MRI特征在胎盘植入疾病分型中的价值

目的探讨胎盘植入疾病不同类型磁共振成像(MRI)特征,以期为临床诊断提供帮助.方法收集2016年9月至2020年5月行MRI检查的胎盘植入患者82例,根据手术结果,侵袭性胎盘植入45例(植入型胎盘植入33例,穿透型胎盘植入12例)作为观察组,粘连型胎盘植入37例作为对照组,比较两组MRI特征差异,分析评估侵袭性胎盘植入的独立危险因素.结果观察组T2W胎盘内低信号带、胎盘/子宫膨出、T2W胎盘后低信号线消失、膀胱壁中断、胎盘床异生血管检出率(86.7%、55.6%、100.0%、26.7%、88.9%)高于对照组(45.9%、10.8%、54.1%、0%、67.6%),差异有统计学意义(P<0.05).二元Logistic回归分析显示T2W胎盘内低信号带(OR 6.783,95%CI:1.353~34.006)、胎盘/子宫膨出(OR 10.257,95%CI:1.551~67.814)是侵袭性胎盘植入独立危险因素,将危险因素纳入诊断模型行ROC分析,结果显示诊断敏感度0.556,特异度0.892,AUC 0.814.结论T2W胎盘内低信号带、胎盘/子宫膨出是侵袭性胎盘植入的独立危险因素,MRI检查有助于区分胎盘植入类型.

Objective To explore the magnetic resonance imaging(MRI)characteristics of different types of placenta accreta spectrum,in order to provide assistance for clinical diagnosis.Methods 82 patients with placenta implantation who underwent MRI examination from September 2016 to May 2020 were retrospectively collected.According to the results of the surgery,45 cases of invasive placenta accreta(including 33 cases of placenta increta and 12 cases of placenta percreta)were taken as the observation group,and 37 cases of placenta accreta were taken as the control group.Then we compared the difference of MRI features between the two groups,to evaluate the independent risk factors of invasive placenta accreta.Results The detection rates of intraplacental dark T2 bands,uterine/placenta bulge,loss of low T2 retroplacental line,bladder wall interruption,and abnormal vasculature of the placental bed of the observation group were 86.7%,55.6%,100.0%,26.7%and 88.9%,respectively.The rate of it was higher than the control group(45.9%,10.8%,54.1%,0%,67.6%,respectively).The difference was statistically significant(P<0.05).Binary Logistic regression analysis showed that the intraplacental dark T2 bands(OR value 6.783,95%CI:1.353~34.006),uterine/placenta bulge(OR value 10.257,95%CI 1.551~67.814)were independent risk factors of the observation group.The risk factors were included in the diagnostic model for ROC analysis,and the diagnostic sensitivity,specificity and AUC were 0.556,0.892 and 0.814,respectively.Conclusion The intraplacental dark T2 bands and uterine/placenta bulge were the independent risk factors for the invasive placenta accreta.MRI examination is helpful to distinguish the type of placenta accreta spectrum.