Placenta Accreta Spectrum: Correlation of MRI Parameters With Pathologic and Surgical Outcomes of High-Risk Pregnancies
Placenta Accreta Spectrum: Correlation of MRI Parameters With Pathologic and Surgical Outcomes of High-Risk Pregnancies
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DOI：
10.2214/ajr.19.21705
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发表时间：
2020-06-01
影响因子：
5
通讯作者：
Twickler, Diane M.
中科院分区：
文献类型：
--
作者：
Clark, Haley R.;Ng, Timothy W.;Twickler, Diane M.
目标。本研究的目的是确定植入胎盘频谱的MRI参数是否与高危妊娠的病理和手术结果相关。材料和方法。这项回顾研究评估了从2007年到现在通过MRI评估的中期和晚期妊娠。如果根据剖腹产的临床病史、超声检查结果或两者兼而有之，怀疑有胎盘侵犯，则将女性纳入研究范围。核磁共振图像由经验丰富的放射科医生检查，他对临床结果视而不见。对18个MRI参数进行评估，并与4个临床结果(侵袭性手术印象、是否需要剖宫产、病理结果、是否需要输血)进行比较。结果：在产妇中，43例需要剖宫产，20例剖宫产，1例阴道分娩。在母亲年龄、胎龄或以前剖腹产的次数方面，这些妇女之间没有统计学差异。在评估的18项MRI参数中，有8项具有统计学意义。优势比最高的5个变量是：隆起(7432)、前置胎盘(7283)、低密度T2线状条带(5.98.5)、疤痕附近胎盘的异质性(4.384)和纤维蛋白沉积(4322)，此外还有其他显著变量包括膀胱-浆膜界面中断、放射科医生对侵袭的解释以及侵袭的最大维度。结论：MRI参数与胎盘侵袭有关，与剖宫产子宫切除术的需要以及侵袭的病理和手术印象有关。根据这些参数，可以创建一个有组织的模板来标准化胎盘侵袭的报告。
OBJECTIVE. The purpose of this study is to determine whether MRI parameters of placenta accreta spectrum correlate with pathologic and surgical outcomes in high-risk pregnancies.MATERIALS AND METHODS. This retrospective study evaluated second- and third-trimester pregnancies assessed by MRI from 2007 to the present. Women were included in the study if placental invasion was suspected on the basis of a clinical history of cesarean delivery, ultrasound findings, or both. MR images were reviewed by an experienced radiologist who was blinded to the clinical outcomes. Eighteen MRI parameters were assessed and compared with four clinical outcomes: surgical impression of invasion, need for cesarean hysterectomy, pathologic findings, and need for blood transfusion.RESULTS. Of 64 women, 43 required cesarean hysterectomy, 20 underwent cesarean delivery, and one delivered vaginally. There was no statistical difference among the women in terms of maternal age, gestational age, or the number of prior cesarean deliveries. Eight of the 18 MRI parameters assessed showed statistical significance. The five variables with the highest odds ratios were bulge (7432), placenta previa (7283), low-attenuation T2 linear bands (5.98.5), placental heterogeneity near the scar (4.384), and fibrin deposition (4322), with additional significant variables including interruption of the bladder-serosa interface, the radiologist's interpretation of invasion, and the largest dimension of invasion. Some previously described parameters, such as the degree of maternal pelvic vascularity, were not statistically significant.CONCLUSION. MRI parameters are associated with placental invasion and correlate with the need for cesarean hysterectomy, as well as pathologic and surgical impressions of invasion. From these parameters, an organized template can be created to standardize reporting of placental invasion.