三维能量多普勒超声与MRI联合诊断植入型凶险性前置胎盘

Three-dimensional Power Doppler Ultrasound and MRI on Dlagnosing Implanted Placenta and Placenta Previa

目的 探讨超声新技术与MRI联合应用诊断植入型凶险性前置胎盘的价值。方法 对二维彩色多普勒超声检查(2D-CDFI)考虑植入型凶险性前置胎盘的54例患者,应用超声新技术三维能量多普勒成像(3D-CPA)对胎盘内及胎盘后方血流进行三维图像采集,随后行核磁共振检查(MRI),对3种方法检查结果与确诊标准进行对比分析。结果 54例拟诊植入型凶险性前置胎盘患者,行二维彩色多普勒超声检查,各型的漏误诊率和总漏误诊率,差异均有统计学意义(P<0.05);三维能量多普勒超声检查,粘连性胎盘及穿透性胎盘漏误诊率均为14.3%,有统计学意义(P<0.05);磁共振检查粘连性胎盘误诊率均为21.4%,差异有统计学意义(P<0.05),植入性胎盘漏诊率为4.2%,无统计学意义(P>0.05),穿透性胎盘无漏误诊。结论 三维能量多普勒超声与核磁共振检查联合应用对既往剖宫产,有前置胎盘怀疑合并胎盘植入的孕妇,可明显降低植入型凶险性前置胎盘漏诊率和误诊率,为临床诊断及治疗方案的制定提供准确的影像学依据。

Objective Discuss the value of the combined use of new ultrasonic techniques and MRI for diagnosing dangerous implanted placenta and placenta previa.Methods 54 patients with implanted placenta and dangerous placenta previa were first checked by 2D-CDFI ultrasound, and then by new ultrasonic techniques, including using 3D-CPA to assess and collect 3D images of blood flow in placenta and its posterior, and using MRI. After all three tests were completed, their results were compared and contrasted. Results There is a significant difference of misdiagnosis and missed diagnosis rate and total misdiagnosis and missed diagnosis rate between the different types of 2D-CDFI for the 54 patients with suspected implanted placenta and dangerous placenta previa (P<0.05). The misdiagnosis and missed diagnosis rates of using 3D power Doppler ultrasound on assessing adherent placenta and penetrative placenta were both 14.3%, indicating statistical significance(P<0.05). The misdiagnosis and missed diagnosis rate of using MRI on assessing adherent placenta and implanted placenta were 21.4% which indicated a significant difference(P<0.05), and 4.2% which indicated a non-significant difference(P>0.05), and its rate on assessing penetrative placenta was nil. Conclusion The combined use of 3D power Doppler ultrasound and MRI can significantly reduce the misdiagnosis and missed diagnosis rate of implanted and dangerous placenta previa for the pregnant with caesarean delivery history and suspected placenta previa and implanted placenta, and it can also provide reliable imaging evidences for clinical diagnosis and treatment.