动态磁共振成像与经会阴超声诊断盆腔器官脱垂的临床价值分析

Comparison of clinical values of dynamic magnetic resonance imaging and transperineal ultrasonography in the diagnosis of pelvic organ prolapse

目的对比动态磁共振成像(MRI)与经会阴超声(TLUS)诊断盆腔器官脱垂(POP)的临床价值。方法选取2019年5月—2021年11月兰州市第一人民医院收治的139例疑似POP患者为研究对象进行前瞻性研究,所有患者行MRI、TLUS、盆腔器官脱垂定量(POP-Q)分度法。记录MRI、TLUS与POP-Q诊断结果,分析MRI、TLUS诊断POP的结果。结果POP-Q分度法诊断139例疑似POP患者中,21例无器官脱垂,23例单纯子宫脱垂,38例单纯膀胱膨出,57例子宫脱垂合并膀胱膨出。MRI诊断99例膀胱膨出,64例子宫脱垂,67例肠疝,81例直肠膨出。TLUS诊断121例明显器官脱垂,其中53例为单腔室脱垂、68例为多腔室脱垂;98例明显膀胱膨出,82例明显子宫脱垂,29例会阴体活动过度。Pearson相关性分析结果表明,MRI、TLUS诊断POP与POP-Q测定的前盆腔、中盆腔、后盆腔均呈正相关(P<0.05)。TLUS诊断明显膀胱膨出的敏感性为96.84%、特异性为86.36%,MRI诊断明显膀胱膨出的敏感性为97.89%、特异性为86.36%,差异无统计学意义(P>0.05)。TLUS诊断明显子宫脱垂的敏感性为97.50%、特异性为91.53%,MRI诊断明显子宫脱垂的敏感性为97.50%、特异性为93.22%,差异无统计学意义(P>0.05)。结论MRI、TLUS与POP-Q评估POP测定值有相关性,MRI、TLUS评估后盆腔脱垂更具优势,动态MRI、TLUS可作为POP-Q评估POP的有效补充,POP-Q结合两种影像学检查方法中的一种评估POP更准确。

Objective To compare the clinical values of dynamic magnetic resonance imaging(MRI)and transperineal ultrasonography(TLUS)in the diagnosis of pelvic organ prolapse(POP).Methods A prospective study was conducted on 139 patients with suspected POP who were admitted to our hospital from May 2019 to November 2021.All patients underwent MRI,TLUS,and Pelvic Organ Prolapse Quantification(POP-Q)examination,and their diagnostic results were recorded.The diagnostic results of MRI and TLUS for POP were analyzed.Results The 139 patients with suspected POP were evaluated via POP-Q,which identified 21 cases without organ prolapse,23 with uterine prolapse,38 with cystocele,and 57 with uterine prolapse combined with cystocele.MRI diagnosis showed 99 cases of cystocele,64 cases of uterine prolapse,67 cases of enterocele,and 81cases of rectocele.TLUS diagnosis showed 121 cases of obvious organ prolapse including 53 cases of singlecompartment prolapse and 68 cases of multi-compartment prolapse,98 cases of obvious cystocele,82 cases of obvious uterine prolapse,and 29 cases of excessive perineal descent.Pearson correlation analysis demonstrated that the parameters of the anterior,middle and posterior compartments determined via POP-Q were positively correlated with those measured via MRI and TLUS.(P<0.05).The sensitivity and specificity of TLUS for diagnosing obvious cystocele were 96.84%and 86.36%,while those of MRI were 97.89%and 86.36%,respectively.There was no difference in the sensitivity and specificity for diagnosing obvious cystocele between the two approaches(P>0.05).The sensitivity and specificity of TLUS for diagnosing obvious uterine prolapse were 97.50%and 91.53%,while those of MRI were 97.50%and 93.22%,respectively.There was also no difference in the sensitivity and specificity for diagnosing obvious uterine prolapse between the two approaches(P>0.05).Conclusions The diagnostic results of POP via MRI and TLUS are significantly correlated with those via POP-Q.MRI and TLUS outweigh POP-Q in the assessment of posterior pelvic prolapse,and can be established as effective supplements to the POP-Q assessment of POP.The combination of MRI or TLUS with POP-Q improves the accuracy of diagnosing POP.