【摘要】 目的 探讨磁共振弥散加权成像(DWI-MRI)与超声诊断前置胎盘及胎盘植入的价值。方法 选择2019年2月至2022年2月在我院妇产科怀疑诊断为前置胎盘和胎盘植入的妊娠晚期妇女96例作为研究对象，所有入组对象均行剖宫产术，且于术前行超声和DWI-MRI检查，分析不同b值DWI图像及信号强度关系，并以术中病理学活检作为诊断的“金标准”，比较两种检查方法对前置胎盘及胎盘植入分型的诊断效能。结果 DWI-MRI、超声对前置胎盘及胎盘植入检出率分别为77.08%和79.17%,Kappa值分别为0.762和0.749。当b值为600 s/mm2时，相应部位的SI Ratio最高(P<0.05)。病理学检查结果显示，完全前置胎盘、部分前置胎盘和边缘性前置胎盘各有23例、36例和11例。DWI-MRI诊断前置胎盘分型诊断符合率为95.83%,Kappa值为0.942；超声诊断前置胎盘分型诊断符合率为89.58%,Kappa值为0.856。病理学检查结果显示，粘连型、植入型和穿透型胎盘植入分别有21例、33例和19例。DWI-MRI检查方法对胎盘植入分型诊断符合率为94.79%,Kappa值为0.929。超声检查方法对胎盘植入分型诊断符合率为87.50%,Kappa值为0.831。结论 DWI-MRI与超声检查在前置胎盘及胎盘植入检出率比较上无明显差异(P>0.05)，但DWI-MRI对前置胎盘及胎盘植入临床分型有较高的诊断效能，b值为600 s/mm2时图像对比度最佳，临床可以此为参考早期判断病理分型。更多还原

【Abstract】 Objective To explore the diagnostic value of diffusion-weighted imaging-magnetic resonance imaging(DWI-MRI) and ultrasound for placenta previa and placenta accreta. Methods A total of 96 women in the third trimester of pregnancy suspected with placenta previa and placenta accreta in obstetrics and gynecology department of the hospital were enrolled as the research objects between February 2019 and February 2022. All underwent cesarean section. Before surgery, ultrasound and DWI-MRI examination were conducted. The relationship between DWI images and signal intensity with different b values was analyzed. Taking intraoperative pathological biopsy as the diagnosis golden standard, diagnostic efficiency of the two methods for the classifications of placenta previa and placenta accreta was compared. Results The detection rates of DWI-MRI and ultrasound on placenta previa and placenta implantation were 77.08% and 79.17%, respectively, and Kappa value was 0.762 and 0.749, respectively.When the b value in DWI-MRI was 600 s/mm~2, SI Ratio of the corresponding site was the highest, and the differences were statistically significant when b values was 0, 400, 800 and 1 000 s/mm~2(P<0.05). The results of pathological examination showed that there were 23 cases, 36 cases and 11 cases with complete, partial and marginal placenta previa, respectively. The diagnostic coincidence rates and Kappa values of DWI-MRI and ultrasound in the diagnosis of placenta previa classifications were(95.83%, 0.942) and(89.58%, 0.856), respectively. The results of pathological examination showed that there were 21 cases, 33 cases and 19 cases with adhesive, implanted and penetrated placenta accreta, respectively. The diagnostic coincidence rates and Kappa values of DWI-MRI and ultrasound in the diagnosis of placenta accreta classifications were(94.79%, 0.929) and(87.50%, 0.831), respectively. Conclusion There is no significant difference between DWI-MRI and ultrasound in the detection rates of placenta previa and placenta accreta(P>0.05). However, DWI-MRI has higher diagnostic efficiency for clinical classifications of placenta previa and placenta accreta. When b value is 600 s/mm~2, the image contrast is the best. Clinically, it can be applied as a reference for early determination of pathological classifications.更多还原