1.5T 与 3.0T MRI 诊断胎盘植入谱系疾病的比较。
Comparison between 1.5-T and 3.0-T MRI for the diagnosis of placenta accreta spectrum disorders.
机构信息
First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece.
First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece.
出版信息
Diagn Interv Imaging. 2022 Sep;103(9):408-417. doi: 10.1016/j.diii.2022.04.005. Epub 2022 May 12.
PURPOSE
Accurate antenatal diagnosis of placenta accreta spectrum (PAS) is important for optimal management. The purpose of this study was to compare the respective capabilities of 1.5-T and 3.0-T MRI in the diagnosis of PAS.
MATERIALS AND METHODS
Between March 2016-March 2021, 190 pregnant women at high risk for PAS underwent dedicated prenatal MRI with either 1.5-T or 3.0-T units at a tertiary imaging center. Cesarian section and MRI were performed less than 6 weeks from each other. Prospectively collected data were evaluated by two experienced genitourinary radiologists for presence and extent of PAS. A comparative study was designed to investigate differences in predictive ability between 1.5-T and 3.0-T MRI groups. Sensitivity, specificity, accuracy, negative and positive prognostic values relative to intraoperative/histological findings, were computed for both groups and were compared with chi-square (χ 2) test. Interobserver agreement was estimated using Kappa test.
RESULTS
One hundred-eighty-two gravid women were included in the study; of these, 91/182 (50%) women were evaluated with 1.5-T (mean age, 35 ± 5.1 [SD] years; mean gestational age: 32.5 weeks) and 91/182 (50%) with 3.0-T MRI (mean age, 34.9 ± 4.9 [SD] years; mean gestational age, 32.1 weeks). 1.5-T MRI yielded 95.7% sensitivity (95% CI: 87.8-99.1) and 81.8% specificity (95% CI: 59.8) and 3.0-T MRI 93.8% sensitivity (95% CI: 86.0-97.9) and 83.3% specificity (95% CI: 48.2-97.7) for PAS identification, with no differences between the two groups (P = 0.725 and P >0.999, respectively). MRI showed excellent predictive ability for detecting extrauterine placental spread with 100% sensitivity (95% CI: 89.4-100.0), 96.7% specificity (95% CI: 88.1-99.6) for 1.5-T and 97% sensitivity (95% CI: 84.2-99.9), 96.7% specificity (95% CI: 88.1-99.6) for 3.0-T without differences between the two groups (P > 0.999). Interobserver agreement was excellent for both groups. The most frequently detected MRI signs of PAS for both 1.5-T and 3.0-T groups were placental heterogeneity (n = 85, 93.5% vs. n = 90, 98.9%; P = 0.413), and intraplacental fetal vessels (n = 64, 70.3% vs. n = 65, 71.4%; P = 0.870).
CONCLUSION
This study suggests that 3.0-T MRI and 1.5-T MRI are equivalent for the diagnosis of PAS.
目的
准确的产前胎盘植入谱系（PAS）诊断对于优化管理很重要。本研究旨在比较 1.5-T 和 3.0-T MRI 在 PAS 诊断中的各自能力。
材料和方法
2016 年 3 月至 2021 年 3 月，在一家三级影像中心，190 名高危 PAS 的孕妇分别在 1.5-T 或 3.0-T 设备上进行了专门的产前 MRI。剖宫产术和 MRI 的时间间隔小于 6 周。前瞻性收集的数据由两位有经验的泌尿生殖放射科医生对 PAS 的存在和程度进行评估。设计了一项对比研究，以调查 1.5-T 和 3.0-T MRI 组之间预测能力的差异。计算了两组的敏感性、特异性、准确性、阴性和阳性预测值，相对于术中/组织学发现，并通过卡方（χ 2）检验进行比较。采用 Kappa 检验估计观察者间的一致性。
结果
182 名孕妇纳入研究；其中，91/182（50%）名孕妇接受 1.5-T（平均年龄 35 ± 5.1[SD]岁；平均妊娠周数：32.5 周）评估，91/182（50%）名孕妇接受 3.0-T MRI（平均年龄 34.9 ± 4.9[SD]岁；平均妊娠周数 32.1 周）。1.5-T MRI 对 PAS 识别的敏感性为 95.7%（95%CI：87.8-99.1），特异性为 81.8%（95%CI：59.8），3.0-T MRI 的敏感性为 93.8%（95%CI：86.0-97.9），特异性为 83.3%（95%CI：48.2-97.7），两组间无差异（P = 0.725 和 P >0.999）。MRI 对检测子宫外胎盘扩散具有出色的预测能力，1.5-T 和 3.0-T 的敏感性均为 100%（95%CI：89.4-100.0），特异性均为 96.7%（95%CI：88.1-99.6），差异无统计学意义（P >0.999）。观察者间的一致性在两组中均为极好。两组最常发现的 PAS MRI 征象是胎盘不均匀（n = 85，93.5% vs. n = 90，98.9%；P = 0.413）和胎盘内胎儿血管（n = 64，70.3% vs. n = 65，71.4%；P = 0.870）。
结论
本研究表明，3.0-T MRI 和 1.5-T MRI 对 PAS 的诊断具有等效性。
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