磁共振成像与经阴道超声在II型剖宫产瘢痕妊娠诊断及个体化治疗中的价值分析

Value Analysis of Magnetic Resonance Imaging and Transvaginal Ultrasound in the Diagnosis and Individualized Treatment of Type II Cesarean Scar Pregnancy

摘要: 目的：探讨相较于经阴道超声(TVS)，磁共振成像(MRI)在II型剖宫产瘢痕妊娠(CSP)精准评估、个体化治疗决策、手术路径规划及高危因素识别中的信息增量价值。方法：回顾性分析2021年1月~2024年12月收治的387例II型CSP患者临床资料，按术前影像学方式分为TVS组(A组，281例)与MRI组(B组，106例)。以术后病理为金标准，比较诊断效能；重点分析MRI在孕囊植入深度、残余肌层厚度(RMT)、膀胱受累及血供风险评估中的补充价值，及其对术式选择的指导作用。结果：MRI诊断灵敏度94.34%、特异度83.33%、AUC = 0.888，均高于TVS (84.70%、74.42%、0.796)，差异有统计学意义(P < 0.05)。MRI可清晰显示肌层连续性、绒毛侵袭深度及与膀胱解剖关系，提供关键增量信息。基于MRI评估的病例术中出血量更少、手术时间更短、急症中转率及并发症率更低、手术成功率更高。两组基线在停经天数、RMT存在不均衡(P < 0.05)，结局改善可能与MRI精准评估相关。结论：相较于TVS，MRI可为II型CSP提供重要增量诊断信息，在精准分型、高危因素识别、手术规划中具有重要价值，可能降低手术风险、改善围手术期结局。推荐MRI作为II型CSP术前重要补充评估手段，尤其适用于TVS诊断存疑、肌层菲薄、血供丰富或有再生育需求的病例。

Abstract: Objective: To investigate the incremental value of magnetic resonance imaging (MRI) versus transvaginal ultrasound (TVS) in the precise evaluation, individualized treatment decision‑making, surgical pathway planning, and identification of high‑risk factors in type II cesarean scar pregnancy (CSP). Methods: Clinical data of 387 patients with type II CSP treated from January 2021 to December 2024 were retrospectively analyzed. The patients were divided into the TVS group (group A, n = 281) and the MRI group (group B, n = 106) according to preoperative imaging modalities. Taking postoperative pathology as the gold standard, the diagnostic efficacy was compared. The supplementary value of MRI in evaluating gestational sac implantation depth, residual myometrial thickness (RMT), bladder involvement, and vascularity risk, as well as its guiding role in surgical selection, were emphatically analyzed. Results: MRI showed a diagnostic sensitivity of 94.34%, specificity of 83.33%, and an AUC of 0.888, all significantly higher than those of TVS (84.70%, 74.42%, 0.796; P < 0.05). MRI clearly demonstrated myometrial continuity, depth of villus invasion, and anatomical relationship with the bladder, providing key incremental information. Cases evaluated by MRI had less intraoperative blood loss, shorter operation time, lower emergency conversion rate and complication rate, and higher surgical success rate. Baseline imbalances were observed in days of amenorrhea and RMT between the two groups (P < 0.05), and the improved outcomes may be associated with precise MRI evaluation. Conclusion: Compared with TVS, MRI provides important incremental diagnostic information for type II CSP and is of great value in accurate classification, high‑risk factor identification, and surgical planning. It may reduce surgical risks and improve perioperative outcomes. MRI is recommended as an important supplementary preoperative evaluation modality for type II CSP, especially for cases with inconclusive TVS findings, thin myometrium, abundant blood supply, or fertility requirements.