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中华产科急救电子杂志 ›› 2014, Vol. 03 ›› Issue (01) : 8 -12. doi: 10.3877/cma.j.issn.2095-3259.2014.01.003

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MRI在产前诊断胎盘植入的应用价值
宋亭1,(), 陈永露1   
  1. 1. 510150 广州医科大学附属第三医院放射科
  • 收稿日期:2013-12-14 出版日期:2014-02-18
  • 通信作者: 宋亭

Application value of MRI technology in the diagnosis of prenatal placenta accreta

Ting Song1(), Yonglu Chen1   

  • Received:2013-12-14 Published:2014-02-18
  • Corresponding author: Ting Song
引用本文:

宋亭, 陈永露. MRI在产前诊断胎盘植入的应用价值[J]. 中华产科急救电子杂志, 2014, 03(01): 8-12.

Ting Song, Yonglu Chen. Application value of MRI technology in the diagnosis of prenatal placenta accreta[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2014, 03(01): 8-12.

胎盘植入是产科严重的并发症之一,依靠临床症状及实验室检查难以在产前做出准确诊断,需要影像学检查辅助诊断。随着磁共振成像(magnetic resonance imaging,MRI)技术的不断发展,MRI越来越多的应用于产前胎盘植入的诊断。

Placenta accreta is one of the serious obstetric complications. Depending clinical symptoms and laboratory tests, it is very difficult for the obstetricians to make an accurate prenatal diagnosis on placenta accrete. It needs imaging evidences. With the growing development of MRI technology, MRI is more and more widely used in the diagnosis of prenatal placenta accreta.

