剖宫产术后疤痕妊娠CT影像特征及其与超声对比分析

Comparison and analysis of CT imaging characteristics and ultrasound of cesarean scar pregnancy

目的探讨剖宫产术后疤痕妊娠(CSP)的CT影像表现及特征,并与超声检查做对比,分析两种诊断方法对CSP的诊断效能。方法回顾性分析2015年5月至2020年5月于浙江大学衢州医院就诊治疗的60例CSP患者的临床及影像学资料,所有患者均接受阴道超声和CT检查,以手术病理检查为"金标准",比较CT和超声在CSP的诊断及分型中的应用价值。结果60例CSP患者中,手术病理检查共诊断出42例植入型CSP,18例单纯孕囊型CSP。CT诊断CSP的灵敏度为90.48%,特异度为72.22%,准确率为85.00%;阴道超声诊断CSP的灵敏度为95.24%,特异度为83.33%,准确率为91.67%;两种检查方式对CSP的诊断准确率比较,差异无统计学意义(χ^(2)=1.294,P>0.05);阴道超声对卵黄囊、胚芽的检出率高于CT,孕囊内出血的检出率低于CT,差异有统计学意义(χ^(2)值分别为8.880、6.269、5.851,P<0.05);两种检查方式对局部瘢痕浸润、宫腔出血或积液的检出率无明显差异(P>0.05)。结论CT与阴道超声检查诊断CSP的准确率均较高,但CT诊断孕囊内出血优于超声,阴道超声显示卵黄囊、胚芽优于CT,二者均为CSP诊断的有效方式。

Objective To investigate the CT imaging manifestations and characteristics of cesarean scar pregnancy(CSP),compare them with ultrasound examination and analyze the diagnostic efficacies of the two diagnostic methods for CSP.Methods Clinical and imaging data of 60 patients with CSP,who were treated in Quzhou Hospital of Zhejiang University between May 2015 and May 2020,were retrospectively analyzed.All patients underwent transvaginal ultrasound and CT examination.With surgical pathological examination as the golden standard,the application values of CT and ultrasound in the diagnosis and classification of CSP were compared.Results Among the 60 patients with CSP,42 cases of implanted CSP and 18 cases of simple gestational sac type CSP were diagnosed by surgical pathological examination.The sensitivity,specificity and accuracy of CT in the diagnosis of CSP were 90.48%,72.22%and 85.00%,respectively.The sensitivity,specificity and accuracy of transvaginal sonography in the diagnosis of CSP were 95.24%,83.33%and 91.67%,respectively.There was no statistically significant difference between the two examinations for the accuracy in the diagnosis of CSP(χ^(2)=1.294,P>0.05).The detection rates of yolk sac and blastema by transvaginal sonography were higher than those by CT,while the detection rate of bleeding in gestational sac was lower than that by CT,and the differences were statistically significant(χ^(2)=8.880,6.269 and 5.851,respectively,P<0.05).The differences in the detection rates of local scar infiltration,uterine bleeding or effusion between the two examinations were not statistically significant(P>0.05).Conclusion Both CT and transvaginal sonography are of high accuracy in the diagnosis of CSP.However,CT is superior to ultrasound in the diagnosis of bleeding in gestational sac.Transvaginal sonography is superior to CT in terms of the display of yolk sac and blastema.Both of them are effective methods for the diagnosis of CSP.