《腹部放射学会和欧洲泌尿生殖放射学会关于胎盘植入性疾病MRI检查的联合共识声明》要点解读

Interpretation of Society of Abdominal Radiology and European Society of Urogenital Radiology Joint Consensus Statement for MR Imaging of Placenta Accreta Spectrum Disorders

2020年2月,由加州大学旧金山分校(UCSF)放射科医师牵头,联合欧洲放射学会(ESR),在《欧洲放射学杂志》(European Radiology)在线刊出腹部放射学会(SAR)和欧洲泌尿生殖放射学会(ESUR)发布的《SAR和ESUR关于PAS的MRI检查的联合共识声明》(SAR and ESUR Joint Consensus Statement for MR Imaging of Placenta Accreta Spectrum Disorders)。该共识声明做出以下推荐,①使用规范化MRI技术方案,获取PAS影像学图像;②使用7项标准化专业术语判读PAS的MRI特点,并出具结构化诊断报告,包括胎盘内T2低信号带、胎盘/子宫膨出、胎盘后T2低信号线消失、子宫肌层变薄/中断、膀胱壁中断、胎盘局部外生团块和胎盘床异生血管。目前,我国孕妇的PAS发病率较高,三级医疗机构及绝大多数县级医疗机构,均配置MRI设备,但是对胎盘MRI影像学诊断的临床研究和应用迄今尚不规范,不能满足临床实践需求。笔者拟结合我国孕妇的PAS影像学诊断的临床实践,对《SAR和ESUR关于PAS的MRI检查的联合共识声明》要点进行解读,旨在为PAS的MRI临床诊断实践提供借鉴,便于达成多学科共识,规范PAS孕妇的围术期管理。产前根据胎盘侵犯的MRI诊断标准,相对准确鉴别诊断PAS类型,可为患者制定个体化的多学科诊治方案,避免术中意外事件发生,从而达到改善母儿结局的目的。

In February 2020,Society of Abdominal Radiology(SAR)and European Society of Urogenital Radiology(ESUR)Joint Consensus Statement for MR Imaging of Placenta Accreta Spectrum Disorders(PAS)which was led by radiologists at the University of California,San Francisco(UCSF),and in conjunction with the European Society of Radiology(ESR)was published online in journal of European Radiology.The consensus statement recommends use of standardized MRI technology to obtain PAS images;meanwhile,it is recommended to use 7 pieces of standardized technical terms to interpret MRI characteristics of PAS and issue a structured diagnostic report,including intraplacental dark T2 bands,placental/uterine bulge,loss of low T2 retroplacental line,myometrial thinning/disruption,bladder wall interruption,focal exophytic placental mass and abnormal vascularization of placental bed.At present,the incidence of PAS is high in China.The tertiary medical institutions and the vast majority of county-level medical institutions are equipped with MRI equipment.However,the clinical research and application of placental imaging diagnosis have not been standardized so far and cannot meet needs of clinical practice in China.The authors intend to interpret the main points of the SAR and ESUR joint consensus statement on MRI of PAS,in conjunction with the clinical practice of imaging diagnosis of PAS in China,and aim to provide a reference for MRI practice of PAS,so as to reach a multidisciplinary consensus and regulate perioperative management of PAS,relatively accurate identification of PAS types before birth by MRI criteria for placental invasion,formulate individualized multidisciplinary diagnosis and treatment plan for patients,try to avoid intraoperative accidents,and improve maternal and fetal outcomes.