Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, Gusu District, Suzhou, 215002, Jiangsu, China.
Department of Obstetrics and Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China.
Abdom Radiol (NY). 2024 Jul;49(7):2525-2533. doi: 10.1007/s00261-024-04272-1. Epub 2024 Mar 7.
To identify whether placental volume, T2 dark band volume, and cervical length measured by MRI correlate with massive hemorrhage (MH) in patients with placenta accreta spectrum (PAS) disorders.
A total of 163 pregnant women with PAS underwent preoperative MRI examination were divided into MH group and non-MH group. The placental volume, T2 dark band volume, and cervical length of PAS patients were measured and evaluated their ability to identify MH in patients with PAS.
Patients with MH had a significantly larger placental volume, larger T2 dark band volume, and shorter cervical length than patients without MH (all P < 0.001). Multivariable logistic regression showed that placental volume (> 890 cm), T2 dark band volume (> 35 cm), and cervical length (< 30 mm) were significant independent risk factor in identification of MH. In all PAS patients, a positive linear correlation was found between placental volume and amount of blood loss (r = 0.527), and between T2 dark band volume and amount of blood loss (r = 0.642), and a negative linear correlation was found between cervical length and amount of blood loss (r = - 0.597). When combined with the three MRI indicators, the sensitivity and specificity in identifying cases at high risk for MH were 91.638% and 94.051%, respectively, with area under the curve (AUC) of 0.923.
The placental volume, T2 dark band volume, and cervical length might be used to predict MH in patients with PAS.
探讨磁共振成像（MRI）测量胎盘体积、T2 暗黑带体积和宫颈长度与胎盘植入谱系疾病（PAS）患者大出血（MH）的相关性。
对 163 例 PAS 患者进行术前 MRI 检查，分为 MH 组和非 MH 组。测量 PAS 患者的胎盘体积、T2 暗黑带体积和宫颈长度，并评估其对 PAS 患者 MH 的识别能力。
MH 患者的胎盘体积、T2 暗黑带体积和宫颈长度均显著大于非 MH 患者（均 P<0.001）。多变量逻辑回归显示，胎盘体积（>890cm）、T2 暗黑带体积（>35cm）和宫颈长度（<30mm）是识别 MH 的独立危险因素。在所有 PAS 患者中，胎盘体积与出血量之间呈正相关（r=0.527），T2 暗黑带体积与出血量之间呈正相关（r=0.642），宫颈长度与出血量之间呈负相关（r=-0.597）。当结合这三个 MRI 指标时，预测 MH 高危病例的敏感性和特异性分别为 91.638%和 94.051%，曲线下面积（AUC）为 0.923。
胎盘体积、T2 暗黑带体积和宫颈长度可用于预测 PAS 患者的 MH。
