Abstract:Objective: To investigate the main imaging findings and diagnostic value of MRI in the diagnosis of postpartum placental residue. Methods: MRI literatures of 90 cases of postpartum placental residue confirmed by clinical surgery and pathology were retrospectively analyzed. The size of the uterus and placenta were measured respectively, T1 and T2 signal intensity and enhancement characteristics of placental residue were evaluated. Other imaging findings including placenta attachment band integrity, uterine muscle thickness and signal intensity were investigated as well. Results: The MRI diagnositic sensitivity of postpartum placental residue without adhesion and implantation, placenta adhesions, placenta residual implantation and placenta penetration were 78.3%, 57.1%, 90.7%, 66.7% respectively, and the diagnostic specificity were 98.5%, 91.3%, 74.5%, 100.0%. For enhanced MRI, the sensitivity were 100.0%, 81.8%, 100.0%, 66.7% correspondingly, and the specificity were 96.8%, 100.0%, 88.2%, 100.0%. The size of placental residue ranged from 36.55 mm×28.60 mm×35.10 mm to 98.30 mm×68.56 mm×135.20 mm, with isointensive T1 signal and heterogeneous T2 signal. In 13 cases of placental residue implantation and 3 cases of placental residue adhesion, multiple thick and tortuous vessels were found inside the myometrium or between myometrium and placental remnant tissue. Post contrast MRI showed no enhancement in 3 cases of placental residue without adhesion and implantation and markedly heterogeneous enhancement during early stage were observed in 9 cases of placental residue adhesions, 17 cases of placental residue implantation and 3 cases of placental residue penetration. Conclusion: Unenhanced and enhanced MRI can be applied in determination of the type of placental residue and evaluation of implant depth,which can also clearly observe the placental residue and the blood supply situation of its attached surface.
贺春燕,张 军. 产后胎盘残留的MRI表现及诊断价值[J]. 中国临床医学影像杂志, 2018, 29(7): 494-497.
HE Chun-yan, ZHANG Jun. MRI manifestations and diagnostic value of postpartum placental residue. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(7): 494-497.
[1]乐杰. 妇产科学[M]. 4版. 北京:人民卫生出版社,2004:255-256.
[2]Weeks AD. The retained placenta[J]. Best Pract Res Clin Obstetr Gynecol, 2008, 22(6): 1103-1117.
[3]廖伟,鲁钊,陈丽英,等. MRI诊断产后胎盘残留[J]. 中国医学影像技术,2013,29(5):770-773.
[4]Weeks AD. Placental influences on the rate of labor progression: a pilot study[J]. Eur J Obstetr Gynecol Rep Biol, 2003, 106(2): 158-159.
[5]陈发煜,李天然,陈凯,等. 产后胎盘植入的MRI表现及临床指导意义[J]. 医疗卫生装备,2016,37(7):84-86.
[6]Maldjian C, Adam R, Pelosi M, et al. MRI appearance of placenta percreta and placenta accreta[J]. Magn Reson Imaging, 1999, 17(7): 965-971.
[7]Maher MA, Abdelaziz A, Bazeed MF. Diagnostic accuracy of ultrasound and MRI in the prenatal diagnosis of placenta accreta[J]. Acta Obstetr Gynecol Scand, 2013, 92(9): 1017-1022.
[8]龙光宇. 产后胎盘植入的MRI表现分析[J]. 中国中西医结合影像学杂志,2016,14(3):275-277.
[9]Calì G, Giambanco L, Puccio G, et al. Morbidly adherent placenta: evaluation of ultrasound diagnostic criteria and differentiation of placenta accreta from percreta[J]. Ultrasound Obstetr Gynecol, 2013, 41(4): 406-412.
[10]D’antonio F, Iacovella C, Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis[J]. Ultrasound Obstetr Gynecol, 2013, 42(5): 509-517.
[11]Derman AY, Nikac V, Haberman S, et al. MRI of placenta accreta: a new imaging perspective[J]. Am J Roentgenol, 2011, 197(6): 1514-1521.
[12]杨培胜,潘雪薇. 胎盘植入的超声和MRI诊断价值[J]. 中国医学影像学杂志,2009,17(1):58-59.
[13]Lim PS, Greenberg M, Edelson MI, et al. Utility of ultrasound and MRI in prenatal diagnosis of placenta accreta: a pilot study[J]. Am J Roentgenol, 2011, 197(6): 1506-1513.
[14]Siauve N, Chalouhi GE, Deloison B, et al. Functional imaging of the human placenta with magnetic resonance[J]. Am J Obstetr Gynecol, 2015, 213(4): S103-S114.
[15]Morita S, Ueno E, Fujimura M, et al. Feasibility of diffusion-weighted MRI for defining placental invasion[J]. J Magn Reson Imaging, 2009, 30(3): 666-671.
[16]Krishnamurthy U, Szalai G, Neelavalli J, et al. Quantitative T2 changes and susceptibility-weighted magnetic resonance imaging in murine pregnancy[J]. Gynecol Obstetr Invest, 2014, 78(1): 33-40.
[17]Takahama J, Kitano S, Marugami N, et al. Retained placental tissue: role of MRI findings in diagnosis and clinical assessment[J]. Abdom Imaging, 2011, 36(1): 110-114.
[18]Warshak CR, Eskander R, Hull AD, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta[J]. Obstetr Gynecol, 2006, 108(3, Part 1): 573-581.
[19]Masselli G, Brunelli R, Parasassi T, et al. Magnetic resonance imaging of clinically stable late pregnancy bleeding: beyond ultrasound[J]. Eur Radiol, 2011, 21(9): 1841.