专题笔谈

胎盘植入影像学诊断研究进展

  • 陈成 ,
  • 余昕烊 ,
  • 张华
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  • 重庆医科大学附属第一医院产科 (重庆 400016 )
张华,主任医师,二级教授,博士研究生导师,重庆医科大学附属第一医院产科主任,从事围产医学专业工作30年。国家临床重点专科学术带头人,国家“高等学校学科创新引智计划(111计划)-母胎医学创新引智基地”中方负责人,入选“重庆市百千万工程领军人才”称号。现任中华医学会围产医学分会营养与代谢学组委员,中国医师协会妇产科分会母胎学组专家委员会委员,中国妇幼保健协会高危妊娠管理专业委员会委员,重庆市医学会围产医学分会主任委员,重庆市医师协会围产医师分会副会长。研究方向聚焦围产医学。发表论文40多篇,参编著作5部,主持国家自然科学基金及省部级科研基金10余项。

收稿日期: 2024-02-19

  网络出版日期: 2024-11-19

基金资助

国家重点研发计划项目(2022YFC2704500)

Advances in imaging diagnosis of placenta accreta spectrum

  • Cheng CHEN ,
  • Xinyang YU ,
  • Hua. ZHANG
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  • Department of Obstetrics and Gynecology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China

Received date: 2024-02-19

  Online published: 2024-11-19

摘要

胎盘植入性疾病(PAS)是指胎盘绒毛不同程度异常黏附或侵入子宫肌层的疾病,可导致严重产科并发症,包括产后出血、子宫切除、围产期感染等。超声是目前诊断PAS最常用的影像学检查手段,尽管其已被广泛使用,但准确性存在争议;因此,近期涌现出新的影像产前诊断指标。该文旨在从超声征象和磁共振成像(MRI)等方面回顾分析PAS的产前诊断指标,并讨论联合诊断方法及其研究进展。

本文引用格式

陈成 , 余昕烊 , 张华 . 胎盘植入影像学诊断研究进展[J]. 实用医学杂志, 2024 , 40(21) : 2976 -2981 . DOI: 10.3969/j.issn.1006-5725.2024.21.003

Abstract

Placenta accreta spectrum (PAS) refers to a condition where placental villi abnormally adhere to or invade the uterine muscle layer to varying degrees. PAS can lead to severe obstetric complications, including postpartum hemorrhage, hysterectomy and even life-threatening situations. Nowadays, the diagnosis of PAS typically relies on imaging examinations such as ultrasound. Despite the widespread use of ultrasound, its accuracy is a subject of controversy, leading to the emergence of new imaging prenatal diagnostic indicators. This article aims to review prenatal diagnostic indicators of PAS, including ultrasound features and magnetic resonance imaging (MRI). Additionally, we will discuss existing joint diagnostic methods and the latest research findings.

