孕晚期三维彩色能量多普勒超声联合超声征象评分对前置胎盘附着及侵袭子宫肌层程度的诊断价值研究

Diagnostic Value of Combined Three-dimensional Color Energy Doppler Ultrasound Sign Score in Late Pregnancy on the Degree of Placenta Praevia Attachment and Invasion of Myometrium

目的:探讨三维彩色能量多普勒超声(3D-PDU)联合超声征象评分对孕晚期前置胎盘(PP)附着及侵袭子宫肌层程度的诊断价值。方法:回顾性分析2020年1月—2022年3月郑州市妇幼保健院收治的172例孕晚期PP患者的临床资料,患者均行3D-PDU检查。采用VOCAL技术分析获得的三维能量图像,计算胎盘区域血管化参数[血管化指数(VI)、流量指数(FI)、血管化—血流指数(VFI)]。根据胎盘附着情况分为胎盘植入(PAS)组(67例)与非PAS组(105例),比较两组患者的胎盘区域血管化参数。根据胎盘绒毛侵入程度将67例PAS患者分为轻度组(胎盘粘连,39例)、中度组(肌层植入,21例)及重度组(穿透性植入,7例)3个亚组,比较各组间血管化参数差异。绘制受试者工作特征曲线(ROC),评估3D-PDU、超声征象评分对前置胎盘附着及侵袭子宫肌层程度的诊断价值。结果:PAS组患者的胎盘区域VI值、FI值、VFI值均显著高于非PAS组,差异有统计学意义(t=15.520、8.448、11.649,P<0.05)。轻度组、中度组、重度组患者的胎盘区域VI值、FI值、VFI值比较,差异有统计学意义(F=28.432、21.726、46.139,P<0.05)。ROC曲线显示,超声征象评分+VI+FI+VFI诊断前置胎盘附着及侵袭子宫肌层程度的曲线下面积(AUC)值为0.901,高于超声征象评分、VI、FI、VFI的0.819、0.812、0.719及0.714。结论:3D-PDU血管化参数VI、FI、VFI联合超声征象评分对孕晚期前置胎盘附着及侵袭子宫肌层程度具有一定的诊断价值。

Objective:To investigate the diagnostic value of three-dimensional color energy Doppler ultrasound(3D-PDU)combined with ultrasound sign scoring for the degree of placenta praevia(PP)attachment and invasion of the myometrium in late pregnancy.Methods:The clinical data of 172 patients with PP in late pregnancy admitted to the hospital from January 2020 to March 2022 were retrospectively analyzed,and all patients underwent 3D-PDU.The 3D energy images obtained were analyzed using the VOCAL technique and the vascularization parameters(vascularization index[VI],flow index[FI],and vascularization-flow index[VFI])were calculated for the placental region.The placenta was divided into a placental implantation(PAS)group(67 patients)and a non-PAS group(105 patients)according to their placental attachment,and the vascularization parameters of the placental area were compared between the two groups.The 67 patients with PAS were divided into three subgroups according to the degree of placental villous invasion:mild(placental adhesions,39 cases),moderate(muscular implantation,21 cases)and severe(penetrating implantation,7 cases).The differences in vascularization parameters between the groups were compared.The subject’s operating characteristic curve(ROC)was plotted and the diagnostic value of 3D-PDU and ultrasound sign score for the degree of placenta praevia attachment and invasion of the myometrium was assessed.Results:The placental area VI,FI,and VFI values were significantly higher in the PAS group than in the non-PAS group,with statistically significant differences(t=15.520,8.448,11.649,P<0.05).The differences were statistically significant when comparing the VI,FI,and VFI values of the placental area in patients in the mild,moderate,and severe groups(F=28.432,21.726,46.139,P<0.05).The ROC curve showed that the area under the curve(AUC)value of 0.901 for the ultrasound sign score+VI+FI+VFI to diagnose the degree of placenta praevia attachment and invasion of the myometrium was higher than 0.819,0.812,0.719 and 0.714 for the ultrasound sign score,VI,FI and VFI.Conclusion:The 3D-PDU vascularization parameters VI,FI,and VFI combined with ultrasound sign score have a certain diagnostic value for the degree of placenta praevia attachment and invasion of the myometrium in late pregnancy.