2DUS联合CDFI对疑似子宫瘢痕妊娠患者早期诊断符合率的影响

Effect of 2DUS combined with CDFI on the coincidence rate of early diagnosis of patients with suspected uterine scar pregnancy

目的探讨二维超声检查(2DUS)联合彩色多普勒血流成像(CDFI)对疑似子宫瘢痕妊娠(SP)患者早期诊断符合率的影响。方法选取2016年1月~2018年4月我院疑似SP患者79例作为观察对象,均行2DUS、CDFI检测,以病理诊断为“金标准”,分析2DUS、CDFI单独检测及联合检测结果,对比单独与联合检测诊断效能。结果1)2DUS、CDFI检测图像特征及病理诊断79例疑似SP患者中,经病理诊断检查确诊31例;2DUS检测图像特征:①16例单纯孕囊型,表现子宫增大8例,稍大6例,正常2例,子宫瘢痕处见“双环征”典型妊娠囊声像,其中4例孕囊内见胎芽、胎心、卵黄囊,另6例未见明显胚芽声像,仅见卵黄囊,子宫内/外口紧闭,孕囊和膀胱间肌层菲薄或正常,子宫肌层不连续;②4例空泡型,子宫稍增大或正常,宫腔内见少量无回声区,宫颈/宫腔内无孕囊,子宫下段切口处无回声空泡;③9例不均质团块型,子宫下段切口位置有杂乱回声团块,内伴片状无回声区,肌层和团块分界模糊,回声紊乱。CDFI检测图像特征:13例血流丰富,16例团块内/周边探及少许血流信号,50例未探及明显血流信号;13例血流丰富者中,11例频谱特征为高速低阻〔阻力指数(RI)<0.5)〕,约占84.62%,妊娠囊周围血流速度33.7~57.8cm/s,平均(42.28±6.01)cm/s;2)瘢痕妊娠患者与正常妊娠者CDFI差异:瘢痕妊娠患者RI值、肌层厚度较正常妊娠者低(P<0.05);3)检测结果:经2DUS检出18例,经CDFI检出20例,经2DUS、CDFI联合检出29例;4)2DUS、CDFI单独检测与联合检测诊断效能:2DUS、CDFI联合检测符合率89.87%、灵敏度93.55%、阴性预测值95.45%高于单独检测,漏诊率12.50%低于单独检测(P<0.05);2DUS、CDFI联合检测特异度87.50%、误诊率12.50%、阳性预测值82.86%与单独检测对比无显著差异(P>0.05)。结论2DUS、CDFI于SP患者诊断中的影像学特征不同,联合诊断可有效提高检测符合率、灵敏度、阴性预测值,降低漏诊率,为临床早期确诊,选择适宜的治疗方案提供理论支持。

Objective To investigate the effect of two-dimensional ultrasound(2DUS)combined with color Doppler flow imaging(CDFI)on the coincidence rate of early diagnosis of patients with suspected uterine scar pregnancy(SP).Methods From January 2016 to April 2018,79 patients with suspected SP in our hospital were selected as subjects.All patients underwent 2DUS and CDFI tests.The pathological diagnosis was regarded as the“gold standard”.The results of 2DUS and CDFI alone and combined detection were compared.We compared the diagnostic efficacy with separate and combined detection.Results 1)2DUS,CDFI detection image characteristics and pathological diagnosis results were as fouows:In this study,79 patients with suspected SP were diagnosed by pathological diagnosis in 31 cases;2DUS detection image features included:①16 cases of simple gestational sac,showing uterus enlargement in 8 cases,slightly larger in 6 cases,normal in 2 cases,uterine scars seen"double ring sign"typical gestational sac image,4 cases of fetal buds in the gestational sac,fetal heart and the yolk sac.The other 6 cases did not see a significant germ image,but only the yolk sac,the uterus/outer mouth was tightly closed,the sac and the bladder muscle layer was thin or normal,the myometrium was not continuous;②for 4 cases of vacuole type,the uterus was slightly enlarged or normal,a small amount of anechoic area was seen in the uterine cavity,there was no gestational sac in the cervix/uterine cavity,and there was no echo vacuol in the incision in the lower part of the uterus;③for 9 cases of heterogeneous mass type,the in-ferior uterus incision position had a disordered echo mass,with a sheet-like anechoic zone,the muscle layer and the mass boundary were blurred,and the echo was disordered.For image characteristics of CDFI detection,13 cases were rich in blood flow,16 cases had a small blood flow signal in/outside the mass,and 50 cases did not detect significant blood flow signals;Of the 13 patients with blood flow,11 were characterized by high-speed and low-resistance〔resistance index(RI)<0.5)〕,accounting for 84.62%,and the blood flow velocity around the gestational sac was 33.7~57.8 cm/s,with an average of(42.28±6.01)cm/s;2)For CDFI difference between scar pregnancy patients and normal pregnancy:RI value and muscle thickness of patients with scar pregnancy were lower than those of normal pregnancy(P<0.05);3)For test results,18 cases were detected by 2DUS,20 cases were detected by CDFI,and 29 cases were detected by 2DUS and CDFI;4)For 2DUS,CDFI alone and combined detection diagnostic efficacy,2DUS,CDFI combined detection rate was 89.87%,sensitivity was 93.55%,negative predictive value of 95.45%which was higher than separate detection,missed diagnosis rate of 12.50%,lower than separate detection(P<0.05);The combined detection specificity of 2DUS and CDFI was 87.50%,the misdiagnosis rate was 12.50%,and the positive predictive value was 82.86%.There was no significant difference between the two groups(P>0.05).Conclusion The imaging features of 2DUS and CDFI in the diagnosis of SP patients are different.Combined diagnosis can effectively improve the detection rate,sensitivity,negative predictive value,reduce the rate of missed diagnosis,and provide data support for early diagnosis and appropriate treatment.