目的：探讨MRI检查诊断产后胎盘植入的影像学特征及价值。方法：对52例怀疑胎盘植入的患者行MRI检查,将其影像征象与临床或手术病理对照,并对其诊断效能进行统计学分析。结果：52例患者中35例经临床或手术病理证实为胎盘植入,MRI正确诊断了31例患者,其诊断胎盘植入的灵敏度为88.57%,特异度为88.24%。胎盘植入主要MRI征象为,胎盘-子宫肌层交界面消失,其诊断灵敏度最高,为91.43%;其次为子宫肌层变薄和胎盘信号不均,其诊断灵敏度分别为74.29%和68.57%。MRI增强检查的诊断灵敏度、特异度分别为54.29%和100%。4例术前MRI诊断为胎盘滞留者,术后病理证实为胎盘植入;2例术前MRI诊断为浅层植入者,术后证实为胎盘滞留。结论：MRI检查对产后胎盘植入的诊断价值较高,对于产后恢复时间≤4周者,建议采用MRI平扫加增强,以免漏诊。
Objective: To investigate the imaging characteristics and diagnostic value of magnetic resonance imaging (MRI) for postpartum placenta implantation. Methods: Fifty-two patients with suspicious postpartum placenta implantation receiving MRI examination were enrolled. The imaging findings on MRI were analyzed in correlation with the clinical and pathological data, and diagnostic performance was calculated. Results: Of the 53 cases, 35 cases were diagnosed as placenta implantation by surgery or pathologic examination, and of them 31 were diagnosed by MRI, with a sensitivity of 88.57%, and specificity of 88.24%. The main MRI feature was placenta-myometrium interface disappearance with a diagnostic sensitivity of 91.43%. And secondly, myometrium was thinned and placenta signal was uneven(sensitivity 74.29% and 68.57%). The sensitivity and specificity of enhanced MRI examination for diagnosing postpartum placenta implantation were 54.29% and 100% respectively. Four cases of retained placenta diagnosed by preoperative MRI were confirmed to be placenta implantation by pathological examination after surgery, While 2 cases of retained placenta were misdiagnosed as placenta implantation by preoperative MRI. Conclusions: MRI is valuable for diagnosing postpartum placenta implantation. For patients with postpartum recovery time less than 4 weeks, enhanced MRI scan is recommended.
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