Shih J C, Palacios Jaraquemada J M Palacios, Su Y N, Shyu M K, Lin C H, Lin S Y, Lee C N
Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Ultrasound Obstet Gynecol. 2009 Feb;33(2):193-203. doi: 10.1002/uog.6284.
To assess the role of three-dimensional (3D) power Doppler in the antenatal diagnosis of placenta accreta and compare its diagnostic performance with gray-scale and color Doppler ultrasonography.
One hundred and seventy pregnant women with persistent placenta previa totalis (after 28 weeks' gestation) were prospectively enrolled into this study. Gray-scale transabdominal ultrasound examination was performed to detect loss of the subendometrial echolucent zone and other abnormalities suggestive of placenta accreta. Color flow mapping was used to scan the whole placenta to detect any newly formed vessels at the serosa-bladder border or the presence of abnormal lacunae. Finally a targeted examination of angioarchitecture in the basal and lateral views of the placenta was carried out using 3D power Doppler. The ultrasound findings were analyzed with reference to the final diagnosis made during Cesarean delivery.
Placenta accreta and its variants (including increta and percreta) were confirmed in 39 patients at the time of Cesarean delivery. Based on receiver-operating characteristics analysis, 'numerous coherent vessels' visualized using 3D power Doppler in the basal view was the best single criterion for the diagnosis of placenta accreta, with a sensitivity of 97% and a specificity of 92%. If we considered the presence of at least one criterion to be diagnostic when using each ultrasound technique, then 3D power Doppler would have the best positive predictive value (76%), followed by gray-scale (51%) and color Doppler (47%). The majority of patients with placenta accreta showed multiple characteristic features on ultrasound imaging. In contrast, those patients with a false-positive diagnosis (i.e. the final diagnosis was placenta previa alone) tended to show isolated ultrasound markers of the condition.
3D power Doppler may be useful as a complementary technique for the antenatal diagnosis or exclusion of placenta accreta.
评估三维（3D）能量多普勒在前置胎盘产前诊断中的作用，并将其诊断性能与灰阶及彩色多普勒超声检查进行比较。
前瞻性纳入170例妊娠28周后持续性完全性前置胎盘的孕妇。采用经腹灰阶超声检查，以检测子宫内膜下无回声区消失及其他提示胎盘植入的异常情况。运用彩色血流图扫描整个胎盘，以检测浆膜-膀胱边界处有无新形成的血管或有无异常血池。最后，使用3D能量多普勒对胎盘基底部和侧面的血管结构进行靶向检查。超声检查结果参照剖宫产时的最终诊断进行分析。
剖宫产时确诊39例胎盘植入及其变异型（包括植入性胎盘和穿透性胎盘）。基于受试者工作特征分析，3D能量多普勒在基底部视图中显示的“大量连贯血管”是诊断胎盘植入的最佳单一标准，敏感性为97%，特异性为92%。如果在使用每种超声技术时将至少存在一项标准视为诊断依据，那么3D能量多普勒的阳性预测值最佳（76%），其次是灰阶超声（51%）和彩色多普勒超声（47%）。大多数胎盘植入患者在超声图像上表现出多种特征性表现。相比之下，那些假阳性诊断的患者（即最终诊断仅为前置胎盘）往往仅表现出孤立的超声标志物。
3D能量多普勒可作为产前诊断或排除胎盘植入的一种辅助技术。
