MRI体素内不相干运动成像对妊高征患者产后子痫病理学反应的预测价值

Predictive value of MRI IVIM imaging on pathological response of postpartum eclampsia of PIH patient

目的:探讨磁共振成像(MRI)体素内不相干运动(IVIM)成像对妊娠高血压综合征(即妊高症)患者产后子痫病理学反应的预测价值。方法:选取医院收治的72例妊娠高血压产妇,按照其是否出现产后子痫分为子痫组(35例)和妊高组(37例),所有产妇均于产前、产后分别行MRI和IVIM成像检查,用双指数模型拟合不同b值下平均信号曲线,计算表观弥散系数(ADC)、弥散系数(D)、灌注系数(D*)及灌注分数(f),评估IVIM成像对妊高征患者产后子痫病理学反应的预测效能。结果:产后子痫组ADC和f值高于妊高组,差异有统计学意义(t=4.205,t=2.611;P<0.05),D值高于妊高组,差异有统计学意义(Z=5.953,P<0.05);而D*值差异无统计学意义(P>0.05);子痫组产前、产后ADC变化值和变化率均大于妊高组,差异有统计学意义(t=16.322,t=5.095;P<0.05),f和D*变化值、变化率两组差异无统计学意义,D变化值和变化率均大于妊高组,差异有统计学意义(Z=3.041,Z=2.938;P<0.05)。ADC变化值、ADC变化率、D变化值、D变化率预测产后子痫灵敏度分别为67.8%、67.8%、73.4%和81.0%,特异度分别为94.5%、88.9%、77.8%和72.3%。结论:妊高征孕妇伴产后子痫患者的产前、产后IVIM成像ADC、D变化值和变化率可作为子痫病理学反应的预测指标,其中D值的变化值和变化率预测效能更优。

Objective:To explore the predictive value of magnetic resonance imaging(MRI)intra voxel incoherent motion(IVIM)imaging on the pathological response of postpartum eclampsia in patients with pregnancy-induced hypertension(PIH).Methods:72 cases with PIH who admitted to hospital were selected and they were divided into eclampsia group(35 cases)and PIH group(37 cases)according to whether occurred postpartum eclampsia.All of parturient underwent MRI and IVIM imaging examination before and after delivery.Double exponential model was used to fit average signal curve under different b values so as to calculate apparent diffusion coefficient(ADC),diffusion coefficient(D),perfusion coefficient(D*)and perfusion fraction(f),and to assess the predictive performance of IVIM imaging for the pathological response of postpartum eclampsia in patients with PIH.Results:The ADC and f value of postpartum eclampsia group were significantly higher than those of PIH group,and the difference was statistically significant(t=4.205,t=2.611,P<0.05).And the D value of former was significantly higher than that of PIH group,and the difference was statistically significant(Z=5.953,P<0.05).While the difference of D*value between two groups was not statistically significant(P>0.05).The prenatal and postnatal change values and change rates of ADC in eclampsia group were significantly higher than those in PIH group(t=16.322,t=5.095,P<0.05),respectively.The differences of change values and changes rate of f and D*between two groups were not statistically significant(P>0.05),while both change value and change rate of D value of former were significantly larger than those of PIH group(Z=3.041,Z=2.938,P<0.05).The sensitivities of ADC change value,ADC change rate,D change value and D change rate were 67.8%,67.8%,73.4%and 81.0%in predicting postpartum eclampsia,respectively.And the specificities of them were 94.5%,88.9%,77.8%and 72.3%,respectively.Conclusion:The change value and change rate of ADC and D of prenatal and postpartum IVIM imaging of PIH pregnant women with postpartum eclampsia can be used as predictors of pathological response of eclampsia.Among them,the change value and change rate of D value have better predictive performance.