参考文献

1 SILVER R M, BRANCH D W. Placenta Accreta Spectrum[J]. N Engl J Med, 2018, 378(16):1529-1536. doi:10.1056/nejmcp1709324
2 MA Y, HU Y, MA J. Animal models of the placenta accreta spectrum: Current status and further perspectives[J]. Front Endocrinol (Lausanne), 2023, 14:1118168. doi:10.3389/fendo.2023.1118168
3 JAUNIAUX E, BUNCE C, GR?NBECK L, et al. Prevalence and main outcomes of placenta accreta spectrum: A systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2019, 221(3):208-218. doi:10.1016/j.ajog.2019.01.233
4 DE OLIVEIRA CARNIELLO M, OLIVEIRA BRITO L G, SARIAN L O, et al. Diagnosis of placenta accreta spectrum in high-risk women using ultrasonography or magnetic resonance imaging: Systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol, 2022, 59(4):428-436. doi:10.1002/uog.24861
5 SHAINKER S A, COLEMAN B, TIMOR-TRITSCH I E, et al. Special Report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: Consensus on definition of markers and approach to the ultrasound examination in pregnancies at risk for placenta accreta spectrum[J]. Am J Obstet Gynecol, 2021, 224(1):B2-B14. doi:10.1016/j.ajog.2020.09.001
6 D’ANTONIO F, TIMOR-TRITSCH I E, KHALIL A, et al. New classification of placenta accreta spectrum disorders should include presence of Cesarean scar pregnancy[J]. Ultrasound Obstet Gynecol, 2022, 59(4):563. doi:10.1002/uog.24880
7 D′ANTONIO F, TIMOR-TRITSCH I E, PALACIOS-JARAQUEMADA J, et al. First-trimester detection of abnormally invasive placenta in high-risk women: Systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol, 2018, 51(2):176-183. doi:10.1002/uog.18840
8 JAUNIAUX E, ZOSMER N, DE BRAUD L V, et al. Development of the utero-placental circulation in cesarean scar pregnancies: A case-control study[J]. Am J Obstet Gynecol, 2022, 226(3):399.e1-399.e10. doi:10.1016/j.ajog.2021.08.056
9 DOULAVERIS G, RYKEN K, PAPATHOMAS D, et al. Early prediction of placenta accreta spectrum in women with prior cesarean delivery using transvaginal ultrasound at 11 to 14 weeks[J]. Am J Obstet Gynecol MFM, 2020, 2(4):100183. doi:10.1016/j.ajogmf.2020.100183
10 SVANVIK T, JACOBSSON A K, CARLSSON Y. Prenatal detection of placenta previa and placenta accreta spectrum: Evaluation of the routine mid-pregnancy obstetric ultrasound screening between 2013 and 2017[J]. Int J Gynaecol Obstet, 2022, 157(3):647-653. doi:10.1002/ijgo.13876
11 JANSEN C H J R, KLEINROUWELER C E, KASTELEIN A W, et al. Follow-up ultrasound in second-trimester low-positioned anterior and posterior placentae: Prospective cohort study[J]. Ultrasound Obstet Gynecol, 2020, 56(5):725-731. doi:10.1002/uog.21903
12 JAUNIAUX E, BHIDE A, KENNEDY A, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening[J]. Int J Gynaecol Obstet, 2018, 140(3):274-280. doi:10.1002/ijgo.12408
13 张天玥. 胎盘植入谱系疾病血清生物标记物及超声标志物的临床研究[D]. 北京:北京协和医学院, 2023.
14 FRATELLI N, PREFUMO F, MAGGI C, et al. Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: Results from the ADoPAD study[J]. Ultrasound Obstet Gynecol, 2022, 60(3):381-389. doi:10.1002/uog.24889
15 ZOSMER N, JAUNIAUX E, BUNCE C, et al. Interobserver agreement on standardized ultrasound and histopathologic signs for the prenatal diagnosis of placenta accreta spectrum disorders[J]. Int J Gynaecol Obstet, 2018, 140(3):326-331. doi:10.1002/ijgo.12389
16 HIH J C, KANG J, TSAI S J, et al. The “rail sign”: An ultrasound finding in placenta accreta spectrum indicating deep villous invasion and adverse outcomes[J]. Am J Obstet Gynecol, 2021, 225(3):292.e1-292.e17. doi:10.1016/j.ajog.2021.03.018
