MRI在瘢痕妊娠的诊治中的应用价值

Value of Magnetic Resonance Imaging(MRI)in the Diagnosis and Clinical Treatment of Cesarean Scar Pregnancy

【目的】探讨磁共振成像(MRI)在剖宫产瘢痕姓娘(cesarean scar pregnancy,CSP)诊治中的应用价值。【方法】回顾性分析2018年1月至2019年10月在本院临床拟诊为CSP的82例患者的经阴道超声及MRI检查结果及临床手术病理资料,探讨MRI在CSP诊治中的应用价值。【结果】82例患者经手术病理确诊为CSP 65例,17例为宫内早孕。65例CSP患者中,超声确诊56例,误诊9例;17例宫内早孕,超声确诊9例,误诊8例,超声诊断CSP的敏感度、特异度、准确度分别为86.15%(56/65)、52.94%(9/17)、79.27%(65/82)。65例CSP患者MRI确诊64例,误诊1例;17例宫内早孕,MRI确诊16例,误诊1例,MRI诊断CSP的敏感度、特异度、准确度分别为98.46%(64/65)、94.12%(16/17)、97.56%(80/82)。ROC曲线分析结果显示:超声AUC为0.695(0.584~0.792),显著低于MRI的0.963(0.896~0.992),其差异有统计学意义(Z=4.123,P<0.001)。根据MRI检查结果,对子宫前壁下段瘢痕厚度<3 mm者行宫腹腔镜联合手术;对>3 mm者行宫腔镜下妊娠物清除术。82例患者均手术成功,治疗效果满意。【结论】MRI对CSP诊断的敏感度、特异度、准确度高于经阴道超声,临床根据MRI检查测定子宫前壁下段瘢痕厚度,选择单纯宫腔镜或宫腹腔镜联合手术能取得较好的治疗效果。

【Objective】To explore the value of MRI in the diagnosis and clinical treatment of cesarean scar pregnancy.【Methods】A retrospective analysis was conducted by analyzing data collected from 82 patients with cesarean scary pregnancy(CSP)at The First Affiliated Hospital of USTC,Division of Life Science and Technology of China from January 2018 to October 219.The TVS performance,MRI results,and clinical data of the patients were analyzed.【Results】Among 82 patients,the final Pathological and Surgical diagnosis included CSP(n=65)and early uterine pregnancy(n=17).Among the 65 cases of CSP,56 cases were detected correctly and 9 cases were incorrectly diagnosed by ultrasonography.Among the 17 cases of early uterine pregnancy,9 cases were correctly diagnosed and 8 cases were misdiagnosed.The sensitivity,specificity and accuracy of ultrasonography for diagnosing CSP were 86.15%(56/65),52.94%(9/17),and 79.27%(65/82),respectively.Among the 65 cases of CSP,64 Cases were detected correctly and 1 case was detected incorrectly diagnosed by MRI.Among the 17 cases of early uterine pregnancy,16 cases were diagnosed correctly and 1 case was misdiagnosed.The sensitivity,specificity and accuracy of MRI for diagnosing CSP were 98.46%(64/65),94.12%(16/17),and 97.56%(80/82),respectively.The ROC curve analysis results showed that the AUC of ultrasound was 0.695(0.584〜0.792),which was significantly lower than the 0.963(0.896〜0.992)of MRI,and the difference was statistically significant(Z=4.123,P<0.001).According to the results of MRI,hysteroscopic combined Laparoscopic surgery was performed if scar thickness of the uterus ≤3 mm.If >3 mm,hysteroscopic pregnancy removal was performed.All 82 patients had successful surgeries and the treatments were satisfactory.【Conclusion】The sensitivity,specificity and accuracy of MRI for CSP diagnosis are higher than those of transvaginal ultrasonography.Scar thickness of the uterus,measured through MRI,can be used as the standard for the choice of hysteroscopic surgery or hysteroscopic combined with laparoscopic surgery.The choice,made according to MRI results,can achieve better treatment results.