Department of Obstetrics, Charité - Universitätsmedizin Berlin Ringgold Standard Institution, Berlin, Germany.
Department of Radiology, Charité - Universitätsmedizin Berlin Ringgold Standard Institution, Berlin, Germany.
Ultrasound Obstet Gynecol. 2017 Oct;50(4):520-526. doi: 10.1002/uog.17349.
To evaluate prospectively the uterine scar after Cesarean section (CS) and the corresponding uterine region after vaginal delivery (VD) at 6 weeks postpartum using transabdominal (TAS) and transvaginal (TVS) sonography with magnetic resonance imaging (MRI) fusion to investigate whether fusion imaging allows standardized and reproducible identification of the scar location and measurement of uterine wall thickness compared with high-resolution MRI alone.
Pelvic MRI was performed 6 weeks after delivery in 30 women (10 with planned CS (PCS), 10 with emergency CS (ECS) and 10 with VD). After transfer of MRI-DICOM datasets to the ultrasound system, the scar region after CS and the corresponding uterine region after VD were examined by TAS (5 MHz) and TVS (10 MHz) using smart fusion with MRI to guide visualization of the region in the corresponding sectional planes for both modalities. Vascularization of the scar region was determined as a percentage area using power Doppler ultrasound. Anterior (AW) and posterior (PW) uterine wall thickness was measured using TAS and TVS with fusion imaging and using MRI alone.
TVS with fusion imaging was applied successfully for uterine assessment at the end of the postpartum period in all women. TAS failed to identify the scar area in three women. Imaging techniques were similar in the evaluation of AW and PW thickness following VD. MRI and MRI/TVS fusion showed significant differences in AW thickness or scar area, in terms of the difference relative to PW thickness, in women with PCS and ECS (MRI: PCS, 4.3 mm; ECS, 4.2 mm; VD, 0.8 mm; P = 0.034; MRI/TVS fusion: PCS, 2.0 mm; ECS, 3.3 mm; VD, 0.0 mm; P = 0.01). The degree of vascularization in the scar region measured by power Doppler ultrasound was lower after PCS (13.1 ± 9.4%/area) and ECS (17.0 ± 8.2%/area) than after VD (34.6 ± 8.5%/area; P = 0.0017).
MRI/ultrasound fusion imaging can be performed in a reproducible manner for examination of the postpartum uterus. MRI/TVS fusion enables standardized identification of the CS scar location and vascularization is reduced in this area. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
使用经腹（TAS）和经阴道（TVS）超声与磁共振成像（MRI）融合技术，前瞻性评估剖宫产（CS）后的子宫瘢痕和阴道分娩（VD）后的相应子宫区域，以研究与单独使用高分辨率 MRI 相比，融合成像是否能标准化和重现性地识别瘢痕位置和测量子宫壁厚度。
在 30 名女性（10 名计划行 CS（PCS），10 名急诊 CS（ECS），10 名行 VD）分娩后 6 周进行盆腔 MRI。将 MRI-DICOM 数据集传输到超声系统后，使用 MRI 引导 TAS（5MHz）和 TVS（10MHz）的智能融合，在相应的剖切面检查 CS 后的瘢痕区域和 VD 后的相应子宫区域。使用能量多普勒超声确定瘢痕区域的血管化程度为面积百分比。使用 TAS 和 TVS 融合成像以及单独使用 MRI 测量 AW 和 PW 子宫壁厚度。
在所有女性中，TVS 融合成像成功应用于产后期末的子宫评估。TAS 在 3 名女性中未能识别出瘢痕区域。在 VD 后，评估 AW 和 PW 厚度时，两种成像技术的结果相似。MRI 和 MRI/TVS 融合显示 PCS 和 ECS 妇女的 AW 厚度或瘢痕面积存在显著差异（与 PW 厚度的差异）（MRI：PCS，4.3mm；ECS，4.2mm；VD，0.8mm；P=0.034；MRI/TVS 融合：PCS，2.0mm；ECS，3.3mm；VD，0.0mm；P=0.01）。PCS（13.1±9.4%/面积）和 ECS（17.0±8.2%/面积）后的瘢痕区域的血管化程度低于 VD（34.6±8.5%/面积；P=0.0017）。
MRI/超声融合成像可重复用于检查产后子宫。MRI/TVS 融合可标准化识别 CS 瘢痕位置，且该区域的血管化减少。版权所有 © 2016 ISUOG。由 John Wiley & Sons Ltd 出版。
