Satpathy Gayatri, Kumar Ishan, Matah Manjari, Verma Ashish
Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Indian J Radiol Imaging. 2018 Apr-Jun;28(2):169-174. doi: 10.4103/ijri.IJRI_325_17.
To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with that of ultrasonography (USG) for the measurement of lower segment cesarean scar during trial of labor after cesarean (TOLAC).
This was a prospective case-control observational study conducted with a cohort of 30 participants being considered for TOLAC but eventually proceeding to lower segment cesarean section (LSCS) at a university-based teaching institute over a period of 2 years. Measurement of scar thicknesses were done by MRI and USG preoperatively and validated by surgical findings. Comparison of diagnostic accuracy as well as the cut-off values (to differentiate a normal scar from an abnormal scar) was done between the two modalities.
Insignificant systematic error between the measurements obtained by the two modalities was noted by a Bland-Altmann analysis. The diagnostic accuracy of USG for differentiating a normal from an abnormal uterine scar was 96.7% while that of MRI was at a slightly lower level of 90%. A strong level of agreement between the two modalities was observed.
MRI offers no advantage in diagnostic accuracy for the measurement of LSCS scar thickness during consideration of TOLAC.
Measurement of uterine scar by MRI has a good correlation with that done on USG in the setting of post-cesarean pregnancy. The results hold good both for normal (grades 1 and 2) and abnormal (grades 3) scars. MRI, however, does not offer any added advantage over sonographic scar thickness measurement for the differentiation of a normal (grades 1 and 2) from an abnormal (grade 3) scar.
比较磁共振成像（MRI）与超声检查（USG）在剖宫产术后试产（TOLAC）期间测量下段剖宫产瘢痕的诊断准确性。
这是一项前瞻性病例对照观察性研究，在一所大学教学机构中，对30名考虑进行TOLAC但最终进行下段剖宫产（LSCS）的参与者进行了为期2年的队列研究。术前通过MRI和USG测量瘢痕厚度，并通过手术结果进行验证。比较了两种检查方式的诊断准确性以及区分正常瘢痕与异常瘢痕的临界值。
Bland-Altmann分析显示，两种检查方式所测结果之间的系统误差不显著。USG区分正常与异常子宫瘢痕的诊断准确性为96.7%，而MRI的诊断准确性略低，为90%。观察到两种检查方式之间具有高度一致性。
在考虑TOLAC时，MRI在测量LSCS瘢痕厚度的诊断准确性方面没有优势。
在剖宫产术后妊娠情况下，MRI测量子宫瘢痕与USG测量结果具有良好的相关性。该结果对于正常（1级和2级）和异常（3级）瘢痕均适用。然而，在区分正常（1级和2级）与异常（3级）瘢痕方面，MRI相较于超声测量瘢痕厚度并无任何额外优势。
