Yang Fengleng, Zhang Qian, Shuai Yongzhong, Wang Zhigang, Jing Huaibo, Wang Xiaodan, Deng Chen, Lin Fanyu, Lai Hua
Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Int J Gynaecol Obstet. 2025 Feb;168(2):525-534. doi: 10.1002/ijgo.15882. Epub 2024 Sep 7.
The aim of the present study was to explore the relationship between the size of cesarean scar diverticulum (CSD) measured on preoperative magnetic resonance imaging (MRI) and adverse events during dilatation and curettage (D&C) procedure in patients with cesarean scar pregnancy (CSP).
The MRI of 197 CSP patients from October 2019 to August 2023 were retrospectively reviewed. The volume, area, and depth of CSD, residual myometrium thickness (RMT), and gestational sac diameter were recorded and tested for correlation with intraoperative estimated blood loss (EBL), and operation time and for any association with the intraoperative adverse events (intraoperative massive hemorrhage [39 cases] and D&C procedure failure [15 cases]). The Spearman test was used to characterize the correlation between the five MRI variables and both the EBL and operation time. The correlation between the five MRI variables and intraoperative adverse events was evaluated with student's t test and Mann-Whitney U test. Diagnostic power of the MRI variables was evaluated by the area under receiver operating characteristic curve (AUC).
The volume, area, and depth of CSD and gestational sac diameter were positively correlated with both EBL and operation time, with the CSD volume having the highest correlation with them (r = 0.543 and 0.461, respectively). Conversely, the RMT displayed a negative correlation with the EBL and operation time. All five MRI variables were significantly associated with both intraoperative massive hemorrhage and D&C failure (all P < 0.001). The CSD volume demonstrated the highest AUC for diagnosing intraoperative massive hemorrhage and D&C failure at 0.893 (95% CI: 0.82-0.92) and 0.901 (95% CI: 0.85-0.94), respectively. The optimal cutoff values for CSD volume in predicting massive hemorrhage and D&C failure were determined to be 5.41 and 8.92 cm, respectively, with corresponding sensitivities/specificities of 92.31/74.68 and 93.33/82.42, respectively.
Quantifying the size of CSD based on preoperative MRI could aid in evaluating risk during D&C in CSP patients, with CSD volume possessing higher diagnostic efficacy than the other four MRI indicators.
本研究旨在探讨剖宫产瘢痕憩室（CSD）在术前磁共振成像（MRI）上测量的大小与剖宫产瘢痕妊娠（CSP）患者刮宫术（D&C）过程中不良事件之间的关系。
回顾性分析2019年10月至2023年8月期间197例CSP患者的MRI。记录CSD的体积、面积和深度、残余肌层厚度（RMT）和孕囊直径，并测试其与术中估计失血量（EBL）、手术时间的相关性，以及与术中不良事件（术中大出血[39例]和刮宫术失败[15例]）的任何关联。采用Spearman检验来描述五个MRI变量与EBL和手术时间之间的相关性。采用学生t检验和Mann-Whitney U检验评估五个MRI变量与术中不良事件之间的相关性。通过受试者操作特征曲线（AUC）下的面积评估MRI变量的诊断效能。
CSD的体积、面积和深度以及孕囊直径与EBL和手术时间均呈正相关，其中CSD体积与它们的相关性最高（分别为r = 0.543和0.461）。相反，RMT与EBL和手术时间呈负相关。所有五个MRI变量均与术中大出血和刮宫术失败显著相关（所有P < 0.001）。CSD体积在诊断术中大出血和刮宫术失败方面的AUC最高，分别为0.893（95%CI：0.82 - 0.92）和0.901（95%CI：0.85 - 0.94）。预测大出血和刮宫术失败的CSD体积最佳截断值分别确定为5.41和8.92 cm，相应的敏感度/特异度分别为92.31/74.68和93.33/82.42。
基于术前MRI对CSD大小进行量化有助于评估CSP患者刮宫术期间的风险，CSD体积比其他四个MRI指标具有更高的诊断效能。
