(22/32), 76.6%(72/94), 83.3%(50/60), 64.7%(22/34), 31.3%(10/32) and 19.4%(12/62) respectively. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value and missed diagnostic rate of placenta implantation by combined MRI and ultrasound were 96.8%(60/62), 87.5%(28/32), 93.6%(88/94), 93.8%(60/64), 93.3%(28/30), 12.5%(4/32) and 3.2%(2/62), respectively. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI and ultrasound examination were significantly higher than those by MRI or ultrasonography alone ( P <0.05). The misdiagnostic rate and missed diagnostic rate were significantly lower than those of MRI and ultrasonography ( P <0.05), but the difference in diagnostic sensitivity and specificity, accuracy, positive predictive value, negative predictive value, misdiagnostic rate and missed diagnosis rate of MRI, ultrasound examination on placenta implantation were not significant ( P >0.05). Conclusion The diagnostic significance of MRI combined with ultrasound is more better than MRI and ultrasonography separate diagnosis.