三维多切面视图多普勒在诊断胎盘植入中的准确性
Accuracy of three-dimensional multislice view Doppler in diagnosis of morbid adherent placenta.
作者信息
Abdel Moniem Alaa M, Ibrahim Ahmed, Akl Sherif A, Aboul-Enen Loay, Abdelazim Ibrahim A
机构信息
Department of Ultrasound and Fetal Care Unit, Ain Shams University, Cairo, Egypt.
Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.
出版信息
J Turk Ger Gynecol Assoc. 2015 Jul 14;16(3):126-36. doi: 10.5152/jtgga.2015.15038. eCollection 2015.
OBJECTIVE
To detect the accuracy of the three-dimensional multislice view (3D MSV) Doppler in the diagnosis of morbid adherent placenta (MAP).
MATERIAL AND METHODS
Fifty pregnant women at ≥28 weeks gestation with suspected MAP were included in this prospective study. Two dimensional (2D) trans-abdominal gray-scale ultrasound scan was performed for the subjects to confirm the gestational age, placental location, and findings suggestive of MAP, followed by the 3D power Doppler and then the 3D MSV Doppler to confirm the diagnosis of MAP. Intraoperative findings and histopathology results of removed uteri in cases managed by emergency hysterectomy were compared with preoperative sonographic findings to detect the accuracy of the 3D MSV Doppler in the diagnosis of MAP.
RESULTS
The 3D MSV Doppler increased the accuracy and predictive values of the diagnostic criteria of MAP compared with the 3D power Doppler. The sensitivity and negative predictive value (NPV) (79.6% and 82.2%, respectively) of crowded vessels over the peripheral sub-placental zone to detect difficult placental separation and considerable intraoperative blood loss in cases of MAP using the 3D power Doppler was increased to 82.6% and 84%, respectively, using the 3D MSV Doppler. In addition, the sensitivity, specificity, and positive predictive value (PPV) (90.9%, 68.8%, and 47%, respectively) of the disruption of the uterine serosa-bladder interface for the detection of emergency hysterectomy in cases of MAP using the 3D power Doppler was increased to 100%, 71.8%, and 50%, respectively, using the 3D MSV Doppler.
CONCLUSION
The 3D MSV Doppler is a useful adjunctive tool to the 3D power Doppler or color Doppler to refine the diagnosis of MAP.
目的
检测三维多平面视图（3D MSV）多普勒超声在诊断胎盘植入方面的准确性。
材料与方法
本前瞻性研究纳入了50例妊娠≥28周且疑似胎盘植入的孕妇。对受试者进行二维（2D）经腹灰阶超声扫描以确定孕周、胎盘位置及提示胎盘植入的表现，随后进行三维能量多普勒超声检查，再进行三维多平面视图（3D MSV）多普勒超声检查以确诊胎盘植入。将急诊子宫切除病例术中子宫切除标本的所见及组织病理学结果与术前超声检查结果进行比较，以检测三维多平面视图（3D MSV）多普勒超声在诊断胎盘植入方面的准确性。
结果
与三维能量多普勒相比，三维多平面视图（3D MSV）多普勒超声提高了胎盘植入诊断标准的准确性和预测价值。使用三维能量多普勒时，胎盘下缘周边区域血管密集对诊断胎盘植入时胎盘剥离困难及术中大量失血的敏感性和阴性预测值（NPV）（分别为79.6%和82.2%），使用三维多平面视图（3D MSV）多普勒超声时分别提高到82.6%和84%。此外，使用三维能量多普勒时，子宫浆膜-膀胱界面中断对诊断胎盘植入时急诊子宫切除的敏感性、特异性和阳性预测值（PPV）（分别为90.9%、68.8%和47%），使用三维多平面视图（3D MSV）多普勒超声时分别提高到100%、71.8%和50%。
结论
三维多平面视图（3D MSV）多普勒超声是三维能量多普勒或彩色多普勒超声的有用辅助工具，有助于完善胎盘植入的诊断。
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