Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis
Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis
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DOI：
10.1002/uog.13327
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发表时间：
2014-07-01
影响因子：
7.1
通讯作者：
Bhide, A.
中科院分区：
文献类型：
--
作者：
D'Antonio, F.;Iacovella, C.;Bhide, A.
目的系统评价产前磁共振成像（MRI）对侵袭性胎盘发育异常的诊断价值，探讨MRI不同征象对侵袭性胎盘发育异常的预测价值。方法采用MEDLINE、EMBASE、CINAHL和科克伦图书馆（包括科克伦系统评价数据库、疗效评价摘要数据库和科克伦对照试验中心注册数据库），结合相关医学主题词进行电子检索，“侵入性胎盘形成”和“磁共振成像”的关键词和单词变体。分析中仅包括在MRI时报告侵入性胎盘形成诊断的前瞻性研究和放射科医师对最终结果不知情的回顾性研究。探索的MRI体征为：子宫膨出、信号不均匀、T2加权序列上胎盘内暗带、子宫肌层局灶性中断和膀胱隆起。敏感性，特异性，阳性和阴性似然比（LR+，LR-）和诊断比值比（DOR）的总结估计的基础上，根据研究的数量，DerSimonian-Laird随机效应或分层总结接收器操作的特点models.Results共18项研究，涉及1010例妊娠侵入性胎盘形成的风险。MRI诊断侵袭性胎盘形成的准确性为：敏感性94.4%（95% CI，86.0-97.9%）;特异性，84.0%（95% CI，76.0-89.8%）; LR+，5.91（95% CI，3.73-9.39）; LR-，0.07（95% CI，0.02-0.18）; DOR，89.0（95% CI，22.8-348.1）。MRI在评估胎盘侵犯的深度和地形方面具有较高的预测准确性。所有五个MRI征象在诊断侵入性胎盘形成障碍方面显示出良好的预测准确性。超声与MRI诊断侵袭性胎盘形成的敏感性（P=0.24）和特异性（P=0.91）均无差异。结论产前MRI诊断侵袭性胎盘形成具有较高的准确性。超声和MRI具有相当的预测准确性。为了评估超声是否能像MRI一样可靠地预测胎盘浸润的深度和地形图，需要进行大规模的人群研究。版权所有（C）2014 ISUOG.出版社：John Wiley & Sons Ltd
Objective To assess systematically the performance of prenatal magnetic resonance imaging (MRI) in diagnosing the presence, degree and topography of disorders of invasive placentation and to explore the role of the different MRI signs in predicting these disorders. The diagnostic accuracy of ultrasound and MRI in the detection of invasive placentation was also compared.Methods MEDLINE, EMBASE, CINAHL and The Cochrane Library, including The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and The Cochrane Central Register of Controlled Trials, were searched electronically utilizing combinations of the relevant medical subject heading terms, keywords and word variants for 'invasive placentation' and 'magnetic resonance imaging'. Only prospective studies reporting a diagnosis of invasive placentation at the time of MRI and retrospective studies in which the radiologist was blinded to the final results were included in the analysis. The MRI signs explored were: uterine bulging, heterogeneous signal intensity, dark intraplacental bands on T2 weighted sequences, focal interruption of the myometrium and tenting of the bladder. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-) and diagnostic odds ratio (DOR) were based, depending on the number of studies, upon DerSimonian-Laird random-effect or hierarchical summary receiver-operating characteristics models.Results A total of 18 studies involving 1010 pregnancies at risk for invasive placentation were included. The overall diagnostic accuracy of MRI in detecting the presence of invasive placentation was: sensitivity, 94.4% (95% CI, 86.0-97.9%); specificity, 84.0% (95% CI, 76.0-89.8%); LR+, 5.91 (95% CI, 3.73-9.39); LR-, 0.07 (95% CI, 0.02-0.18); DOR, 89.0 (95% CI, 22.8-348.1). MRI had a high predictive accuracy in assessing both the depth and topography of placental invasion. All five MRI signs showed good predictive accuracy in the diagnosis of disorders of invasive placentation. There was no difference in either the sensitivity (P=0.24) or the specificity (P=0.91) between ultrasound and MRI for the detection of invasive placentation.Conclusions Prenatal MRI is highly accurate in diagnosing disorders of invasive placentation. Ultrasound and MRI have comparable predictive accuracy. Large population-based studies are needed in order to assess whether ultrasound can predict the depth and topography of placental invasion as reliably as can MRI. Copyright (C) 2014 ISUOG. Published by John Wiley & Sons Ltd.