目的: 评估DWI-MRI（扩散加权成像磁共振成像）与超声联合使用在诊断胎盘植入中的价值。方法: 本研究纳入了2021年1月至2023年12月在常州市妇幼保健院收治的102例疑似胎盘植入的孕妇。所有患者均接受了超声检查和DWI-MRI扫描。使用超声DWI-MRI的结果作为诊断工具,与术后病理结果对比,比较DWI-MRI联合超声与病理学诊断胎盘植入分型结果,评估其诊断准确性。结果: 102例疑似胎盘植入的孕妇病理诊断显示86例阳性和16例阴性。超声检测在86例阳性病例中识别出75例为阳性,误将13例阴性病例判断为阳性,而DWI-MRI联合超声在同样的阳性病例中识别出85例,误诊7例阴性病例为阳性。DWI-MRI联合超声表现出更高的敏感度（98.84%）和特异度（56.25%）,阳性预测值为92.39%,阴性预测值为76.47%,而超声组的敏感度为87.21%,特异度为18.75%,阳性预测值为85.23%,阴性预测值为21.43%。此外,联合组的诊断准确率为92.16%,超声组为76.47%。超声显示胎盘厚度增加、异质回声、模糊的界面和异常血流模式,而DWI-MRI展示了胎盘的高信号强度、子宫壁的中断和异质性信号增强,两种方法都能有效地描绘异常血管。在胎盘植入分型诊断结果中,超声正确诊断植入型为45例,粘连型为24例,穿透型为6例,正常情况为3例;DWI-MRI联合超声则更为精确,植入型诊断为51例,粘连型为27例,穿透型为7例,正常情况为9例。结论: DWI-MRI联合超声在诊断胎盘植入方面具有较高的诊断准确性,可以作为临床上判断胎盘植入的有效工具。此联合诊断方法有助于提前识别高风险孕妇,从而进行适当的临床干预,降低母婴风险。
Abstract
Objective To evaluate the value of DWI-MRI (diffusion-weighted magnetic resonance imaging) combined with ultrasound in the diagnosis of placental implantation. Method This study included 102 pregnant women who were admitted to Changzhou Maternal and Child Health Care Hospital from January 2021 to December 2023 and were suspected of having placental implantation. All patients underwent ultrasound examination and DWI-MRI scan. Using the results of ultrasound DWI-MRI as a diagnostic tool, compare the results of DWI-MRI combined with ultrasound and pathological diagnosis of placental implantation with postoperative pathological results, and evaluate its diagnostic accuracy. Result The pathological diagnosis of 102 pregnant women suspected of placental implantation showed 86 positive cases and 16 negative cases. Ultrasound testing identified 75 out of 86 positive cases as positive and mistakenly judged 13 negative cases as positive, while DWI-MRI combined with ultrasound identified 85 out of the same positive cases and misdiagnosed 7 negative cases as positive. The combination of DWI-MRI and ultrasound showed higher sensitivity (98.84%) and specificity (56.25%), with a positive predictive value of 92.39% and a negative predictive value of 76.47%, while the sensitivity of the ultrasound group was 87.21%, specificity was 18.75%, positive predictive value was 85.23%, and negative predictive value was 21.43%. In addition, the diagnostic accuracy of the combined group was 92.16%, while that of the ultrasound group was 76.47%. Ultrasound shows an increase in placental thickness, heterogeneous echoes, blurred interfaces, and abnormal blood flow patterns, while DWI-MRI shows high signal intensity of the placenta, interruption of the uterine wall, and heterogeneous signal enhancement. Both methods can effectively depict abnormal blood vessels. In the classification diagnosis of placental implantation, 45 cases were correctly diagnosed by ultrasound, 24 cases were adhesive type, 6 cases were penetrating type, and 3 cases were normal; The combination of DWI-MRI and ultrasound is more accurate, with 51 cases diagnosed as implanted type, 27 cases as adhesive type, 7 cases as penetrating type, and 9 cases as normal. Conclusion The combination of DWI-MRI and ultrasound has high diagnostic accuracy in the diagnosis of placental implantation and can serve as an effective tool for clinical diagnosis of placental implantation. This combined diagnostic method helps to identify high-risk pregnant women in advance, enabling appropriate clinical interventions and reducing maternal and infant risks.
关键词
胎盘植入 /
扩散加权成像磁共振成像 /
超声 /
母婴风险 /
病理学
Key words
placental implantation /
dwi-mri /
ultrasound /
maternal and infant risks /
pathology
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基金
江苏省自然科学基金青年项目“胎盘植入的MRI表现及其诊断价值研究”（BK20210038）
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