凶险性前置胎盘伴胎盘植入患者孕晚期胎盘位置、MRI信号征象特点和产前诊断价值

Placental Sites and the Characteristics of MRI Signs in Patients with Pernicious Placenta Previa and Placenta Accreta During the Third Trimester and Their Prenatal Diagnosis Value

目的 研究凶险性前置胎盘(PPP)伴胎盘植入患者孕晚期胎盘位置、MRI信号征象特点和产前诊断价值。方法 选取2018年4月至2021年4月于本院收治的139例PPP患者,均行产前MRI和手术检查,以手术病理结果为“金标准”,比较不同检测方式对PPP的诊断结果,分析MRI的信号征象特点以及产前诊断价值。结果 139例患者经手术诊断单纯PPP患者37例,PPP伴胎盘植入102例,其中胎盘附着前壁、前壁及右侧壁、后壁和前后壁及左侧壁分别为90例、29例、14例和6例;MRI检测PPP的灵敏度为96.99%,特异度83.33%,准确率为96.40%,误诊率为16.67%,漏诊率为3.01%;MRI检查胎盘位置符合率分别为98.89%、86.21%、85.71%和100%;PPP伴胎盘植入患者胎盘信号不均、胎盘内血管影,子宫局部外凸和膀胱壁突起例数明显多于单纯PPP患者(P<0.05)。结论 PPP伴胎盘植入患者具有较典型的MRI信号征象特点,MRI诊断PPP具有不错的灵敏度、特异度和准确率,产前诊断价值较高。

Objective To study the placental sites and the characteristics of MRI signs in patients with pernicious placenta previa(PPP) and placenta accreta during the third trimester and their prenatal diagnosis value. Methods A total of 139 patients with PPP admitted to the hospital were enrolled between April 2018 and April 2021. All underwent prenatal MRI and surgical examinations. Taking surgical pathological results as the golden standard,diagnosis results of PPP by different detection methods were compared. The characteristics of MRI signs and their prenatal diagnosis value were analyzed.Results Of the 139 patients,it was confirmed by surgical pathology that there were 37 cases with PPP and 102 cases with PPP and placenta accreta. There were 90 cases,29 cases,14 cases and 6 cases with placentas attached to anterior walls,anterior and right walls,posterior and anteroposterior walls,and left walls,respectively. The sensitivity,specificity,accuracy rate,misdiagnosis rate and missed diagnosis rate of MRI in the detection of PPP were 96.99%,83.33%,96.40%,16.67% and 3.01%. The coincidence rate of MRI in the detection of placental sites in PPP were 98.89%,86.21%,85.71% and 100%. The number of cases with uneven placental signals,intraplacental vascular shadows,local uterine protrusion and bladder wall protrusion in patients with PPP and placenta accreta was significantly more than that in patients only with PPP(P<0.05). Conclusion There are typical characteristics of MRI sings in patients with PPP and placenta accreta. The sensitivity,specificity and accuracy rate of MRI in the diagnosis of PPP are superior,which is of good prenatal diagnosis value.