磁共振成像联合临床因素评分量表对胎盘植入的诊断价值

Diagnostic value of magnetic resonance imaging combined with clinical factor rating scale for placenta accreta spectrum disorders

目的:探讨磁共振成像联合临床因素评分量表对胎盘植入的诊断价值。方法:回顾性分析2018年1月—2022年10月汕头市中心医院收治的105例疑似胎盘植入孕妇的磁共振成像和临床资料。以手术记录或病理结果将105例孕妇分为无胎盘植入组(n=54)和胎盘植入组(n=51,其中粘连型12例、植入型34例和穿透型5例)。比较磁共振成像征象和临床因素在无胎盘植入与胎盘植入组间的差异,制定磁共振成像征象联合临床因素评分量表,采用受试者操作特征曲线评估评分量表的诊断效能。结果:胎盘内T2低信号带(OR=5.571,95%CI:1.534~20.228)、胎盘隆起(OR=7.641,95%CI:1.176~34.018)、胎盘后低信号带消失(OR=4.845,95%CI:1.413~16.619)为胎盘植入的独立危险因素(均P<0.05)。磁共振成像征象联合临床因素评分量表诊断无胎盘植入与胎盘植入的界值为3.5分(敏感度为86.3%,特异度为75.9%),粘连型与植入型的界值为5.5分(敏感度为79.4%,特异度为66.7%),植入型与穿透型的界值为9.5分(敏感度为80%,特异度为100%)。结论:磁共振成像联合临床因素评分量表对胎盘植入有较好的诊断价值。

Objective:To investigate the diagnostic value of magnetic resonance imaging(MRI)combined with clinical factor rating scale for placenta accreta spectrum disorders.Methods:MRI and clinical data of 105 pregnant women with suspected placenta accreta spectrum disorders(PAS)admitted to Shantou Central Hospital from January 2018 to October 2022 were retrospectively analyzed.The 105 pregnant women were divided into no PAS group(n=54)and PAS group(n=51,including 12 cases of placenta accreta,34 cases of placenta increta and 5 cases of placenta percreta)by surgical records or pathological findings.The differences of MRI signs and clinical factors between the no-PAS and PAS groups were compared,and the MRI signs combined with clinical factors rating scale was developed,and the diagnostic efficacy of the rating scale was assessed using the receiver operator characteristic curve.Results:Intra-placental T2 hyposignal band(OR=5.571,95%CI:1.534-20.228),placental augmentation(OR=7.641,95%CI:1.176-34.018),and disappearance of post-placental hyposignal band(OR=4.845,95%CI:1.413-16.619)were independent risk factors for PAS(all P<0.05).The MRI sign combined with clinical factor rating scale had a cut-off value of 3.5 points(sensitivity 86.3%,specificity 75.9%)for the diagnosis of no PAS versus PAS,5.5 points(sensitivity 79.4%,specificity 66.7%)for the cut-off value of placenta accreta versus placenta increta,and 9.5 points for the cut-off value of placenta increta versus placenta percreta(sensitivity 80%,specificity 100%).Conclusion:MRI combined with the clinical factor rating scale has a good diagnostic value for PAS.