磁共振成像对妊娠中晚期产前胎盘植入的诊断价值

The diagnostic value of MRI for prenatal placenta accreta in second trimester of pregnancy

目的探讨磁共振成像(MRI)对妊娠中晚期产前胎盘植入的诊断及分类价值。方法回顾性分析焦作市第二人民医院2014年8月至2017年12月39例产前胎盘植入病人的影像及临床资料,所有病人均行常规MRI平扫,且经手术病理或临床证实。结果 MRI诊断胎盘植入粘连型或植入型8例,植入型6例,植入型或穿通型16例,穿通型9例。36例子宫肌层变薄,结构模糊、中断(部分、完全);37例胎盘与肌层分界不清,分界处可见流空血管,或伴局部血肿;38例胎盘信号出现异质性;9例胎盘局部结节样、三角形隆突,1例子宫膀胱交界面模糊、消失,膀胱壁中断,局部呈"帐篷样"改变;19例子宫轮廓局限性膨隆,呈梨形改变1例。结论 MRI对妊娠中晚期产前胎盘植入的诊断具有较高价值;对诊断粘连型胎盘植入能力不足,难以精确区分植入型胎盘植入,可以明确诊断穿通型胎盘植入。

Objective To investigate the value of MRI in the diagnosis and classification of prenatal placenta accreta(PA)in the second trimester of pregnancy.Methods The images and clinical data of 39 cases of prenatal placenta accreta from August 2014 to December 2017 in Jiaozuo Second People’s Hospital were retrospectively analyzed.All patients underwent plain MRI and con⁃firmed by operation and pathology or clinic.Results According to MRI diagnosis,there were 8 cases of placenta with adhesion or implantation type,6 cases with implantation type,16 cases with implanted or penetration type,and 9 cases with penetration type.There wer 36 cases of myometrium thinning,structural obstruction(partial,complete);37 cases of placenta and myometrial demar⁃cation was unclear,the boundary showed empty blood vessels,or with hematoma;38 cases of placental signal heterogeneity;9 case of local nodular placenta⁃like,triangular bulge,1 case of uterine bladder interface fuzzy or disappear,the bladder wall interrupted,the local"tent⁃like"changes;19 cases of uterine bulge limited bulging,pear⁃shaped changes in 1 case.Conclusion MRI is of great value in the diagnosis of PA in the second trimester of pregnancy.It is difficult to diagnose the adhesion type PA,and to dis⁃tinguish the implant PA accurately,but penetrating type PA can be clearly diagnosed.