| 摘要: |
| 目的 分析剖宫产后子宫瘢痕妊娠（CSP）的MRI表现，评价MRI对CSP的诊治价值。方法 回顾性分析38例临床及病理证实为CSP患者的MRI资料。患者年龄为19~50岁，既往剖宫产1~2次，本次妊娠距上次剖宫产间隔时间2~11年，停经时间为32~90d，尿人绒毛膜促性腺激素（HCG）均阳性，血β-HCG为159.7~210800.0U/L。29例以停经后少量阴道出血就诊，9例以下腹痛就诊。结果 矢状面T2加权像上38例患者孕囊均显示清楚，其中28例孕囊形态规则，呈圆形或卵圆形，T1低信号、T2高信号；10例孕囊呈不规则混杂囊实性病灶，T1稍低信号、T2稍高信号，增强后内容物明显强化。所有病例囊壁均完整，并位于子宫前下壁峡部剖宫产瘢痕处。MRI0级2例，孕囊位于瘢痕表面，向宫腔内生长，未累及肌层；1级13例，孕囊稍向肌层侵犯，但主要在宫腔内生长，与肌层分界较清楚；2级14例，孕囊较小且完全植入肌层，子宫内膜结合带连续性中断，子宫前下壁菲薄，呈“W”或“U”形，未侵及浆膜层；3级9例，孕囊较大，完全植入肌层后并凸出于子宫轮廓外，压迫膀胱。15例MRI0级、1级患者主要予甲氨蝶呤、米非司酮或米索前列醇等药物治疗，和（或）超声引导下清宫术治疗；23例2级、3级患者主要予清宫术、瘢痕部位病灶切除术及瘢痕修补术治疗。结论 CSP的MRI表现典型，对临床治疗决策尤其是手术方式选择有指导意义。 |
| 关键词: 磁共振成像 瘢痕妊娠 剖宫产术 异位妊娠 |
| DOI：10.16781/j.0258-879x.2020.08.0913 |
| 投稿时间：2019-06-27修订日期：2019-09-11 |
| 基金项目: |
|
| Diagnostic value of magnetic resonance imaging in cesarean scar pregnancy |
| ZHONG Jing-jiao1,ZHENG Jie2,MA Wen-jie3,GONG Jing1,ZHAN Qian1* |
(1. Department of Radiology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Laboratory Medicine, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
3. Department of Emergency, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the magnetic resonance imaging (MRI) features of caesarean scar pregnancy (CSP), and to evaluate the diagnosis value of MRI in CSP. Methods The MRI data of 38 patients with clinically and pathologically confirmed CSP were retrospectively analyzed. These patients aged 19 to 50 years old, with one to two previous cesarean sections. The interval between this pregnancy and the last cesarean section was 2 to 11 years, the menopause time was 32 to 90 days, the urine human chorionic gonadotrophin (HCG) were all positive, and the blood β-HCG was 159.7-210 800.0 U/L. Twenty-nine cases were treated due to a small amount of vaginal bleeding after menopause, and nine cases due to abdominal pain. Results On the sagittal T2-weighted image, 38 cases of gestational sacs were clearly showed, of which 28 cases had round or oval morphology, with low signal on T1 and high signal on T2; 10 cases of gestational sacs showed irregular mixed cystic solidity with slightly low signal on T1 and slightly high signal on T2, and the contents were significantly strengthened after the enhancement. In all cases, the cyst wall was intact and located at the scar of the cesarean section of the anterior inferior wall of the uterus. In two cases of MRI grade 0, the gestational sac was located on the scar surface and grew into the uterine cavity without involving the myometrium; in 13 cases of grade 1, the gestational sac slightly invaded the myometrium, but mainly grew in the uterine cavity, with a clear boundary between the gestational sac and the myometrium; in 14 cases of grade 2, the gestational sac was small and completely implanted into the myometrium, the endometrial junction was continuously interrupted, the anterior-inferior wall of the uterus was thin, in the shape of "W" or "U", without invading the serosa; in nine cases of grade 3, the gestational sac was large, completely implanted into the myometrium and protruded out of the uterine contour, compressing the bladder. Fifteen patients of MRI grade 0 and 1 were mainly treated with methotrexate, mifepristone or misoprostol, and/or ultrasound-guided curettage; 23 patients of grade 2 and 3 were mainly treated with curettage, excision of scar lesions and scar repair. Conclusion The typical MRI features of CSP can guide the clinical treatment decision-making, especially for the choice of operation mode. |
| Key words: magnetic resonance imaging scar pregnancy cesarean section ectopic pregnancy |
