Liu Liqun, Yan Xiaoli, Liu Jingjing, Yan Ping, Du Mingshan, Wang Runyuan, Wu Yi, Wang Dan
Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, China.
Ann Transl Med. 2023 Jan 15;11(1):8. doi: 10.21037/atm-22-2940. Epub 2023 Jan 10.
The aim of this study was to investigate the significance and feasibility of risk assessments based on the three-dimensional (3D) reconstruction of magnetic resonance imaging (MRI) of invasive placenta accreta (IPA) to create individualized surgical protocols and perioperative management plans in late pregnancy.
MRI and clinical data of 36 pregnant women with IPA admitted to Southwest Hospital from January 2017 to June 2021 were retrospectively analyzed. The patients were divided into the following 4 groups: peripartum hysterectomy (PH), abdominal aortic balloon block (AABB), PH with AABB, and nonsurgical treatment. Each group was then divided into severe and nonsevere postpartum hemorrhage subgroups based on postpartum hemorrhage volumes of not more than 2,000 mL and more than 2,000 mL, respectively. The uteri, placentas, IPA, and urinary bladders in each group were segmented and 3-dimensionally reconstructed using Amira 5.2.2 (Visage Imaging, Richmond, Australia) software, and their surface areas and volumes were calculated. A multifactorial unconditional logistic regression analysis was performed to evaluate the 3D morphological parameters of postpartum hemorrhage and calculate the optimal threshold.
The bleeding volume, IPA area, placental area:uterine area ratio, IPA area:placental area ratio, maximum depth of IPA, placental position score, IPA position score, and implantation volume were greater in the severe postpartum hemorrhage subgroup than in the nonsevere postpartum hemorrhage subgroup of all groups. In the multifactorial regression analysis, the areas under the receiver operating characteristic curve of the implantation area, implantation volume, maximum depth of implantation, and implantation area:placental area ratio exceeded 0.9 and correlated strongly with severe postpartum hemorrhage, while those of the uterine area, uterine volume, placental area, placental volume, and placental area:uterine area ratio were between 0.5 and 0.7 and correlated with severe postpartum hemorrhage. The threshold (cutoff values) determining severe postpartum hemorrhage were 20,286.25 mm of the implantation area, 0.01271 of the implantation area:placental area ratio, 15.03 mm of the maximum depth of implantation, and 46,846 mm of the implantation volume.
The MRI 3D reconstruction of IPA and its adjacent structures can accurately display the location, anatomical morphology, and spatial relationship of IPA, which can be used to improve the accuracy of IPA diagnosis, predict postpartum hemorrhage, and provide optimized treatment decisions for obstetricians.
本研究旨在探讨基于侵袭性胎盘植入（IPA）磁共振成像（MRI）三维（3D）重建进行风险评估的意义及可行性，以制定晚期妊娠个体化手术方案及围手术期管理计划。
回顾性分析2017年1月至2021年6月入住西南医院的36例IPA孕妇的MRI及临床资料。患者分为以下4组：围产期子宫切除术（PH）、腹主动脉球囊阻断（AABB）、PH联合AABB及非手术治疗。然后根据产后出血量分别不超过2000 mL和超过2000 mL，将每组再分为严重产后出血亚组和非严重产后出血亚组。使用Amira 5.2.2（澳大利亚里士满Visage Imaging公司）软件对每组的子宫、胎盘、IPA及膀胱进行分割并三维重建，计算其表面积和体积。进行多因素无条件逻辑回归分析，评估产后出血的3D形态学参数并计算最佳阈值。
所有组的严重产后出血亚组的出血量、IPA面积、胎盘面积与子宫面积比值、IPA面积与胎盘面积比值、IPA最大深度、胎盘位置评分、IPA位置评分及植入体积均高于非严重产后出血亚组。在多因素回归分析中，植入面积、植入体积、植入最大深度及植入面积与胎盘面积比值的受试者工作特征曲线下面积超过0.9，与严重产后出血密切相关，而子宫面积、子宫体积、胎盘面积、胎盘体积及胎盘面积与子宫面积比值的曲线下面积在0.5至0.7之间，与严重产后出血相关。确定严重产后出血的阈值（截断值）为植入面积20286.25 mm、植入面积与胎盘面积比值0.01271、植入最大深度15.03 mm及植入体积为46846 mm。
IPA及其相邻结构的MRI三维重建能够准确显示IPA的位置、解剖形态及空间关系，可用于提高IPA诊断的准确性、预测产后出血，并为产科医生提供优化的治疗决策。
