MRI在妊娠期胎盘植入中的产前诊断价值及影像特征

Prenatal Diagnostic Value and Imaging Features of MRI in Placental Implantation During Pregnancy

目的探讨磁共振在妊娠期胎盘植入的产前诊断价值及影像特征。方法回顾性分析在我院产前就诊的51例疑似妊娠期胎盘植入的患者,经临床手术和病理诊断结果确诊49例,应用Kappa检验分析MRI、US与临床手术或病理诊断胎盘植入的一致性,并分别计算MRI、US诊断妊娠期胎盘植入的灵敏度、特异度等统计学指标。计算MRI、US对妊娠期胎盘植入不同类型的检出率和MRI妊娠期胎盘植入各征象的检出率。结果MRI诊断妊娠期胎盘植入的敏感度、特异度、阳性预测值、阴性预测值分别为98%、50%、98%、50%。US诊断妊娠期胎盘植入的敏感度、特异度、阳性预测值、阴性预测值分别为78%、50%、78%、8%。MRI和US的Kappa值分别为0.42、0.48,表示两者与临床手术或病理诊断具有中高度一致性。对诊断穿透型胎盘植入MRI和US都有较高的检出率,但是在诊断粘连型胎盘植入的检出率方面US较MRI低。结论MRI对诊断妊娠期胎盘植入的准确性较高,对胎盘植入的分级诊断价值也要高于US。产前MRI检查对于临床术前评估尤为重要,可以作为一种有效及无创的检查手段。

Objective To explore the prenatal diagnostic value and imaging features of MRI in placental implantation during pregnancy.Methods Retrospectively analyzed in our hospital antenatal clinic of 51 patients with suspected pregnancy placenta implantation,the clinical surgery and pathological diagnosis confirmed in 49 cases,Kappa test is used to analyze the MRI,US and the consistency of the clinical pathological diagnosis of placenta implantation surgery or MRI,US and calculate the sensitivity of diagnosis of pregnancy placenta increta,specific degree of statistical indicators.The detection rates of different types of placental implantation in pregnancy by MRI and US and the detection rates of various signs of placental implantation in pregnancy by MRI were calculated.Results The sensitivity,specificity,positive predictive value and negative predictive value of MRI in diagnosing placental implantation during pregnancy were 98%,50%,98%and 50%,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of US in diagnosing placental implantation in pregnancy were 78%,50%,78%and 8%,respectively.The Kappa values of MRI and US were 0.42 and 0.48 respectively,indicating that they were moderately consistent with clinical surgery or pathological diagnosis.Both MRI and US had higher detection rate for diagnosis of penetrating placenta implantation,but US had lower detection rate for diagnosis of adhesion placenta implantation than MRI.Conclusion MRI is more accurate in the diagnosis of placental implantation in pregnancy,and the value of graded diagnosis of placental implantation is higher than that of US.Prenatal MRI is particularly important for preoperative clinical evaluation and can be an effective and noninvasive examination.