探讨磁共振成像在胎盘植入分级诊断中的应用

The application of magnetic resonance imaging in placenta increta

目的探讨磁共振成像(magnetic resonance imaging,MRI)在胎盘植入分级诊断中的价值。方法回顾性分析广西医科大学第一附属医院2011年7月至2016年7月61例因可疑胎盘植入而行MRI检查患者的手术病理、临床结局等资料。结果 MRI诊断胎盘植入的总体敏感度为86.4%,特异度70.6%。MRI诊断穿透性胎盘植入与手术病理诊断符合率最高(100%),其次为植入性胎盘植入(79.2%)。穿透性胎盘植入组中出血量(7350±3300)m L、输血量[红细胞(24.6±12.1)u,血浆(2137.5±1598.6)m L]最高(P<0.05);植入性胎盘植入组中出血量(3279.41m L±2133.7)m L、输血量[红细胞(11.0±6.1)u,血浆(902.94±802)m L]高于粘连性胎盘植入组、无胎盘植入组(P<0.05)。穿透性胎盘植入组中子宫切除率为100%,与粘连性胎盘植入组、无胎盘植入组相比有统计学差异(P<0.05)。植入性胎盘植入组的子宫切除率(61.9%)高于粘连性胎盘植入组、无胎盘植入组(P<0.05)。结论MRI对诊断植入性、穿透性胎盘有重要价值,但对粘连性胎盘诊断价值有限。穿透性胎盘、植入性胎盘是导致严重产后出血、围产期紧急子宫切除的重要原因,在MRI诊断中应予以区分。

Objective To explore the application value of MRI in placental increta.Methods Datas of 61 cases with a diagnosis of suspected placental invasion from July 2011 to July 2016 were included in this study and the maternal outcomes and the accuracy of MRI in the diagnosis of placental invasion retrospective were analyzed.Results The sensitivity was 86.4% and specificity was 70.6% in the diagnosis of placenta accreta.MRI had the highest accuracy of diagnosis coincidence rate with surgery and pathology in assessing the adequacy of placenta percreta(100%) and in increta was(79.2%).The blood loss was(7350 ± 3300) m L, the red blood cells transfusion was(24.6 ± 12.1) u, the blood plasma transfusion was(2137.5 ± 1598.6) m L in placenta percreta group were highest(P < 0.05) when compared with other groups.The blood loss was(3279.4 ± 2133.7) m L,red blood cells transfusion was(11.0 ± 6.1) u, the blood plasma transfusion was(902.94 ± 802) m L in placenta increta group,which was higher than placenta accreta group(P < 0.05).The hystetrectomy rate was 100% in placental percreta group which has significance difference between placenta accreta group and no placenta accretegroup(P < 0.05).The hystetrectomy rate was 61.9% in placental increta group which was higher than placenta accreta group and no placenta accrete group(P < 0.05).Conclusions MRI has important value in the diagnosis of placenta increta and placenta percreta, but has limitition in the diagnosis of placenta accreta.Placenta increta and placenta percreta are an important causes of severe postpartum hemorrhage and perinatal emergency hysterectomy,and should be distinguished in MRI diagnosis.