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目的:探讨MRI检查诊断产后胎盘植入的影像学特征及价值。方法:对52例怀疑胎盘植入的患者行MRI检查,将其影像征象与临床或手术病理对照,并对其诊断效能进行统计学分析。结果 :52例患者中35例经临床或手术病理证实为胎盘植入,MRI正确诊断了31例患者,其诊断胎盘植入的灵敏度为88.57%,特异度为88.24%。胎盘植入主要MRI征象为,胎盘-子宫肌层交界面消失,其诊断灵敏度最高,为91.43%;其次为子宫肌层变薄和胎盘信号不均,其诊断灵敏度分别为74.29%和68.57%。MRI增强检查的诊断灵敏度、特异度分别为54.29%和100%。4例术前MRI诊断为胎盘滞留者,术后病理证实为胎盘植入;2例术前MRI诊断为浅层植入者,术后证实为胎盘滞留。结论:MRI检查对产后胎盘植入的诊断价值较高,对于产后恢复时间≤4周者,建议采用MRI平扫加增强,以免漏诊。
Objective: To investigate the imaging features and value of MRI in the diagnosis of postpartum placenta accreta. Methods: Fifty-two patients suspected of placenta accreta were underwent MRI examination, and their imaging signs were compared with the clinical or surgical pathology. The diagnostic efficacy of the placenta was statistically analyzed. Results: Totally 35 cases of 52 patients were placenta accretated by clinical or surgical pathology, and 31 patients were correctly diagnosed by MRI. The sensitivity of placenta accreta was 88.57% and the specificity was 88.24%. The main signs of placenta accreta MRI, placenta - myometrium disappeared at the interface, the highest diagnostic sensitivity of 91.43%; followed by thinning of the myometrium and placental signal unevenness, the diagnostic sensitivity of 74.29% and 68.57%, respectively. The diagnostic sensitivity and specificity of MRI enhanced MRI were 54.29% and 100% respectively. 4 cases of preoperative MRI diagnosis of placenta accreta, postoperative pathology confirmed placenta accreta; 2 cases of preoperative MRI diagnosis of shallow implants, postoperative confirmed as placenta accreta. Conclusion: The diagnostic value of MRI examination for postpartum placenta accreta is high. For patients with postpartum recovery ≤ 4 weeks, MRI scan and enhancement are recommended to avoid misdiagnosis.