彩色多普勒超声与磁共振成像对凶险性前置胎盘合并胎盘植入的产前诊断价值比较

Comparison of color Doppler ultrasound and magnetic resonance imaging for prenatal diagnosis of pernicious placenta previa with placenta accreta

摘要:

目的 对比彩色多普勒超声与磁共振成像（MRI）对凶险性前置胎盘合并胎盘植入的产前诊断价值。方法 纳入2023年1月—2026年1月常州市妇幼保健院收治的93例疑似凶险性前置胎盘合并胎盘植入的孕妇，以病理结果为金标准，评估产前影像学检查的诊断效能及其与病理结果的一致性。所有入组孕妇产前均行彩色多普勒超声（经腹及经阴道）和MRI检查，并由2名高年资医师以双盲法独立阅片。评估两种检查方法单独与联合应用的诊断效能指标。结果 共纳入93例疑似病例，经术后病理确诊阳性61例、阴性32例，彩色多普勒超声的敏感性为86.89%（53/61），特异性为84.38%（27/32）；MRI的敏感性为91.80%（56/61），特异性为87.50%（28/32）；两者联合应用的敏感性为98.36%（60/61），特异性为93.75%（30/32）。结论 彩色多普勒超声和MRI对凶险性前置胎盘合并胎盘植入均有较高诊断价值，其中MRI在评估胎盘浸润深度及范围方面更具优势。

Abstract:

Objective To compare the prenatal diagnostic value of color Doppler ultrasound and magnetic resonance imaging (MRI) for pernicious placenta previa with placenta accreta.Methods Ninety-three pregnant women with suspected pernicious placenta previa with placenta accreta who were treated at Changzhou Maternal and Child Health Hospital between January 2023 and January 2026 were enrolled. Using postoperative pathological findings as the gold standard, the diagnostic performance of prenatal imaging and its agreement with pathological findings were evaluated. All participants underwent prenatal color Doppler ultrasonography (transabdominal and transvaginal) and MRI. Images were independently reviewed in a double-blind manner by two experienced physicians. The diagnostic performance of each method alone and in combination was evaluated.Results Among the 93 suspected cases, postoperative pathology confirmed 61 positive and 32 negative cases. The sensitivity and specificity of color Doppler ultrasound were 86.89% (53/61) and 84.38% (27/32), respectively; those of MRI were 91.80% (56/61) and 87.50% (28/32), respectively; and those of the combined approach were 98.36% (60/61) and 93.75% (30/32), respectively.Conclusion Color Doppler ultrasound and MRI both have high diagnostic value for pernicious placenta previa with placenta accreta. MRI has a particular advantage in assessing the depth and extent of placental invasion.