Yang Qing, Lv Xiaoli, Wang Wenjing, Chen Fenghua, Yao Liping, Ren Min
Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
J Obstet Gynaecol Can. 2025 Feb;47(2):102736. doi: 10.1016/j.jogc.2024.102736. Epub 2024 Dec 2.
Cesarean scar disorder (CSD) is a recently defined condition resulting from cesarean delivery (CD) surgery, and transvaginal uterine diverticulum repair (TVUDR) is generally chosen for treatment of CSD. This study constructed a prediction model for CSD disappearance after TVUDR using imaging data for CSD measured by transvaginal ultrasound (TVU), MRI, and contrast-enhanced MRI.
The data of 283 women with previous CD treated with TVUDR were retrospectively collected between January 2014 and February 2016. The imaging data for the CSD parameters were measured, including length, width (W), depth (D), residual myometrium thickness (RMT), RMT/depth (RMT/D), and RMT/(RMT + depth) [RMT/(RMT+D)].
Of the patients included, 129 women presented with disappearance of CSD. We noted potential differences between CSD disappearance and existence after TVUDR for W, RMT, RMT/D, and RMT/(RMT+D) measured by MRI, and D, RMT/D, and RMT/(RMT+D) measured by contrast-enhanced MRI. After adjusting for potential confounding factors, W measured using MRI was found to be associated with the disappearance of CSD (OR 1.134; 95% CI 1.050-1.224, P = 0.001). Subsequently, the W measured by MRI was selected in the prediction model, for which the C-index was 0.624. The area under the receiver operating characteristic curve in the least absolute shrinkage and selection model was 62.40% (95% CI 54.96-69.83%).
MRI and contrast-enhanced MRI were found to be relatively accurate methods for detecting CSD. Moreover, W measured using MRI was significantly associated with the disappearance of CSD after TVUDR.
剖宫产瘢痕缺陷（CSD）是一种因剖宫产手术导致的近期定义的病症，经阴道子宫憩室修复术（TVUDR）通常被选用于治疗CSD。本研究利用经阴道超声（TVU）、MRI及对比增强MRI测量的CSD影像数据构建了TVUDR术后CSD消失的预测模型。
回顾性收集2014年1月至2016年2月间接受TVUDR治疗的283例有剖宫产史女性的数据。测量CSD参数的影像数据，包括长度、宽度（W）、深度（D）、残余肌层厚度（RMT）、RMT/深度（RMT/D）以及RMT/（RMT + 深度）[RMT/（RMT+D）]。
纳入的患者中，129例女性的CSD消失。我们注意到，MRI测量的W、RMT、RMT/D及RMT/（RMT+D），以及对比增强MRI测量的D、RMT/D及RMT/（RMT+D）在TVUDR术后CSD消失与存在之间存在潜在差异。在调整潜在混杂因素后，发现MRI测量的W与CSD消失相关（OR 1.134；95%CI 1.050 - 1.224，P = 0.001）。随后，在预测模型中选用MRI测量的W，其C指数为0.624。在最小绝对收缩与选择算子模型中，受试者工作特征曲线下面积为62.40%（95%CI 54.96 - 69.83%）。
发现MRI及对比增强MRI是检测CSD的相对准确的方法。此外，MRI测量的W与TVUDR术后CSD消失显著相关。
