动态MRI诊断女性盆腔器官脱垂的临床应用价值

Clinical application value of dynamic magnetic resonance imaging in diagnosis of female pelvic organ prolapse

目的探讨动态核磁共振成像(MRI)诊断女性盆腔器官脱垂(POP)的临床应用价值。方法收集2020年1月—2022年5月在河南科技大学第三附属医院妇科就诊的POP患者28例,进行妇科检查、盆腔器官脱垂定量(POP-Q)分期、动态MRI检查,分别进行HMO分度、PCL分级,将两者的测量数据及诊断结果进行对比分析。结果POP体格检查诊断结果:阴道前壁膨出27例,子宫脱垂27例,阴道后壁膨出19例。HMO分度诊断结果:膀胱膨出23例,子宫脱垂26例,直肠膨出15例。PCL分级诊断结果:膀胱膨出24例,子宫脱垂26例,直肠膨出13例。妇科检查位点与动态MRI测量点的相关性:Aa、Ba、C、Ap、Bp临床测量5点与动态MRI测量相关点均呈正相关。在诊断POP方面,HMO分度与POP-Q分期诊断前、中、后盆腔脱垂的一致性Kappa检验结果分别为:K=0.291、0.650、0.414;PCL分级与POP-Q分期诊断前、中、后盆腔脱垂的一致性Kappa检验结果分别为:K=0.364、0.650、0.443;两种方法均显示出诊断前盆腔一致性弱,中盆腔、后盆腔一致性中等。在诊断脱垂程度一致性方面,HMO分度与POP-Q分期诊断前、中、后盆腔脱垂程度的Kappa检验结果分别为:K=0.030、0.150、0.279,一致性均差;PCL分级与POP-Q分期诊断前、中、后盆腔脱垂程度的Kappa检验结果分别为:K=0.486、0.552、0.443,一致性均中等。结论动态MRI能够准确评估POP,对评估中盆腔脱垂更敏感,在进行POP分期时,使用PCL分级法较HMO分度法更客观、准确。

Objective To explore the clinical application value of dynamic magnetic resonance imaging(MRI)in diagnosing female pelvic organ prolapse(POP).Methods A total of 28 POP patients treated in Department of Gynecology,the Third Affiliated Hospital of He'nan University of Science and Technology were collected.Gynecology examination,quantitative pelvic organ prolapse(POP-Q)staging,and dynamic MRI were performed,then HMO grading and PCL classification were conducted,the measurement data and diagnostic results of the two methods were compared and analyzed.Results The diagnostic results of POP physical examination:27 cases with prolapse of ante-rior vaginal wall,27 cases with prolapse of uterus,19 cases with prolapse of posterior vaginal wall;the diagnostic results of HMO grading:23 cases with prolapse of anterior vaginal wall,26 cases with prolapse of uterus,15 cases with prolapse of posterior vaginal wall;the diagnos-tic results of PCL classification:24 cases with prolapse of anterior vaginal wall,26 cases with prolapse of uterus,13 cases with prolapse of posterior vaginal wall.The correlations between gynecological examination sites and MRI measurement sites:Aa,Ba,C,Ap,and Bp sites were positively correlated with related measurement sites of dynamic MRI.In the aspect of POP diagnosis,Kappa test results of consistency of HMO grading and POP-Q staging in diagnosis of anterior,middle,and posterior pelvic cavity showed that K values were 0.291,0.650,and 0.414,respectively;Kappa test results of consistency of PCL classification and POP-Q staging in diagnosis of anterior,middle,and posterior pelvic cavity showed that K values were 0.364,0.650,and 0.443,respectively,which showed that the consistency of diagnosis of anterior pelvic cavity was weak,the consistency of diagnosis of middle and posterior pelvic cavity were middle.In the aspect of prolapse de-gree,Kappa test results of consistency of HMO grading and POP-Q staging in diagnosis of anterior,middle,and posterior pelvic cavity showed that K values were 0.030,0.150,and 0.279,respectively,the consistency was weak;test results of consistency of PCL classifica-tion and POP-Q staging in diagnosis of anterior,middle,and posterior pelvic cavity showed that K values were 0.486,0.552,and 0.443,respectively,the consistency was middle.Conclusion Dynamic MRI can accurately evaluate POP,and it is more sensitive to assessment of middle pelvic prolapse.When performing POP staging,PCL classification is more objective and accurate compared with HMO grading.