标题：产前超声及MRI在胎盘植入中的诊断价值

      作者：刘蓉，赵秋霞，段文姣，刘亚娟，李琼兰，杨丹    (宜昌市中心人民医院超声科，湖北 宜昌 443003)

      卷次： 2018年29卷20期

      【摘要】 目的 探讨产前超声和MRI在诊断胎盘植入中的临床应用价值。方法 回顾性分析宜昌市中心人民医院2015年1月至2017年9月临床确诊为胎盘植入的73例患者的超声及MRI影像学资料。结果 73例胎盘植入患者中前壁胎盘57例，后壁胎盘16例；所有患者在产前行超声检查，均为前置胎盘，其中2例合并球拍状胎盘，1例合并血管前置；超声诊断正确60例，准确率为82.19%，漏诊13例，其中2例为前壁胎盘，11例为后壁胎盘。仅有18例患者在产前进行MRI检查，MRI诊断正确16例，准确率为88.89%，漏诊2例，其中1例为前壁胎盘，1例为后壁胎盘；两者产前诊断胎盘植入的准确率比较差异无统计学意义(P>0.05)；39例患者在我院进行早孕期颈部透明层检查，25例胎盘完全覆盖位于宫颈内口，14例胎盘接近宫颈内口，其中6例胎盘与子宫肌壁间显示欠清晰。结论 超声是诊断胎盘植入最重要影像学检查手段，如从早孕期关注胎盘可对临床提供更多参考信息。对于胎盘形态、胎盘植入程度，尤其是后壁胎盘，MRI要优于超声。因此，当超声检查有疑问或困难时，MRI是有效的补充检查工具。
      【关键词】 胎盘植入；超声；核磁共振；诊断
      【中图分类号】 R714.56 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2891—03

Value of ultrasound and MRI in the prenatal diagnosis of morbidly adherent placenta.
LIU Rong, ZHAO Qiu-xia,DUAN Wen-jiao, LIU Ya-juan, LI Qiong-lan, YANG Dan. Department of Ultrasound, Yichang Central People's Hospital,Yichang 443003, Hubei, CHINA
【Abstract】 Objective To investigate the clinical value of ultrasound and MRI in the prenatal diagnosis of mor-bidly adherent placenta. Methods The clinical data, ultrasound and MRI findings of 73 patients with morbidly adher-ent placenta in Yichang Central People's Hospital from January 2015 to September 2017 were retrospectively analyzed,in order to evaluate the value of ultrasound and MRI in the diagnosis of morbidly adherent placenta. Results The 73cases were assessed by prenatal ultrasound, including 57 cases of anterior placentas and 16 cases of posterior placentas.All cases were proved as placenta previa by prenatal ultrasound, of which 2 cases were complicated with battledore pla-centa and 1 case with vascular previa. A toal of 60 cases were correctly diagnosed (the diagnosis coincidence rate was82.19%), and 13 cases suffered missed diagnosis (2 cases of anterior placenta, 11 cases of posterior placenta). Only 18cases were assessed by prenatal MRI, of which 16 cases were correctly diagnosed (the diagnosis coincidence rate was88.89%) and 2 cases suffered missed diagnosis (1 case of anterior placenta, 1 case of posterior placenta). However, therewas no statistically significant differences between the two methods in the diagnosis coincidence rates (P>0.05). At thesame time, 39 cases were assessed with nuchal translucency (NT) examination, including 25 placentas were completelycovered in the internal cervical os and 14 placentas near the internal cervical os, of which 6 cases were unclear of myo-metrical border. Conclusion Ultrasound is an important examination method, and observing placenta from early preg-nancy can provide more reference information. Compared with ultrasound, MRI can more correctly show placenta mor-phology and the degree of placental invasion, especially posterior placentas. Therefore, MRI can serve as a complementa-ry tool after doubtful or difficult ultrasound examination.
      【Key words】 Morbidly adherent placenta; Ultrasound; Magnetic resonance imaging; Diagnosis·论 著·doi:10.3969/j.issn.1003-6350.2018.20.024基金项目：湖北省自然科学基金(编号：2012FFB01203)