Effect of magnetic resonance imaging in diagnosisof placenta previa complicating with placenta implantation
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摘要:目的 探讨磁共振成像(MRI)对凶险性前置胎盘(PPP)伴胎盘植入的诊断效果。方法 回顾性分析经产前MRI检查明确为PPP的90例孕晚期孕妇的临床资料，以手术和病理结果为金标准，观察MRI对单纯PPP和PPP伴胎盘植入及其分型的诊断效果，计算灵敏度、特异度、准确度和阳性预测值、阴性预测值，分析MRI诊断结果与手术病理结果的一致性。结果 手术病理证实90例PPP孕妇中单纯PPP者24例，占26.67%, 发生胎盘植入者66例，占73.33%; MRI诊断PPP伴胎盘植入的灵敏度、特异度、准确度分别为92.42%(61/66)、87.50%(21/24)、91.11%(82/90), 阳性预测值、阴性预测值分别为95.31%(61/64)、80.77%(21/26); 误诊8例，其中5例胎盘植入误诊为单纯PPP, 3例单纯PPP误诊为胎盘植入，总体误诊率为8.89%(8/90); MRI对PPP伴胎盘植入的诊断效果与手术病理金标准一致性较好(Kappa=0.728, P < 0.05); 手术病理证实, 66例胎盘植入包括42.42%(28/66)粘连型、31.82%(21/66)植入型和25.76%(17/66)穿透型，MRI对上述3种分型胎盘植入的检出率分别为82.14%(23/28)、90.48%(19/21)、100.00%(17/17)。结论 MRI能较好地观察胎盘组织与子宫肌层的关系，对PPP伴胎盘植入及分型有较高的诊断价值，可为临床制定干预方案提供可靠影像学依据。Abstract:Objective To investigate the diagnostic effect of magnetic resonance imaging (MRI) on the pernicious placenta previa (PPP) with placenta implantation.Methods The clinical data of 90 pregnant women confirmed as PPP comfirmed by MRI in our hospital were analyzed retrospectively. The results of operation and pathology were taken as the gold standard, the diagnostic effect of MRI on PPP, PPP with placenta implantation and their classifications were observed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated. The diagnostic consistency was compared between MRI and pathological results.Results Among 90 cases with PPP, there were 24 cases with PPP alone, accounting for 26.67%, 66 cases with placenta implantation, accounting for 73.33%. The sensitivity, specificity and accuracy of MRI in diagnosing PPP complicating with placenta implantation were 92.42% (61/66), 87.50% (21/24) and 91.11% (82/90), respectively, and positive predictive value and negative predictive value were 95.31% (61/64) and 80.77% (21/26), respectively. Eight cases were misdiagnosed, including 5 cases complicating with placenta implantation were misdiagnosed as PPP alone and 3 cases with PPP alone were misdiagnosed as placenta implantation, with a total misdiagnose rate of 8.89%(8/90). The diagnosis of MRI for PPP combined with placental implantation had better consistence compared with the gold standard of surgical pathology (Kappa= 0.728, P < 0.05). Surgical pathology results showed that there were 66 cases with placental implantation, including 42.42%(28/66) of patients with adhesion type, 31.82%(21/66) with implantable type, and 25.76% (17/66) with penetration type, and the their detection rates of MRI were 82.14%(23/28), 90.48%(19/21) and 100.00%(17/17), respectively.Conclusion MRI can better observe the relationship between placental tissue and myometrium of uterus, and has significant diagnostic value for PPP with placental implantation and typing, which can provide reliable imaging basis for clinical intervention.
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表 1 手术病理和MRI对单纯PPP及PPP伴胎盘植入的诊断结果[n(%)]
诊断结果 手术病理诊断 MRI诊断 单纯PPP PPP伴胎盘植入 单纯PPP 24(26.67) 21(87.50) 3(12.50) PPP伴胎盘植入 66(73.33) 5(7.58) 61(92.42) 合计 90(100.00) 26(28.89) 64(71.11) PPP: 凶险性前置胎盘; MRI: 磁共振成像。 
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表 2 手术病理和MRI对PPP伴胎盘植入分型的诊断结果[n(%)]
分型 手术病理诊断 MRI诊断 无植入 粘连型 植入型 穿透型 单纯PPP 24(26.67) 21(87.50) 2(8.33) 1(41.67) 0 粘连型 28(42.42) 4(14.29) 23(82.14) 1(3.57) 0 植入型 21(31.82) 1(4.76) 1(4.76) 19(90.48) 0 穿透型 17(25.76) 0 0 0 17(100.00) 合计 90(100.00) 26(28.89) 26(28.89) 21(23.33) 17(18.89) PPP: 凶险性前置胎盘; MRI: 磁共振成像。
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