三维超声对孕囊型子宫瘢痕妊娠的诊断价值

Diagnostic Value of 3D Ultrasound Images in the Gestational Sac Type of Cesarean Scar Pregnancy

目的 探讨三维超声及其相关技术在剖宫产术后孕囊型子宫瘢痕妊娠的超声声像图特征。方法 收集86例剖宫产术后孕囊型子宫瘢痕妊娠的超声声像图表现,通过二维及三维超声对比分析,总结三维超声及其相关技术的超声声像图表现,分析三维超声在剖宫产术后子宫瘢痕妊娠显像的特征及优势。结果 86例剖宫产术后孕囊型子宫瘢痕妊娠的二维及三维超声表现均呈子宫下段囊性结构,其周边可见高速低阻的血流信号,血流信号来源于子宫前壁下段肌层。二维和三维超声的妊娠囊边界、瘢痕处肌层厚度、血供情况、内部结构及孕囊瘢痕附着情况比较,差异有统计学意义(P<0.05),且三维超声显像均优于二维超声;子宫内膜厚度、囊性结构大小的二维和三维超声比较,差异无统计学意义(P>0.05)。三维超声的优势在于多种成像模式各有所长且相互补充,三维超声表面模式显示子宫结构、孕囊及包块结构更直观、更立体;三维断层超声成像(TUI)可对感兴趣区域进行全方位断层分析,精确测量瘢痕处肌层厚度,显示病区内部结构更细致,提供类似MRI的图像信息,具有较高的客观性及可重复性;三维容积空间对比成像(VCI)可区分子宫内膜与瘢痕的回声,提高孕囊瘢痕附着处边界的清晰度。并且三维超声可显示二维超声无法显示的冠状面,增加了图像的信息;三维超声显示血流信号更清晰。结论 三维超声对剖宫产术后子宫瘢痕妊娠的显像较二维超声具有一定的优势,在对宫产术后子宫瘢痕妊娠的诊断及鉴别诊断具有重要临床价值。

Objective To investigate the ultrasonic characteristics of 3 D ultrasound and its related techniques in pregnancy with cystic scar of uterus after cesarean section.Methods The ultrasonographic features of 86 cases of cesarean scar pregnancy with gestational sac were collected.The ultrasonographic performance of 3 D ultrasound and its related technologies were summarized through 2 D and 3 D ultrasound comparative analysis.The characteristics and advantages of 3 D ultrasound in uterine scar pregnancy imaging after cesarean section was analyzed.Results The 2 D and 3 D ultrasound findings of 86 cases of gestational cystic scar pregnancy after cesarean section showed cystic structure in the lower uterine segment,and high speed and low resistance blood flow signal can be seen around.The blood flow signal comes from the lower part of the anterior uterine wall.The boundary of gestational sac,thickness of muscle layer,blood supply,internal structure and scar attachment of gestational sac by two-dimensional and three-dimensional ultrasound were statistically significant(P0.05).The advantage of 3 D ultrasound lies in that various imaging modes have their own advantages and complement each other.3 D ultrasound surface mode was more intuitive and stereoscopic to display the structure of uterus,gestational sac and mass.3 D tomographic ultrasound(TUI) can be used to analyze the region of interest in all directions,Accurate measurement of myometrial thickness in scar.It showed that the internal structure of the ward was more detailed,and could provide image information similar to MRI.It has high objectivity and repeatability.3 D volume space contrast imaging(VCI) can distinguish the echo of endometrium and scar,then improve the definition of scar attachment boundary of gestational sac.3 D ultrasound can display the coronal plane and increase the image information.3 D ultrasound showed more comprehensive blood flow signals.Conclusion Compared with 2 D ultrasound,3 D ultrasound has certain advantages in the imaging of cesarean scar pregnancy,which has important clinical value in the diagnosis and differential diagnosis of cesarean scar pregnancy.