摘要
目的:探讨剖宫产术后子宫疤痕妊娠(cesarean scar pregnancy,CPS)的MRI影像学特点,分析其对CPS的早期诊断及治疗价值。方法:分析2016年1月—2018年7月在我院经临床手术病理证实为CPS早孕患者41例,术前均行盆腔3.0TMRI和超声检查,观察其MRI和超声影像学特点,比较MRI和超声诊断CPS的特异度、准确度。结果:41例CPS患者中,超声正确诊断39例,诊断错误2例,正确率为95.12%;诊断正确39例均显示疤痕位于子宫下段前壁,妊娠囊位于疤痕处;超声表现为单纯孕囊型33,呈较均匀无回声团,其中28例见胚芽,20例见原始心管搏动,10例见卵黄囊;6例表现为混合包块型,呈混合回声团,并有不规则液性暗区。MRI均诊断正确,正确率为100%;41例MRI均能清晰显示妊娠囊位于子宫下段前壁疤痕处,并清楚显示疤痕处子宫肌层厚度及妊娠囊与周围组织的关系;36例表现为单纯孕囊型呈长T1长T2信号,其中1例囊内可见等T1稍长T2胚芽,其余5例囊内见小斑片状长T1短T2信号,增强扫描囊壁呈较明显环状强化;囊内除1例胚芽强化外,其余囊内均无强化;5例表现为混合包块型呈等、短、长T1及T2混杂信号,孕囊附着处周围见流空血管环绕;增强扫描包块呈明显不均匀强化,以孕囊附着处强化更明显。结论:MRI诊断CPS的特异度和准确度均高于超声,能够更清楚地显示子宫疤痕及妊娠囊与周围组织的关系,以及妊娠囊附着周围的血供情况,为临床早期选择正确的治疗方案提供更多可靠的信息。
Objective To investigate the MRI imaging features of cesarean scar pregnancy and analyze its value in early diagnosis and treatment of CPS.Methods 41 patients with CPS early pregnancy confirmed by clinical operation and pathology from January 2016 to June 2018 were examined the pelvic by 3.0T MRI and ultrasound examination before operation.The characteristics of MRI and ultrasound imaging were observed and the specificity and accuracy of CPS were compared by MRI and ultrasound.Results Among the 41 CPS patients,39 cases were correctly diagnosed by ultrasound and 2 cases were misdiagnosed,the correct rate was 95.12%.The correct diagnosis of 39 cases showed that the scar was located in the anterior wall of the lower uterine segment and the gestation sac was located at the scar.The ultrasonic manifestation was 33 of the simple gestation sac and the more homogeneous anechoic group,of which 28 cases were germ,20 case of primitive cardiac pulsation,10 The yolk sac was found in 6 cases.The mixed masses showed mixed echo masses and irregular liquid dark areas.MRI was correctly diagnosed and the correct rate was 100%.41 cases of MRI can clearly show the scar of the anterior wall of the lower segment of the uterus,and clearly show the thickness of the myometrium in the scar and the relationship between the gestational sac and the surrounding tissue.36 cases show that the simple gestational sac is long T1 long T2 signal,of which 1 cases can see the same T1 and slightly long T2 embryo in the sac,and the other 5 cases see small patch like long T1 short T2 letter in the cyst.The wall of the enhanced scanning capsule was enhanced,and there was no enhancement in the other sacs except for 1 cases of germ enhancement.In 5 cases,the mixed cladding was equal,short,long T1 and T2 mixed signals,and the surrounding space of the gestation sac was surrounded by the flow of empty vessels.The enhancement scan showed a significant uneven enhancement,and the attachment of the gestational sac was more obvious.Conclusion The specificity and accuracy of MRI for the diagnosis of CPS are higher than those of ultrasound.It can clearly show the relationship between the uterine scar and the pregnancy sac and the surrounding tissue,as well as the blood supply around the attachment of the pregnancy sac,so as to provide more reliable information for the early selection of the correct treatment scheme.
作者
赵沁萍
丁可
黄建宁
黄瑞岁
陈炯
王大成
刘满荣
Zhao Qinping;Ding Ke;Huang Jianning;Huang Ruisui;Chen Jiong;Wang Dacheng;Liu Manrong(Department of Radiology.Nanning Second People's Hospital,Nanning Guagnxi 530031,China)
出处
《影像研究与医学应用》
2019年第4期5-8,共4页
Journal of Imaging Research and Medical Applications
基金
南宁市科技局重点研发计划项目课题(NO:20163121)
关键词
剖宫产术
疤痕妊娠
磁共振成像技术
超声检查
Cesarean section
Scar pregnancy
Magnetic resonance imaging
Ultrasonography
