CAJ | 학술논문

目的：探讨产后胎盘植入的影像学表现特征及其病理表现的关系。材料与方法回顾性分析14例经临床及病理证实的产后胎盘植入患者，年龄24～39岁，平均(30.6±2.5)岁。14例中10例行MRI检查，另4例行CT检查，总结其MRI及CT影像特点及诊断价值。结果14例均确诊，子宫体积不同程度增大，MRI表现为子宫内见混杂信号团块影，局部内膜及结合带不完整，边缘模糊甚至中断。孕龄短的胎盘表现为单纯的团块状结构，孕龄长的胎盘具有特征性的叶状、结节状结构。以子宫肌层为对照，T1WI病灶表现为等低信号，与宫壁分界欠清，T2WI表现为以高信号为主的混杂信号影，内散在条状及点状低信号，病灶侵入肌层，肌层局部明显变薄，3例累及浆膜层；CT病灶则呈稍低密度，边界不清；增强扫描病灶呈不均匀明显强化类似“花瓣”样，其强化程度高于子宫肌层，坏死区无强化表现为“裂隙”状。结论 MRI较CT能更清晰显示植入胎盘的形态、位置及深度，对病变程度的判断与病理分型基本一致，是诊断产后胎盘植入的重要手段。
목적：탐토산후태반식입적영상학표현특정급기병리표현적관계。재료여방법회고성분석14례경림상급병리증실적산후태반식입환자，년령24～39세，평균(30.6±2.5)세。14례중10례행MRI검사，령4례행CT검사，총결기MRI급CT영상특점급진단개치。결과14례균학진，자궁체적불동정도증대，MRI표현위자궁내견혼잡신호단괴영，국부내막급결합대불완정，변연모호심지중단。잉령단적태반표현위단순적단괴상결구，잉령장적태반구유특정성적협상、결절상결구。이자궁기층위대조，T1WI병조표현위등저신호，여궁벽분계흠청，T2WI표현위이고신호위주적혼잡신호영，내산재조상급점상저신호，병조침입기층，기층국부명현변박，3례루급장막층；CT병조칙정초저밀도，변계불청；증강소묘병조정불균균명현강화유사“화판”양，기강화정도고우자궁기층，배사구무강화표현위“렬극”상。결론 MRI교CT능경청석현시식입태반적형태、위치급심도，대병변정도적판단여병리분형기본일치，시진단산후태반식입적중요수단。
Objective: To investigate the features and diagnostic value of MRI and CT in postpartum placenta accreta(PA).Materials and Methods:Fourteen cases PA comfirmed clinically or pathologically were retrospectively analyzed (aged 24—39 years old, with an average of 30.6±2.5 years old). Ten cases were examined by MRI scans, four cases by conventional and contrast-enhanced CT scans, their imaging appearances were analysed.Results:Fourteen cases were correctly diagnosed with MRI and CT. Uterus enlarged in various degrees, the mixed signal intensity mass was showed in it. The integrity of endometrium and junctional zone of myometrium was destructed. Placentas of shorter gestational age appeared to be a mixed simple mass, the longer ones to be lobulated structure distinctively. Compared with the signal intensity of the outer layer of the myometrium, the signal intensity of implanted placenta showed isointense or hypointense and its boundary with uterus was not clear on T1WI. On T2WI, it showed significantly mixed hyperintense, and spread strip and punctate low signal shadows. The lesions invaded myometrium, and made the myometrium thinning locally. The lesions invaded close to perimetrium in 3 cases. By CT scan, they showed a ill-deifned low density, by enhancement scan, placentas were heterogeneous enhancement significantly, appeared to be“petal shaped”, similar to enriched degree of myometrium. The necrotic area were not enhanced, depicted as“crack shaped”. Conclusion:Compared with CT, MRI can make correct diagnosis of PA and judge the general degree of placental invasion, as similar with pathologic types. It is a kind of auxiliary diagnostic tool ideally.