Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
EAfetus 7328, Université Paris Descartes, Paris, France.
BJOG. 2017 Jan;124(1):88-95. doi: 10.1111/1471-0528.14164. Epub 2016 Jun 27.
To assess the added value of intravenous gadolinium injection to magnetic resonance imaging (MRI) -based diagnosis of abnormally invasive placenta (AIP) and to examine this in relation to the radiologist's experience.
Retrospective study.
Between March 2009 and October 2012, 31 pregnant women who had previous caesarean delivery together with a placenta praevia and suspected placenta accreta on ultrasound in the third trimester of pregnancy.
All were offered MRI examination, and made aware of the limited (but so far reassuring) data regarding fetal safety of gadolinium. Twenty pregnant women agreed to undergo prenatal MRI (1.5 T), with and without gadolinium injection.
Two sets of MRI examinations without and with gadolinium were reviewed independently 2 months apart by two senior and two junior radiologists; all were blinded to the outcome (known in all cases). Histopathological findings and clinical signs of AIP were considered as the defining criteria of diagnosis.
accuracy of MRI with and without gadolinium was assessed.
Eight of the 20 women had confirmed abnormal placental invasion. The overall performance of both sets of readers in detecting AIP increased with gadolinium-sensitivity and specificity of 75.0% (42.0-100%) and 47.9% (19.9-75.9%) increasing to 87.5% (57.1-100%) and 60.4% (33.9-86.9%), respectively (P = 0.04). The added value of gadolinium remained irrespective of radiologist's experience, although senior radiologists performed better overall (sensitivity and specificity of 87.5% and 62.5% versus 62.5% and 33.3%, respectively, increasing with injection to 93.8% and 70.8% versus 81.3% and 50%, respectively; P < 10 ).
There was an association between gadolinium use and improvement in MRI-based diagnostic accuracy for the diagnosis of AIP, for both junior and senior radiologists.
Gadolinium injection improves MRI performance of radiologists for the diagnosis of placenta accreta.
评估静脉注射钆对比剂对磁共振成像（MRI）诊断异常性胎盘植入（AIP）的附加价值，并研究其与放射科医师经验的关系。
回顾性研究。
2009 年 3 月至 2012 年 10 月期间，31 名有剖宫产史且妊娠晚期超声检查提示前置胎盘和可疑胎盘植入的孕妇。
所有孕妇均接受 MRI 检查，并了解关于胎儿安全性的有限（但迄今为止令人放心）的钆对比剂数据。20 名孕妇同意进行产前 MRI（1.5T）检查，包括和不包括钆对比剂注射。
由 2 名资深和 2 名初级放射科医生分别在相隔 2 个月的时间内独立阅片，阅片时均对结果不知情（所有病例均已知结果）。组织病理学发现和 AIP 的临床征象被认为是诊断的标准。
评估 MRI 检查有无钆对比剂的准确性。
20 名孕妇中 8 人被证实存在异常胎盘侵犯。有和没有使用钆对比剂时，两组阅片者诊断 AIP 的总体表现均有所提高，其敏感性和特异性分别为 75.0%（42.0%-100%）和 47.9%（19.9%-75.9%），增加至 87.5%（57.1%-100%）和 60.4%（33.9%-86.9%）（P=0.04）。钆对比剂的附加价值与放射科医生的经验无关，尽管资深放射科医生总体表现更好（敏感性和特异性分别为 87.5%和 62.5%，增加至 93.8%和 70.8%；81.3%和 50%，增加至 81.3%和 70.8%；P<10）。
在诊断 AIP 时，使用钆对比剂与 MRI 诊断准确性的提高有关，初级和资深放射科医生均如此。
钆对比剂注射可提高放射科医生对胎盘植入的 MRI 诊断性能。
