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Objective ToinvestigatethevalueofpreoperativeMRIforplacentapreviainpredictionofmassivepostpartumhemorrhage. Methods AretrospectiveanalysisoftheclinicalhistoryandprenatalMRIfeaturesof362patientswithplacentapreviawereperformed. Ofthese,54casesexperiencedseverepostpartum hemorrhage.Results Univariateanalysisshowedthattheageofpregnantwomen (χ2＝3.951,P＝0.047),gestationalage(χ2＝6.257,P＝0.012),numberofcesareansections(χ2＝36.372,P＝0.001)andgemellary pregnancy(χ2＝7.933,P＝0.005)wereassociated with massivepostpartum hemorrhage.Amongthe MRIsigns,Uterinebulging (OR,46.712;95%CI,13.067－166.987),placentalprotrusionsign (OR,22.787;95% CI,4.595－113),andintroplacentalT2dark band(OR,14.757;95%CI,7.149－30.461)indicatedhighriskwithmassivepostpartumhemorrhage.Myometrialthinningorlocalized interruption,unevenplacentalsignal,abnormalbloodvesselsbelowtheplacenta,abundantbloodvesselsinloweruterusandcervix, cervicalshorteningandothersignsfortheevaluationofseverepostpartumhemorrhagewerealsostatisticallysignificant.Conclusion MRIcanpredictmostoftheseverepostpartumhemorrhagebeforesurgeryandisveryhelpfultoimprovethepatientprognosis.
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Objective To explore the MRI findings of placental protusion sign in predicting postpartum hemorrhage in patients with placenta previa.Methods Totally 354 placenta previa patients with whole clinical data underwent MR scaning 2 weeks before operation.Association of postpartum hemorrhage and placental protusion sign was analyzed.Results Among 354 patients with placental previa,the age of the pregnant women (x2 =4.34,P=0.04),gestational age at delivery (x2 =5.19,P=0.02) and the number of cesarean sections (x2 =44.85,P＜0.01) had associated with postpartum hemorrhage.Eight cases had placental protusion sign in MRI,while 6 cases occurred postpartum hemorrhage.The incidence of postpartum hemorrhage was 75.00％ (6/8) and 12.72％ (44/346) in patients with placenta accreta and with placental abruption,respectively (x2 =20.14,P＜0.01).The sensitivity,specificity,odds ratio (95％ confidence interval) and positive likelihood ratio of predicting postpartum hemorrhage was 12.00％ (6/50),99.34％ (302/304),20.59 (4.03,105.23) and 15.68,respectively.Conclusion MRI placental protrusion sign has important clinical reference value in predicting postpartum hemorrhage.
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Objective To evaluate the clinical efficacy of uterine artery chemoembolization (UACE) and uterine artery embolization (UAE) with subsequent curettage in treating cesarean scar pregnancy (CSP). Methods A total of 79 patients with clinically-confirmed CSP were randomly divided into two groups:group A (UACE group,n=43) and group B (UAE group,n=36). Patients in each group were subdivided into two subgroups: endogenous type subgroup and exogenous type subgroup. Interventional management (UACE for group A and UAE for group B) with subsequent curettage was carried out in all patients of both groups. The amount of blood loss during curettage, the recovered time of human chorionic gonadotropin (HCG) level, the twice treatment rate and the success rate of treatment were measured and were used as the therapeutic evaluation parameters. The results were compared between group A and group B as well as between the subgroups. Results After UACE or UAE, the uterine dilation and curettage was successfully accomplished in all patients of both groups. Hysterectomy was not needed in all patients. Statistically significant differences in the recovered time of HCG level, occurrence of complications and the twice treatment rate existed between the two groups (P0.05). The exogenous type of cesarean scar pregnancy in group A and group B was proved in 15 cases and 11 cases respectively, and the success rate of treatment for them was 86.7%(13/15) and 45.5%(5/11) respectively (P<0.05). The differences in postoperative vaginal bleeding time, the menstrual recovery time, the recovered time of HCG level, the twice treatment rate and the success rate of treatment between the two exogenous type subgroups were statistically significant (P<0.05 in all). Conclusion For the treatment of cesarean scar pregnancy, both UAE and UACE with subsequent curettage are safe and effective. For the treatment of endogenous type of CSP, it is better to use UAE, while for the treatment of exogenous type of CSP, it is better to use UACE.