图2 为孕35周患者T2WI-TSE矢状位MRI图片。胎盘(红色箭头)附着于子宫前壁,下缘距离宫颈内口>7 cm,子宫壁明显变薄,子宫壁三层结构显示清晰,内层为子宫蜕膜层,显示为低信号(白色箭头),外层为子宫浆膜层,显示为低信号(橙色箭头),两者中间为子宫肌层,信号稍高于子宫浆膜及蜕膜层
图3 胎盘植入患者孕36周MRI图像。A、B、C为同一患者,手术病理证实为胎盘粘连;A:T2WI-TSE轴位,胎盘(红色箭头)附着于子宫前壁,子宫蜕膜层低信号带不完整,胎盘组织与子宫肌层分界不清(白色箭头);B:T2WI-TSE矢状位,胎盘(红色箭头)与子宫前壁分界不清(白色箭头);C:DWI弥散技术(b值=800)轴位,胎盘(红色箭头)与子宫前壁分界不清(白色箭头),子宫肌层(橙色箭头)信号稍低于胎盘组织
图4 胎盘植入患者孕37周MRI图片。手术病理证实为胎盘植入;A:T2WI-TSE矢状位,胎盘附着于子宫后壁,下缘完全覆盖宫颈内口,其内信号不均匀,可见斑片状低信号影(白色及橙色箭头),胎盘与子宫后壁部分分界不清(红色箭头);B:B-FFE轴位,见胎盘内信号不均匀,可见类圆形高信号影(橙色箭头),与A图中斑片状低信号影(橙色箭头)相对应,考虑为胎盘内扭曲增粗血管
图5 前置胎盘并胎盘穿透患者MRI图片。A:为T2WI-TSE矢状位,胎盘组织附着于子宫前壁,下缘完全覆盖宫颈内口,子宫壁与膀胱分界欠清晰,见膀胱"帐篷征"(白色箭头),B:为增强图像,前置胎盘并胎盘穿透肌层(红色箭头),至膀胱壁上缘,白色箭头显示膀胱壁上缘凹陷
[1]
高劲松,刘俊涛. 产后出血[M]∥曹泽毅. 中华妇产科学. 临床版. 北京:人民卫生出版社,2010:149-150.
[2]
Kayem G, Deneux-Tharaux C, Sentilhes L. PACCRETA: clinical situations at high risk of placenta ACCRETA/percreta: impact of diagnostic methods and management on maternal morbidity[J]. Acta Obstet Gynecol Scand, 2013, 92(4):476-482.
[3]
Leyendecker JR, DuBose M, Hosseinzadeh K, et al. MRI of pregnancy-related issues: abnormal placentation[J]. AJR Am J Roentgenol, 2012, 198(2):311-320.
[4]
郑琼,李胜利. 胎盘植入产前诊断新进展[J/CD]. 中华医学超声杂志(电子版), 2013, (7):538-541.
[5]
Hibbeln JF, Shors SM, Byrd SE. MRI: is there a role in obstetrics[J]. Clin Obstet Gynecol, 2012, 55(1):352-366.
[6]
Melissa G, Deborah R, Faith D. The likelihood of placenta previa with greater number of cesarean deliveries and high parity[J]. Obstet Gynecol, 2002, 99(6):976-980.
[7]
陈敦金. 胎盘植入[M]. 长沙:湖南科技技术出版社,2013:1-2.
[8]
Kapoor DS, Tincello DG, Kingston RE. Life-threatening obstetric haemorrhage in second trimester from a placenta percreta with raised alpha-fetoprotein levels[J]. J Obstet Gynaecol, 2003, 23(5):570-571.
[9]
Ophir E, Tendler R, Odeh M, et al. Creatine kinase as a biochemical marker in diagnosis of placenta increta and percreta[J]. Am J Obstet Gynecol, 1999, 180(4):1039-1040.
[10]
El Behery MM, Rasha L E, El Alfy Y. Cell-free placental mRNA in maternal plasma to predict placental invasion in patients with placenta accreta[J]. Int J Gynaecol Obstet, 2010, 109(1):30-33.
[11]
Sekizawa A, Yokokawa K, Sugito Y, et al. Evaluation of bidirectional transfer of plasma DNA through placenta[J]. Hum Genet, 2003, 113(4):307-310.
[12]
Maher MA, Abdelaziz A, Bazeed MF. Diagnostic accuracy of ultrasound and MRI in the prenatal diagnosis of placenta accreta[J]. Acta Obstet Gynecol Scand, 2013, 92(9):1017-1022.
[13]
Meng X, Xie L, Song W. Comparing the diagnostic value of ultrsound and magnetic resonance imaging for placenta accreta: a systematic review and meta-analysis[J]. Ultrasound Med Biol, 2013, 39(11):1958-1965.
[14]
Masselli G, Brunelli R, Casciani E, et al. Magnetic resonance imaging in the evaluation of placental adhesive disorders: correlation with color Doppler ultrasound[J]. Eur Radiol, 2008, 18(6):1292-1299.
[15]
彭软,谢红宁,杨建波,等. 胎盘植入的产前超声诊断及其影响因素研究[J]. 中国临床医学影像杂志,2010, 21(1):67-69.
[16]
刘正平,郭晓玲. 前置胎盘的诊断和治疗[J/CD]. 中华产科急救电子杂志,2013, 2(1):3-4.
[17]
Martinez M. Magnetic resonance imaging in 300 cases of placenta accreta: surgical correlation of new findings[J]. Acta Obstet Gynecol Scand, 2006, 85(3):377-379.
[18]
Okuda Y, Sagami F, Tirone P, et al. Reproductive and developmental toxicity study of gadobenate dimeglumine formulation (E7155) (3)--Study of embryo-fetal toxicity in rabbits by intravenous administration[J]. J Toxicol Sci, 1999, 24 (1):79-87.
[19]
Levine D. Obstetric MRI[J]. J Magn Reson Imaging, 2006, 24(1):1-15.
[20]
Derman AY, Nikac V, Haberman S, et al. MRI of placenta accreta: a new imaging perspective[J]. AJR Am J Roentgenol, 2011, 197(6):1514-1521.
[21]
Morita S, Ueno E, Fujimura M, et al. Feasibility of diffusion-weighted MRI for defining placental invasion[J]. J Magn Reson Imaging, 2009, 30(3):666-671.
[22]
Numminen K, Halavaara J, Isoniemi H, et al. magnetic resonance imaging of the liver true fast imaging with steady state free precession sequence facilitates rapid and reliable distinction between hepatic hemangiomas and liver malignancies[J]. J Comput Assist Tomogr, 2003, 27(4):571-576.
[23]
Alamo L, Anaye A, Rey J, et al. Detection of suspected placental invasion by MRI: do the results depend on observer′ experience[J]. Eur J Radiol, 2013, 82(2):51-57.
[24]
Maldjian C, Adam R, Pelosi M, et al. MRI appearance of placenta percreta and placenta accreta. Magn Reson Imaging[J]. 1999, 17(7):965-971.
[25]
Lim PS, Greenberg M, Edelson MI, et al. Utility of ultrasound and MRI in prenatal diagnosis of placenta accreta: a pilot study[J]. AJR Am J Roentgenol, 2011, 197(6):1506-1513.
[26]
Mazouni C, Gorincour G, Juhan V, et al. Placenta accreta: a review of current advances in prenatal diagnosis[J]. Placenta, 2007, 28(7):599-603.
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