Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China.
School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, West Hi-tech Zone, Chengdu, 611731, China.
Arch Gynecol Obstet. 2024 Feb;309(2):503-514. doi: 10.1007/s00404-023-06947-4. Epub 2023 Feb 15.
To investigate the diagnostic value of monoexponential, biexponential, and diffusion kurtosis MR imaging (MRI) in distinguishing invasive placentas.
A total of 53 patients with invasive placentas and 47 patients with noninvasive placentas undergoing conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) were retrospectively enrolled. The mean, minimum, and maximum parameters including the apparent diffusion coefficient (ADC) and exponential ADC (eADC) from standard DWI, diffusion kurtosis (MK), and diffusion coefficient (MD) from DKI and pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from IVIM were measured and compared from the volumetric analysis. Receiver operating characteristics (ROC) curve and logistic regression analyses were conducted to evaluate the diagnostic efficiency of different diffusion parameters for distinguishing invasive placentas.
Comparisons between accreta lesions in patients with invasive placentas (AL) and lower 1/3 part of the placenta in patients with noninvasive placentas (LP) demonstrated that MD mean, D mean, and D* mean were significantly lower while ADC max and D max were significantly higher in invasive placentas (all p < 0.05). Multivariate analysis demonstrated that D mean, D max and D* mean differed significantly among all the studied parameters for invasive placentas. A combined use of these three parameters yielded an AUC of 0.86 with sensitivity, specificity, and accuracy of 84.91%, 76.60%, and 80%, respectively.
The combined use of different IVIM parameters is helpful in distinguishing invasive placentas.
探讨单指数、双指数和扩散峰度磁共振成像（MRI）在鉴别侵袭性胎盘中的诊断价值。
回顾性分析了 53 例侵袭性胎盘患者和 47 例非侵袭性胎盘患者的常规弥散加权成像（DWI）、体素内不相干运动（IVIM）和弥散峰度成像（DKI）资料。从标准 DWI 测量表观弥散系数（ADC）和指数 ADC（eADC）的均值、最小值和最大值，从 DKI 测量弥散峰度（MK）和弥散系数（MD）以及从 IVIM 测量纯弥散系数（D）、假性弥散系数（D*）和灌注分数（f），并进行容积分析。采用受试者工作特征（ROC）曲线和逻辑回归分析评估不同弥散参数鉴别侵袭性胎盘的诊断效能。
比较侵袭性胎盘患者的胎盘病灶（AL）与非侵袭性胎盘患者胎盘下 1/3 部分（LP），结果显示侵袭性胎盘的 MD 均值、D 均值和 D均值明显降低，而 ADC 最大值和 D 最大值明显升高（均 P<0.05）。多因素分析显示，MD 均值、D 最大值和 D均值在所有研究参数中差异均有统计学意义。联合使用这三个参数的 AUC 为 0.86，敏感性、特异性和准确性分别为 84.91%、76.60%和 80%。
联合使用不同 IVIM 参数有助于鉴别侵袭性胎盘。
