The value of specific MRI features in the evaluation of suspected placental invasion
The value of specific MRI features in the evaluation of suspected placental invasion
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DOI：
10.1016/j.mri.2006.10.007
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发表时间：
2007-01-01
影响因子：
2.5
通讯作者：
Budorick, Nancy E.
中科院分区：
文献类型：
--
作者：
Lax, Allison;Prince, Martin R.;Budorick, Nancy E.
目的：本研究的目的是确定产前 MRI 扫描中可能有助于预测是否存在植入性胎盘、植入性胎盘或穿透性胎盘的影像学特征。 对象和方法：对 10 例根据病理和临床报告诊断为植入性胎盘、植入性胎盘或穿透性胎盘的患者以及 10 例无胎盘侵犯的患者进行产前 MR 扫描回顾性分析。两名 MRI 阅片专家对患者的真实诊断不知情，并被要求对胎盘和邻近结构的 17 个 MRI 特征进行评分。使用 kappa 统计来评估评估者间的可靠性。然后将具有中等 kappa 统计量或更好 (K > .40) 的特征与每个观察者的真实诊断进行比较。结果：其中 7 个评分特征的观察者间可靠性 kappa > .40：前置胎盘 (kappa=.83)；异常子宫膨出（kappa=.48）；胎盘内出血（kappa=.51）； T-2 加权 (T2W) 成像信号强度的异质性 (kappa=.61)； T2W 成像上存在暗胎盘内带（kappa=.53）；胎盘厚度增加（kappa=.69）；以及胎盘下方肌网的 T2W 成像可视化 (kappa=.44)。使用 Fisher 两侧精确检验，胎盘浸润患者与无胎盘浸润患者的比例在以下三个特征上存在统计学显着差异：异常子宫膨出（评分者 1，P=.005；评分者 2，P=.011）； T2W成像信号强度的异质性（评分者1，P=.006；评分者2，P=.010）； T2W 成像上胎盘内暗带的存在（评分者 1，P=.003；评分者 2，P=.033）。结论：MRI 可以作为超声的有用辅助手段，用于产前诊断植入性胎盘。胎盘侵犯患者的 MRI 表现出的三个特征似乎对诊断有用：子宫膨隆；胎盘内的异质信号强度； T2W 成像中胎盘内暗带的存在。 (c) 2007 Elsevier Inc. 保留所有权利。
Objective: The objective of this study was to determine imaging features that may help predict the presence of placenta accreta, placenta increta or placenta percreta on prenatal MRI scanning.Subjects and Methods: A retrospective review of the prenatal MR scans of 10 patients with a diagnosis of placenta accreta, placenta increta or placenta percreta made by pathologic and clinical reports and of 10 patients without placental invasion was performed. Two expert MRI readers were blinded to the patients' true diagnosis and were asked to score a total of 17 MRI features of the placenta and adjacent structures. The interrater reliability was assessed using kappa statistics. The features with a moderate kappa statistic or better (K > .40) were then compared with the true diagnosis for each observer.Results: Seven of the scored features had an interobserver reliability of kappa >.40: placenta previa (kappa=.83); abnormal uterine bulging (kappa=.48); intraplacental hemorrhage (kappa=.51); heterogeneity of signal intensity on T-2-weighted (T2W) imaging (kappa=.61); the presence of dark intraplacental bands on T2W imaging (kappa=.53); increased placental thickness (kappa=.69); and visualization of the myornetrium beneath the placenta on T2W imaging (kappa=.44). Using Fisher's two-sided exact test, there was a statistically significant difference between the proportion of patients with placental invasion and those without placental invasion for three of the features: abnormal uterine bulging (Rater 1, P=.005; Rater 2, P=.011); heterogeneity of T2W imaging signal intensity(Rater 1, P=.006; Rater 2, P=.010); and presence of dark intraplacental bands on T2W imaging (Rater 1, P=.003; Rater 2, P=.033).Conclusions: MRI can be a useful adjunct to ultrasound in diagnosing placenta accreta prenatally. Three features that are seen oil MRI in patients with placental invasion appear to be useful for diagnosis: uterine bulging; heterogeneous signal intensity within the placenta; and the presence of dark intraplacental bands on T2W imaging. (c) 2007 Elsevier Inc. All rights reserved.