摘要
目的探讨产前MRI扫描中可能有助于预测胎盘粘连、胎盘植入或穿透性胎盘存在的影像学特征,找出最有诊断价值的征象。方法回顾性分析广州市花都区人民医院2010年1月至2017年12月诊治的经手术病理证实的胎盘粘连、胎盘植入或穿透性胎盘患者15例(胎盘植入组)及胎盘正常患者15例(胎盘正常组)的产前MRI扫描资料,两名MRI诊断副主任医师采取双盲法对患者的胎盘及邻近结构的10个MRI特征进行评分,使用kappa统计数据评估两位医师诊断结果的一致性,然后将kappa统计量适中或较高(kappa>0.40)的征象与每位医师的真实诊断进行比较。结果10个MRI影像征象中有8个评分特征的观察者间信度为kappa>0.40:前置胎盘(κ=0.89)、子宫异常膨隆(κ=0.57)、胎盘内出血(κ=0.45)、胎盘内T2低信号带(κ=0.76)、胎盘内流空血管影(κ=0.67)、胎盘与子宫交界处模糊(κ=0.63)、胎盘信号不均匀(κ=0.53)、子宫肌层连续性中断(κ=0.64)。采用Fisher′s双边精确检验,胎盘植入患者的比例与胎盘正常的比例在以下三个特征上差异有统计学意义:子宫异常膨隆(P=0.015、P=0.011),胎盘T2信号不均匀性(P=0.006、P=0.013)、胎盘内T2线性低信号带(P=0.032、P=0.010)。结论MRI可作为超声诊断产前胎盘植入的有用辅助工具,其中三个特征对胎盘植入患者诊断价值较高:子宫异常膨隆、胎盘内T2信号不均匀性、胎盘内T2低信号带。
Objective To determine imaging features that may help predict the presence of placenta accreta,placenta increta or placenta percreta on prenatal MRI scanning in order to identify the most diagnostic findings.Methods The prenatal MRI scan data of placenta accreta,placenta increta or placenta percreta(placenta implantation group,n=15)and normal placenta(placenta normal group,n=15)diagnosed and treated by surgical pathology from January 2010 to December 2017 in the People's Hospital of Huadu District were retrospectively analyzed.Two expert MRI doctors were blinded to the patients'true diagnosis and were asked to score a total of 10 MRI features of the placenta and adjacent structures.The interrater reliability was assessed using kappa statistics.The features with a moderate kappa statistic or better(kappa>0.40)were then compared with the true diagnosis for each observer.Results Eight of the scored features had an interobserver reliability of kappa>0.40:placenta previa(κ=0.89);abnormal uterine bulging(κ=0.57);intraplacental hemorrhage(κ=0.45);the presence of dark intraplacental bands on T2W imaging(κ=0.76);flow-empty blood vessels in placenta(κ=0.67);border on placenta and uterus blurring(κ=0.63);heterogeneity of signal intensity on T2-weighted(T2W)imaging(κ=0.53);and continuity of myometrium was interrupted(κ=0.64).Using Fisher's two-sided exact test,there were statistically significant differences between the proportion of patients with placental invasion and those without placental invasion for three of the features:abnormal uterine bulging(P=0.015,P=0.011);heterogeneity of T2W imaging signal intensity(P=0.006,P=0.013);and presence of dark intraplacental bands on T2W imaging(P=0.032,P=0.010).Conclusion MRI can be a useful adjunct to ultrasound in diagnosing placenta accreta prenatally.Three features that are seen on MRI in patients with placental invasion appear to be useful for diagnosis:uterine bulging;heterogeneous signal intensity within the placenta;and the presence of dark intraplacental bands on T2
作者
谭敏仪
曾燕妮
袁强
吴志成
彭剑峰
Tan Minyi;Zeng Yanni;Yuan Qiang;Wu Zhicheng;Peng Jianfeng(Department of Radiology,the Peoples Hospital of Huadu District,Guangzhou,Guangdong 51O8OO,China)
出处
《中国基层医药》
CAS
2019年第16期1999-2002,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
磁共振成像
胎盘疾病
胎盘
侵入性
前置胎盘
产前诊断
诊断
Magnetic resonance imaging
Placenta diseases
Placenta accreta
Placenta previa
Prenatal diagnosis
Diagnosis
