摘要
目的探讨产前磁共振成像(MRI)检查对孕晚期胎盘植入分级诊断的价值及其对临床治疗的指导意义。方法回顾性分析经手术或病理诊断为胎盘植入病人92例,根据其孕晚期MRI及超声(US)图像特点,进行分级诊断。应用$2检验分析MRI和US在胎盘植入分级诊断方面的差异性,Kappa检验分析MRI、US与手术或病理诊断胎盘植入分级的一致性,并分别计算MRI、US诊断Ⅰ级、Ⅱ级、Ⅲ级胎盘植入的灵敏度、特异度、一致性。结果 MRI和US诊断胎盘植入分级差异有统计学意义(χ2=9.64,P<0.05),MRI与手术或病理诊断胎盘植入分级的一致性(Kappa=0.61)优于US与手术或病理诊断(Kappa=0.22)。MRI诊断Ⅰ级、Ⅱ级、Ⅲ级胎盘植入的灵敏度(66.67%、79.07%、78.57%)、特异度(57.14%、75.56%、84.62%)、与手术或病理诊断的一致性(0.59、0.56、0.67)均优于US诊断(诊断Ⅰ级、Ⅱ级、Ⅲ级胎盘植入的灵敏度分别为50.00%、76.74%、33.33%,特异度分别为30.00%、54.10%、70.00%,与手术或病理诊断的一致性分别为0.32、0.18、0.22)。结论 MRI对于胎盘植入的分级诊断价值优于US,且与手术或病理分级诊断一致性较好,对孕晚期胎盘植入孕妇经手术终止妊娠具有指导意义。
Objective To investigate the value of prenatal magnetic resonance imaging（MRI）in classification of placenta accreta in late pregnancy and its guiding significance in clinical treatment. Methods A retrospective analysis was performed for the clinical data of 92 patients who were diagnosed with placenta accreta by surgery or pathology,and classification was performed according to the MRI features and ultrasound findings in late pregnancy.The chi-square test was used to analyze the difference in the classification of placenta accreta between MRI and ultrasound;the Kappatest was used to analyze the consistency between MRI/ultrasound and surgery/pathology in the classification of placenta accrete;the sensitivities,specificities,and consistency of MRI and ultrasound in the diagnosis of gradeⅠ,Ⅱ,andⅢ placenta accreta were calculated. Results There was a significant difference between MRI and ultrasound in the classification of placenta accreta（χ2=9.64,P〈0.05）,and the consistency between MRI and surgery/pathology in the classification of placenta accrete was superior to that between ultrasound and surgery/pathology（Kappa=0.22）.In the diagnosis of gradeⅠ,Ⅱ,andⅢ placenta accreta,MRI had sensitivities of 66.67%,79.07%,and 78.57%and specificities of 57.14%,75.56%,and 84.62%,respectively,while ultrasound had sensitivities of 50.00%,76.74%,and33.33% and specificities of 30.00%,54.10%,and 70.00%,respectively;the consistency between MRI and surgery/pathology in the diagnosis of gradeⅠ,Ⅱ,andⅢ placenta accreta was superior to that between ultrasound and surgery/pathology（0.59/0.56/0.67 vs 0.32/0.18/0.22）. Conclusion MRI has a better value than ultrasound in the classification of placenta accreta and good consistency with surgery/pathology in the classification of placenta accreta.Therefore,it has guiding significance in surgical termination of pregnancy for pregnant women with placenta accreta in late pregnancy.
作者
赵敏
万欣
王艳
徐琳
ZHAO Min;WAN Xin;WANG Yan;XU Lin(The Obstetric of Affiliated Hospital of Qingdao University, Qingdao 2GG003, Chin)
出处
《青岛大学学报（医学版）》
CAS
2018年第3期359-361,366,共4页
Journal of Qingdao University(Medical Sciences)
关键词
侵入性胎盘
磁共振成像
超声检查
产前诊断
placenta accreta
magnetic resonance imaging
ultrasonography
prenotal diagnosis
