阴道超声联合MRI对剖宫产史孕妇瘢痕妊娠的诊断价值

Value of Transvaginal Ultrasonography Combined with MRI in the Diagnosis of Cesarean Scar Pregnancy

目的分析阴道超声联合磁共振(MRI)对剖宫产史孕妇子宫瘢痕妊娠的诊断价值。方法选择2018年10月至2019年10月经我院收治的初诊为剖宫产史瘢痕妊娠孕妇65例。对孕妇进行阴道超声、MRI检查、阴道超声联合MRI检查,并将上述检查结果与手术病理结果进行比较,分析其诊断价值。结果阴道超声检查中阳性结果44例(67.69%),阴性结果21例(32.31%);与病理检查结果比较,44例阳性中3例阴性、41例阳性,21例阴性结果中5例阴性、16例阳性;阴道超声诊断敏感度为71.93%(41/57),特异性为62.50%(5/8),总准确率为70.77%(46/65),阳性预测值为93.18%(41/44),阴性预测值为23.81%(5/21),Kappa值为0.771。MRI检查中阳性结果49例(75.38%),阴性结果16例(24.62%);与病理检查结果比较,49例阳性中4例阴性、45例阳性,16例阴性结果中5例阴性、12例阳性;MRI诊断敏感度为78.95%(45/57),特异性50.00%(4/8),总准确率为75.38%(49/65),阳性预测值为91.84%(45/49),阴性预测值为25.00%(4/16);Kappa值为0.773。联合检查中阳性结果56例(86.15%),阴性结果9例(13.85%);与病理检查结果比较,56例阳性中3例阴性、53例阳性,9例阴性结果中5例阴性、4例阳性;联合检查诊断敏感度为92.98%(53/57),特异性62.50%(5/8),总准确率为89.23%(58/65),阳性预测值为94.64%(53/56),阴性预测值为55.56%(5/9),Kappa值为0.775。结论阴道超声联合MRI对剖宫产史子宫瘢痕妊娠孕妇有较高诊断价值。

Objective To investigate the value of transvaginal ultrasonography combined with Magnetic Resonance Imaging(MRI)in the diagnosis of cesarean scar pregnancy.Methods 65 cases of cesarean scar pregnancy in our hospital from October 2018 to October 2019 were enrolled.All women received transvaginal ultrasonography,MRI,or transvaginal ultrasonography combined with MRI.The results were compared with pathological results,then the diagnostic value of different diagnostic methods was analyzed.Results 44 cases(67.69%)were positive,and 21 cases(32.31%)were negative in transvaginal ultrasonography.Compared with pathological examinations,there were 3 negative cases in 44 positive cases and 16 positive cases in 21 negative cases.The sensitivity,specificity,total accuracy,positive predictive value,negative predictive value and kappa value of transvaginal ultrasound were 71.93%(41/57),62.50%(5/8),70.77%(46/65),93.18%(41/44),23.81%(5/21)and 0.771.MRI showed that 49 cases(75.38%)were positive,and 16 cases(24.62%)were negative.Compared with pathological examinations,there were four negative cases in 49 positive cases and 12 positive cases in 16 negative cases.The sensitivity,specificity,total accuracy,positive predictive value,negative predictive value,and kappa value of transvaginal ultrasound were 78.95%(45/57),50.00%(4/8),75.38%(49/65),91.84%(45/49),25.00%(4/16),and 0.773.Transvaginal ultrasonography combined with MRI showed 56 positive cases(86.15%)and 9 negative cases(13.85%).Compared with pathological examinations,there were three negative cases in 56 positive cases and four positive cases in 9 negative cases.The sensitivity,specificity,total accuracy,positive predictive value,negative predictive value,and kappa value of transvaginal ultrasound were 92.98%(53/57),62.50%(5/8),89.23%(58/65),94.64%(53/56),55.56%(5/9),and 0.775.Conclusion Transvaginal ultrasonography combined with MRI has high clinical value in the diagnosis of cesarean scar pregnancy.