经阴道超声与MRI动态增强对剖宫产术后瘢痕妊娠的早期诊断价值对比

Comparison of The Value Between Transvaginal Ultrasound and MRI Dynamic Enhancement in the Early Diagnosis of Caesarean Scar Pregnancy

目的比较经阴道超声与核磁共振(MRI)动态增强对剖宫产术后瘢痕妊娠(GSP)的早期诊断价值。方法回顾性分析2016年5月至2018年5月唐山市妇幼保健院就诊治疗的62例GSP患者的临床及影像资料,分析不同检查方法对GSP的诊断符合率及影像学表现。结果MRI增强动态扫描诊断GSP符合率(93.55%)较经阴道超声检查诊断符合率(90.32%)稍高(P>0.05);而MRI动态增强扫描检查诊断植入绒毛符合率为(80.00%)显著高于经阴道超声检查(40.00%)(P<0.05)。阴道超声中36例为孕囊向宫腔内生长,20例为孕囊向子宫肌层甚至浆膜层生长,8例在其瘢痕处及周围探及丰富血流。MRI平扫示瘢痕部位较低信号,孕囊在T1WI时为均匀低信号,在T2W2为混杂或高信号。在DWI中呈现高信号、孕囊壁环形高信号和无明显高信号孕囊分别为22例、34例和6例,进一步增强显示环形强化和结节状或不均匀强化为26例和36例。结论阴道超声与MRI动态增强扫描对GSP均具有较高的诊断率,但MRI动态增强扫描影像学表现更为清晰和细微,诊断植入绒毛符合率更高,更有利于指导临床治疗。

Objective To analyze and compare the early diagnostic value of transvaginal ultrasound and magnetic resonance imaging(MRI)dynamic enhancement for caesarean scar pregnancy(GSP).Methods The clinical and imaging data of 62 patients with GSP who were treated in Tangshan Maternal and Child Health Hospital from May 2016 to May 2018 were retrospectively analyzed.The diagnostic accuracy of different examination for GSP and the imaging features was analyzed.Results The coincidence rate for the diagnosis of GSP(93.55%)with MRI dynamic enhancement scanning was slightly higher than that with transvaginal ultrasound(90.32%)(P>0.05).The coincidence rate for the diagnosis of implanting villus with MRI dynamic enhancement scanning was significantly higher(80.00%)than that with transvaginal ultrasonography(40.00%)(P<0.05).In transvaginal ultrasound examination,there were 36 patients whose fertilized egg grew into uterine cavity,20 patients whose fertilized egg grew into myometrium or serosa layer,and 8 patients who were explored abundant blood flow at and around the scar.MRI plain scan showed a lower signal on the scar.The fertilized egg was a uniform low signal at T1WI and a mixed or high signal at T2W2.There were 22 cases showing high signal in DWI,34 cases showing circular high signal on the wall of the fertilized egg and 6 cases showing fertilized egg with no obvious high signal.Further enhancements showed there were 26 cases with circular enhancement and 36 cases with nodular or heterogeneous enhancement.Conclusion Transvaginal ultrasound and MRI dynamic enhanced scan have a high diagnostic rate for GSP,but the imaging features of MRI dynamic enhanced scanning are clearer and more subtle and the diagnostic accuracy of villus implantation is higher,which is more favorable to guide clinical treatment.