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Objective To explore the diagnostic value of MRI in invasively pernicious placenta previa.Methods MRI and color doppler ultrasound were performed in 1 50 patients with pernicious placenta previa.According to the operation or pathology findings, the diagnostic value of placental invasion was compared among MRI,color doppler ultrasound and both of them.Analyzed and com-pared the MRI findings of 64 patients which were confirmed as invasive placenta including adherent placenta in 20 patients,implanted one in 38 and penetrated one in 6.Results Significant difference was not found among MRI,color doppler ultrasound and both in the diagnostic value of invasive placenta (P >0.05).There was a significant difference among adherent placenta,implanted one and pen-etrated one in the diagnostic value of MRI (P <0.05),and the highest and lowest values were penetrated placenta and adherent pla-centa respectively.Conclusion MRI is an important diagnostic method in invasively pernicious placenta previa,which was useful for its classification but with a limitation for the diagnosis of adherent placenta.
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ObjectiveTo investigate the MRI features of placenta accreta.MethodsFrom Apr 2009 to Jun 2011,15 patients with placenta accrete received MRI examination.In them,placenta accrcta was diagnosed based on clinical manifestations or postoperative histopathologv.The MR features of placenta accreta in thcm( study group) were retrospectively analyzed and compared with those in 15 pregnant women without placenta accreta (control group)with Fisher exact test.ResultsIn the 15 patients with placenta accreta,uterine bulging and(or) a focal outward contour bulge was detected in 14 patients; heterogeneous signal intensity in the placenta was detected in 15 patients; dark intraplacental bands on T2-weighted images was detected in 15 patients; and increased subplacental vascularity was detected in 11 patients on T1- weighted images.In the study group,14 patients showed at least three of the above four features,and in all of them uterine bulging and(or) a focal outward contour bulge,heterogeneous signal intensity in the placenta and dark intraplacental bands on T2-weighted images were detected; one patient showed heterogeneous signal intensity in the placenta,dark intraplacental bands on T2-weighted images and increased subplacental vascularity.In the control group,none patient had three of the above features.Uterine bulging and(or) a focal outward contour bulge,heterogeneous signal intensity in the placenta,dark intraplacental bands on T2-weighted images and increased subplacental vascularity were detected in 3,6,3 and 4 patients (P=0.000,0.001,0.000 and 0.027 ),respectively.ConclusionsThe main MRI features of placenta accreta are uterine bulging and(or) a focal outward contour bulge,heterogeneous signal intensity in the placenta and dark intraplacental bands on T2-weighted images Besides,increased subplacental vascularity also could provide useful information for the diagnosis of placenta accreta.
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Objective:To explore the clinical value of stereotactic wire-localized biopsy(SWLB)in digital mammography in the detection of microcalcification of the breast.Methods:A total of 45 patients with nonpalpable breast lesions which were positive for microcalcification by mammography but could not be detected clinically underwent SWLB.Their mammography fndings were analyzed in detail with pathology.Results:Among the 45 cases,13 cases(28.9%)had malignant lesions including ductal carcinoma in situ in 3 cases (20.1%),ductal carcinoma in situ with microinvasion in 4 cases(30.8%),invasive ductal carcinoma in 5 cases (38.5%)and intraductal papillary carcinoma in 1 case(7.7%).Thirty-two cases(71.1%)had benign lesions,2 cases(6.3%)of which were severe atypical hyperplasia.Conclusion:SWLB can accurately guide the surgical excision of nonpalpable breast microcalcification lesions and diagnose microcalcifications exactly,which is helpful for increasing the detection rate of eady-stage breast cancer.
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100 u/L 24 months later and another 38 year-old patient underwent surgical operation of ovaries bilaterally before UAE. Conclusions Temporary amenorrhea may not mean ovarian dysfunction or failure. The probability of ovarian dysfunction or failure after UAE is low, which mainly occur in the peirmenopausal patients. Consideration of the probability of inducing early ovarian failure, caution should be taken for UAE on the patients having ovarian surgery before. (J Intervent Radiol, 2006, 15: 472-475)
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Objective To sum up the experience of embolization uterine aterial to treat uterine leiomyoma and to discuss how to prevent and manage the complications.Methods 103 patients with uterine leiomyoma have treated by uterine aterial embolized.Postembolization syndrome and 18 accidents out of 16 patients were reviewed.Results Postembolization syndrome were treated by conservation therapy,among the 18 accidents,there were 6 aterial rupture,after embolization the rupture aterial,no serious complications occurred;6 uterine aterial spasm,4 were cured after treated,1 aterial false embolized,1 embolized uterine aterial with Gelfoam particle;3 patients fibroids extrusion,the fibroids was detached easily,all were cured after conservation treated;1 had amenorrheal after embolization;1 case urine bladder aterial was embolized,there was not complication after conservation treat;1 case had uterine infection,no serious complications occurred after hysterectomy.Conclusion The correct management of the complications may helpful to increase the cure rate.