Department of Obstetrics and Gynecology, University of Gaziantep, Gaziantep, Turkey.
Department of Radiology, University of Gaziantep, Gaziantep, Turkey.
J Obstet Gynaecol Res. 2020 May;46(5):699-706. doi: 10.1111/jog.14229. Epub 2020 Mar 9.
To compare acoustic radiation force impulse (ARFI) elastography values and histopathological diagnoses (accreta, increta, percreta) in patients suspected of having abnormal placental invasion (API).
This prospective study included 54 patients in the third trimester with a history of caesarian section (CS) and API based on gray scale and Doppler ultrasonography (USG) and 35 healthy controls. Patients underwent ARFI elastography preoperatively. Elastography measurements of the fetal and maternal sides of the placenta were compared to histopathology.
Patients had higher maternal-side, fetal-side and average elastography values (P = 0.001). Intraoperatively, eight patients (14.8%) showed abnormal cervical canal invasion and 46 (85.2%) bladder and/or parametrial invasion. Eight patients underwent CS + placental-bed suture, 11 CS + excision of the lower segment, and 35 caesarean-hysterectomy. Histopathology of lower segment excision/caesarian-hysterectomy patients determined 10 (21.7%) accreta, 10 (21.7%) increta and 26 (56.6%) percreta cases. ARFI values were highest in the percreta subgroup. The increta subgroup showed higher ARFI values than the accreta subgroup but maternal-side, fetal-side and average ARFI values were not significantly different across the subgroups (P > 0.05). The cut-off values for average, peripheral and central elastography were determined as >0.90, >0.76, >0.98 (m/s) with sensitivities of 98, 64, 98% and specificities of 85, 80, 91%, respectively.
ARFI elastography can detect API. However, it cannot determine invasion depth reliably. More studies with subgroup analyses are warranted to reveal its usefulness for invasion depth.
比较疑似异常胎盘植入（API）患者的声辐射力脉冲（ARFI）弹性成像值与组织病理学诊断（粘连、植入、穿透性）。
本前瞻性研究纳入了 54 例因剖宫产史和灰阶及多普勒超声（USG）提示 API 而疑似胎盘异常植入的孕晚期患者和 35 例健康对照者。所有患者均行术前 ARFI 弹性成像检查。比较胎盘胎儿侧和母体侧的弹性成像测量值与组织病理学结果。
患者的母体侧、胎儿侧和平均弹性成像值均较高（P = 0.001）。术中 8 例（14.8%）患者表现为宫颈管异常浸润，46 例（85.2%）患者表现为膀胱和/或宫旁浸润。8 例行剖宫产+胎盘床缝合术，11 例行剖宫产+下段切除术，35 例行剖宫产+子宫切除术。下段切除术/剖宫产+子宫切除术患者的组织病理学检查结果显示 10 例（21.7%）粘连、10 例（21.7%）植入和 26 例（56.6%）穿透性植入。穿透性植入亚组的 ARFI 值最高。植入亚组的 ARFI 值高于粘连亚组，但各亚组间的母体侧、胎儿侧和平均 ARFI 值无显著差异（P>0.05）。平均、周边和中央弹性成像的截断值分别确定为>0.90、>0.76、>0.98（m/s），其灵敏度分别为 98%、64%、98%，特异性分别为 85%、80%、91%。
ARFI 弹性成像可检测 API，但无法可靠判断浸润深度。需要进一步开展亚组分析研究，以明确其对浸润深度的应用价值。
