多序列磁共振检查对不同类型胎盘植入的诊断价值及影像学征象分析

Diagnostic Value and Imaging Analysis of Multi Sequence Magnetic Resonance Imaging in Different Types of Placental Implantation

目的:探讨多序列磁共振(MRI)检查对不同类型胎盘植入(PIA)的诊断价值。方法:回顾性分析2019年10月-2021年12月柳州市潭中人民医院收治的97例疑似PIA患者的临床特征和MRI资料。以病理及手术诊断结果为金标准,评估多序列MRI诊断粘连型PIA、植入型PIA、穿透型PIA的诊断效能。比较不同类型PIA的TWI低信号带面积,并分析PIA类型与TWI低信号带面积的相关性。结果:多序列MRI诊断粘连型PIA的敏感度为87.1%、特异度为92.4%、准确度为90.7%;诊断植入型PIA的敏感度为77.8%、特异度为90.2%、准确度为85.6%;诊断穿透型PIA的敏感度为94.1%、特异度为97.5%、准确度为96.9%。多序列MRI诊断不同类型PIA的敏感度、特异度比较,差异均无统计学意义(P>0.05),但诊断不同PIA类型的准确度比较,差异有统计学意义(P<0.05)。多序列MRI诊断粘连型、穿透型PIA与病理及手术诊断结果的一致性高(Kappa=0.788、0.895,P<0.05),诊断植入型PIA与病理及手术诊断结果的一致性一般(Kappa=0.687,P<0.05)。PIA类型与T_(2)WI低信号带面积呈正相关性(r=0.699,P<0.05)。结论:多序列MRI诊断不同类型PIA的价值显著,可以提供子宫肌层与胎盘组织关系的影像学信息,指导临床采取针对性治疗。

Objective:To explore the diagnostic value of multi sequence magnetic resonance imaging(MRI)in different types of placental implantation(PIA).Method:The clinical features and MRI data of 97 patients with suspected PIA treated in Liuzhou Tanzhong People’s Hospital from October 2019 to December 2021 were analyzed retrospectively.Pathological and surgical findings were used as the gold standard,the diagnostic efficacy of multi sequence MRI in the diagnosis of adhesive PIA,implanted PIA and penetrating PIA was evaluated.The TWI low signal band area of different types of PIA was compared,and the correlation between PIA types and TWI low signal band area was analyzed.Result:The sensitivity,specificity and accuracy of multi sequence MRI in the diagnosis of adhesive PIA were 87.1%,92.4%and 90.7%;the sensitivity,specificity and accuracy of diagnosis of implanted PIA were 77.8%,90.2%and 85.6%;the sensitivity,specificity and accuracy of penetrating PIA were 94.1%,97.5%and 96.9%.There were no significant differences in the sensitivity and specificity of multi sequence MRI in the diagnosis of different types of PIA(P>0.05),but the accuracy of diagnosing different PIA types was statistically significant(P<0.05).The consistency of multi sequence MRI in the diagnosis of adhesive type and penetrating type PIA with pathological and surgical diagnosis results were high(Kappa=0.788,0.895,P<0.05),and the consistency between the diagnosis of implanted type PIA and pathological and surgical diagnosis results was general(Kappa=0.687,P<0.05).The type of PIA was positively correlated with the area of low signal band on T_(2)WI(r=0.699,P<0.05).Conclusion:Multi sequence MRI has significant value in the diagnosis of different types of PIA,it can provide imaging information on the relationship between uterine myometrium and placental tissue,which is conducive to guiding clinical targeted treatment.