MRI Signs Associated With Bladder Injury During Cesarean Delivery in Severe Placenta Accreta Spectrum Disorders.

IF 3.3 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of Magnetic Resonance Imaging Pub Date : 2025-01-09 DOI:10.1002/jmri.29703
Xin Chen, Xiaohan Zheng, Xianyun Cai, Huiwen Wang, Ruiqin Shan, Yongzhong Gu, Xietong Wang, Guangbin Wang
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Abstract

Background: Bladder injury during cesarean delivery (CD) in pregnant women with severe placenta accreta spectrum (PAS) disorders mostly occurs in the dissection of vesico-uterine space. Placental MRI may help to assess the risk of bladder injury preoperatively.

Purpose: To identify the high-risk MRI signs of bladder injury during CD in women with severe PAS.

Study type: Retrospective.

Subjects: One hundred sixty-seven women with surgically confirmed severe PAS, defined as to increta or percreta, who underwent planned CD and available placental MRI.

Field strength/sequence: 1.5 Tesla, half-Fourier single-shot turbo spin echo sequence and true fast imaging with steady state free precession sequence.

Assessment: Presence of following imaging features of the vesico-uterine region were independently evaluated by three radiologists (with 8, 8, and 15 years of experience, respectively): vesico-uterine space hypervascularity, vesico-uterine space without chemical shift line, bladder wall interruption with hyperintense nodularity, bladder tenting, and uterine-placental bulge.

Statistical tests: Univariable analyses (Chi-square or Fisher's exact test) and multivariable regression analyses were used. A P value <0.05 was considered significant.

Results: Thirty-three of the women (19.8%) experienced bladder injury during CD. MRI features were significantly more frequent in the bladder injury group compared with the no bladder injury group: 69.7% vs. 26.9% in vesico-uterine space hypervascularity, 57.6% vs. 21.6% in absent chemical shift line in the vesico-uterine space, 18.2% vs. 1.5% in bladder wall interruption with hyperintense nodularity, 39.4% vs. 14.9% in bladder tenting, and 78.8% vs. 39.6% in uterine-placental bulging. Vesico-uterine space hypervascularity, absent chemical shift line, and uterine-placental bulge were independently associated with the risk of bladder injury (odds ratios: 4.190, 3.555, and 3.569, respectively).

Data conclusion: Vesico-uterine space hypervascularity, vesico-uterine space without chemical shift line and uterine-placental bulge were associated with bladder injury during CD in women with severe PAS.

Plain language summary: Bladder injury is a serious complication of cesarean delivery in pregnant women with severe placenta accreta spectrum, frequently resulting in massive hemorrhage, bladder dysfunction and severe infection. Accurate prenatal assessment is important to minimize these adverse consequences. This study showed that MRI features, including vesico-uterine space hypervascularity, vesico-uterine space without chemical shift line and uterine-placental bulge, were independently associated with bladder injury. These high-risk MRI signs may serve as effective means for prenatal assessment of bladder injury. This study would broaden the application of MRI in severe placenta accreta spectrum.

Evidence level: 3 TECHNICAL EFFICACY: Stage 2.

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严重胎盘增生谱系障碍患者剖宫产时膀胱损伤的MRI征象。
背景:重度胎盘增生症(PAS)孕妇剖宫产(CD)时膀胱损伤多发生在膀胱-子宫间隙剥离。胎盘MRI可能有助于评估术前膀胱损伤的风险。目的:探讨重症PAS患者CD期间膀胱损伤的高危MRI征象。研究类型:回顾性。研究对象:167名经手术确认为重度PAS的女性,定义为increta或percreta,她们接受了计划的CD和可用的胎盘MRI。场强/序列:1.5特斯拉,半傅立叶单次涡轮自旋回波序列和真正的快速成像与稳态自由进动序列。评估:由三名放射科医生(分别具有8年、8年和15年经验)独立评估膀胱-子宫区域的以下影像学特征:膀胱-子宫间隙血管增生、膀胱-子宫间隙无化学移位线、膀胱壁中断伴高强度结节、膀胱支索和子宫-胎盘膨出。统计检验:采用单变量分析(卡方检验或Fisher精确检验)和多变量回归分析。结果:33名女性(19.8%)在CD期间出现膀胱损伤。与无膀胱损伤组相比,膀胱损伤组的MRI特征明显更频繁:膀胱-子宫间隙血管增生为69.7%对26.9%,膀胱-子宫间隙无化学移位线为57.6%对21.6%,膀胱壁中断伴高结节性为18.2%对1.5%,膀胱帐篷状为39.4%对14.9%,子宫-胎盘膨出为78.8%对39.6%。膀胱-子宫间隙血管增生、化学移位线缺失和子宫-胎盘膨出与膀胱损伤风险独立相关(优势比分别为4.190、3.555和3.569)。结论:膀胱-子宫间隙血管增生、膀胱-子宫间隙无化学移位线、子宫-胎盘膨出与重度PAS患者CD期膀胱损伤有关。膀胱损伤是重度胎盘增生谱孕妇剖宫产的严重并发症,常导致大出血、膀胱功能障碍和严重感染。准确的产前评估对于减少这些不良后果非常重要。本研究显示,膀胱-子宫间隙血管增生、膀胱-子宫间隙无化学移位线、子宫-胎盘膨出等MRI表现与膀胱损伤独立相关。这些高危MRI征象可作为产前评估膀胱损伤的有效手段。本研究将拓宽MRI在重症胎盘增生谱中的应用。证据等级:3技术功效:第2阶段。
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来源期刊
CiteScore
9.70
自引率
6.80%
发文量
494
审稿时长
2 months
期刊介绍: The Journal of Magnetic Resonance Imaging (JMRI) is an international journal devoted to the timely publication of basic and clinical research, educational and review articles, and other information related to the diagnostic applications of magnetic resonance.
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