17 DI PASQUO E, GHI T, CALì G, et al. Intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low-lying placenta[J]. Ultrasound Obstet Gynecol, 2020, 55(4):460-466. doi:10.1002/uog.21866
18 BERTUCCI E, SILEO F G, GRANDI G, et al. The Jellyfish Sign: A New Sonographic Cervical Marker to Predict Maternal Morbidity in Abnormally Invasive Placenta Previa[J]. Ultraschall Med, 2019, 40(1):40-46. doi:10.1055/s-0043-119872
19 ALLWOOD R X, SELF A, COLLINS S L. Separation sign: Novel ultrasound sign for ruling out diagnosis of placenta accreta spectrum[J]. Ultrasound Obstet Gynecol, 2022, 60(3):390-395. doi:10.1002/uog.26021
20 SKUPSKI D W, DUZYJ C M, SCHOLL J, et al. Evaluation of classic and novel ultrasound signs of placenta accreta spectrum[J]. Ultrasound Obstet Gynecol, 2022, 59(4):465-473. doi:10.1002/uog.24804
21 AGARWAL S, AGARWAL A, CHANDAK S. Role of placenta accreta index in prediction of morbidly adherent placenta: A reliability study[J]. Ultrasound,2021, 29(2):92-99. doi:10.1177/1742271x20959742
22 CALI G, FORLANI F, LEES C, et al. Prenatal ultrasound staging system for placenta accreta spectrum disorders[J]. Ultrasound Obstet Gynecol, 2019, 53(6):752-760. doi:10.1002/uog.20246
23 PILLONI E, ALEMANNO M G, GAGLIOTI P, et al. Accuracy of ultrasound in antenatal diagnosis of placental attachment disorders[J]. Ultrasound Obstet Gynecol, 2016, 47(3):302-307. doi:10.1002/uog.14893
24 ZHANG J, LI H, FENG D, et al. Ultrasound scoring system for prenatal diagnosis of placenta accreta spectrum[J]. BMC Pregnancy Childbirth, 2023, 23(1):569. doi:10.1186/s12884-023-05886-x
25 HASHIM H ABU, SHALABY E M, HUSSIEN M H, et al. Diagnostic accuracy of the placenta accreta index for placenta accreta spectrum: A prospective study[J]. Int J Gynaecol Obstet,2022,156(1):71-76. doi:10.1002/ijgo.13610
26 ADU-BREDU T K, RIDWAN R, ADITIAWARMAN A, et al. Three-Dimensional Volume Rendering Ultrasound for Assessing Placenta Accreta Spectrum Severity and Discriminating it from Simple Scar Dehiscence[J]. Am J Obstet Gynecol MFM, 2024, 7:101321. doi:10.1016/j.ajogmf.2024.101321
27 DALL’ASTA A, FORLANI F, SHAH H, et al. Evaluation of the Tramline Sign in the Prediction of Placenta Accreta Spectrum and Perioperative Outcomes in Anterior Placenta Previa[J]. Ultraschall Med, 2022, 43(6):e118-e124. doi:10.1055/a-1309-1665
28 JHA P, PōDER L, BOURGIOTI C, et al. Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders[J]. Eur Radiol, 2020, 30(5):2604-2615. doi:10.1007/s00330-019-06617-7
29 BOURGIOTI C, ZAFEIROPOULOU K, FOTOPOULOS S, et al. MRI Features Predictive of Invasive Placenta With Extrauterine Spread in High-Risk Gravid Patients: A Prospective Evaluation[J]. AJR Am J Roentgenol, 2018, 211(3):701-711. doi:10.2214/ajr.17.19303
30 FAMILIARI A, LIBERATI M, LIM P, et al. Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: A systematic review and meta-analysis[J]. Acta Obstet Gynecol Scand, 2018, 97(5):507-520. doi:10.1111/aogs.13258
31 BOURGIOTI C, ZAFEIROPOULOU K, FOTOPOULOS S, et al. MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders[J]. J Magn Reson Imaging, 2019, 50(2):602-618. doi:10.1002/jmri.26592
32 XIA J, HU Y, HUANG Z, et al. A novel MRI-based diagnostic model for predicting placenta accreta spectrum[J]. Magn Reson Imaging, 2024,109:34-41. doi:10.1016/j.mri.2024.02.014
