CEUS与增强MR对评估FUAS治疗胎盘植入的疗效比较

Comparison of CEUS and Enhanced MR in Evaluating the Efficacy of FUAS in the Treatment of Placenta Accreta

目的:聚焦超声消融(FUAS)前后采用超声造影(CEUS)和增强磁共振成像(MR)对胎盘植入进行评估,探讨两种评价方法的效果差异。方法:本院2019年11月至2022年9月收治的18例胎盘植入患者,分别采用CEUS和增强MR两种检查方法对胎盘植入病灶治疗前血供以及治疗后疗效进行比较评估。采取两名超声医生分别独立评估疗效的方法减少人为干扰;通过测量胎盘病灶内最大血管直径,预估FUAS疗效。结果:⑴FUAS治疗前,CEUS和增强MR评估胎盘病灶血供ROC的AUC分别为0.764和0.804,表现出较好的一致性(Kappa=0.723,P<0.01);⑵FUAS治疗后,两名观察者CEUS疗效评估的一致性好(Kappa=0.793,P<0.01);⑶FUAS治疗后,两种方法疗效评估也表现出较好的一致性(Kappa=0.797,P<0.01)。结论:CEUS与增强MR互相辅助可对FUAS治疗前后评价更精准,尽管增强MR图像质量优于CEUS,但CEUS因其简便、无辐射风险、安全系数高等优势,可达到与增强MR相当的评价效果,值得临床推广。

Objective Contrast-enhanced ultrasound(CEUS)and enhanced magnetic resonance imaging(MR)were used to evaluate placenta accreta before and after focused ultrasound ablation(FUAS),and the differences in the effects of the two evaluation methods were discussed.Methods From November 2019 to September 2022,18 patients with placenta ac⁃creta were treated in our hospital.Two examination methods,CEUS and enhanced MR,were used to compare and evaluate the blood supply of placenta accreta lesions before treatment and the curative effect after treatment.Two sonographers inde⁃pendently evaluated the curative effect to reduce human interference.The curative effect of FUAS was estimated by measur⁃ing the largest vessel diameter in the placental lesion.Results①Before FUAS treatment,the AUC of blood supply ROC of placental lesions evaluated by CEUS and enhanced MR were 0.764 and 0.804 respectively,showing good consistency(Kap⁃pa=0723,P<0.01);②After FUAS treatment,the consistency of CEUS efficacy evaluation between the two observers was good(Kappa=0.793,P<0.01);③After FUAS treatment,the efficacy evaluation of the two methods also showed good con⁃sistency(Kappa=0.797,P<0.01).Conclusion The mutual assistance of CEUS and enhanced MR can provide more accu⁃rate evaluation of FUAS before and after treatment.Although the image quality of enhanced MR is better than that of CEUS,CEUS,due to its advantages of simplicity,no radiation risk,and high safety factor,can achieve comparable evaluation re⁃sults to enhanced MR and is worthy of clinical promotion.