早期瘢痕妊娠的MRI的表现和诊断价值

MRI Findings and Diagnostic Value of Early Scar Pregnancy

目的分析早期剖宫产瘢痕妊娠(CSP)的MRI表现,以提高对这类产科危重症诊断的准确性。方法2017年1月至2019年6月期间,对我院经过手术和病理证实的剖宫产手术后宫腔内瘢痕处早期妊娠的22例患者的MRI资料进行回顾性分析,所有患者均采用MR平扫+增强进行检查,将MRI表现与手术、病理所见进行对照分析。结果单纯孕囊型患者21例,团块型病灶患者1例。瘢痕区呈深V状5例,深U状14例,线或细带状3例。孕囊外壁T2WI可显示低信号线11例,孕囊内壁显示低信号线12例。DWI孕囊呈环状混杂等高信号。增强扫描孕囊呈轻中度环状强化。T2WI、DWI、T1WI增强序列对囊壁内外壁的显示有不同的价值。结论MRI多序列扫描,有助于综合判读孕囊绒毛膜与瘢痕接触的程度,推测孕囊可能的植入部位,对于孕早期CSP诊断具有重要价值。

Objective To analyze the MRI features of early cesarean scar pregnancy(CSP)in order to improve the diagnostic accuracy of this kind of critical obstetric illness.Methods From January 2017 to June 2019,the MRI features of 22 patients with early pregnancy in intrauterine scar after cesarean section confirmed by surgery and pathology were retrospectively analyzed.All patients were examined by plain and enhanced MR scans,and the MRI findings were compared with the surgical findings.Results Twenty-one patients were classified as simple type of gestational sac and mass type in one case.The scars were deep V-shaped in 5 cases,deep U-shaped in 14 cases and linear or ribbon-like in 3 cases.There were 11 cases of low signal lines on the outer wall of the fetal sac on T2WI and 12 cases of low signal lines on the inner wall of the pregnancy sac.On DWI,the gestational sac showed ring-shaped mixed iso-intensity.Contrast-enhanced scanning showed mild to moderate annular enhancement of the gestational sac.The enhancement sequences of T2WI,DWI and T1WI had different values for the showing of the outer margin of the cyst wall.Conclusion MRI multi-sequence scanning is helpful to comprehensively judge the contact degree between chorionic villi and scar,and to speculate the possible implantation site of gestational sac,which is of great value for the diagnosis of CSP in early pregnancy.