33 ZOU L, WANG P, SONG Z, et al. Effectiveness of a fetal magnetic resonance imaging scoring system for predicting the prognosis of pernicious placenta previa: A retrospective study[J]. Front Physiol, 2022,13:921273. doi:10.3389/fphys.2022.921273
34 徐玉静, 高文娟, 徐晓臣, 等. 2020 ACR胎盘植入性疾病影像学检查指南解读[J]. 现代妇产科进展, 2021, 30(12): 954-956. doi:10.13283/j.cnki.xdfckjz.2021.12.039
35 KLIEWER M A, BOCKOVEN C G, REEDER S B, et al. Ferumoxytol-enhanced MR demonstration of changes to internal placental structure in placenta accreta spectrum: Preliminary findings[J]. Placenta, 2023, 134:1-8. doi:10.1016/j.placenta.2023.02.003
36 HOROWITZ J M, HOTALEN I M, MILLER E S, et al. How Can Pelvic MRI with Diffusion-Weighted Imaging Help My Pregnant Patient?[J]. Am J Perinatol, 2020, 37(6):577-588. doi:10.1055/s-0039-1685492
37 LI H, LU T, LI M, et al. Differentiation of placenta percreta through MRI features and diffusion-weighted magnetic resonance imaging[J]. Insights Imaging, 2023, 14(1):93. doi:10.1186/s13244-023-01448-z
38 LU T, WANG Y, GUO A, et al. Monoexponential, biexponential and diffusion kurtosis MR imaging models: Quantitative biomarkers in the diagnosis of placenta accreta spectrum disorders[J]. BMC Pregnancy Childbirth, 2022, 22(1):349. doi:10.1186/s12884-022-04644-9
39 LEóN R L, BROWN B P, PERSOHN S A, et al. Intravoxel incoherent motion MR imaging analysis for diagnosis of placenta accrete spectrum disorders: A pilot feasibility study[J]. Magn Reson Imaging, 2021, 80:26-32. doi:10.1016/j.mri.2021.03.007
40 王颖超, 黄刚. MRI新技术在胎盘植入性病变评估的研究进展[J]. 磁共振成像, 2023, 14(1): 194-197,202.
41 徐蕊, 何明钰, 刘新峰, 等. 磁共振新兴技术在肝纤维化的研究进展[J]. 实用医学杂志, 2023, 39(1):124-128.
42 YOUNG D, KHAN N, HOBSON S R, et al. Diagnosis of placenta accreta spectrum using ultrasound texture feature fusion and machine learning[J]. Comput Biol Med, 2024, 178: 108757. doi:10.1016/j.compbiomed.2024.108757
43 ROMEO V, RICCIARDI C, CUOCOLO R, et al. Machine learning analysis of MRI-derived texture features to predict placenta accreta spectrum in patients with placenta previa[J]. Magn Reson Imaging, 2019, 64:71-76. doi:10.1016/j.mri.2019.05.017
44 REN H, MORI N, MUGIKURA S, et al. Prediction of placenta accreta spectrum using texture analysis on coronal and sagittal T2-weighted imaging[J]. Abdom Radiol (NY), 2021, 46(11):5344-5352. doi:10.1007/s00261-021-03226-1
45 YE Z, XUAN R, OUYANG M, et al. Prediction of placenta accreta spectrum by combining deep learning and radiomics using T2WI: A multicenter study[J]. Abdom Radiol (NY), 2022, 47(12):4205-4218. doi:10.1007/s00261-022-03673-4
46 XUAN R, LI T, WANG Y, et al. Prenatal prediction and typing of placental invasion using MRI deep and radiomic features[J]. BioMedical Engineering OnLine, 2021, 20: 56. doi:10.1186/s12938-021-00893-5
47 CHU C, LIU M, ZHANG Y, et al. MRI-Based Radiomics Analysis for Intraoperative Risk Assessment in Gravid Patients at High Risk with Placenta Accreta Spectrum[J]. Diagnostics (Basel), 2022, 12(2):485. doi:10.3390/diagnostics12020485
48 ZONG M, PEI X, YAN K, et al. Deep Learning Model Based on Multisequence MRI Images for Assessing Adverse Pregnancy Outcome in Placenta Accreta[J]. J Magn Reson Imaging, 2024, 59(2): 510-521. doi:10.1002/jmri.29023
49 STANZIONE A, VERDE F, CUOCOLO R, et al. Placenta Accreta Spectrum Disorders and Radiomics: Systematic review and quality appraisal[J]. Eur J Radiol, 2022, 155:110497. doi:10.1016/j.ejrad.2022.110497
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