Multi-sequence Study Of Uterus And Scar Magnetic Resonance After Cesarean Section

Purpose:cesaneam ce(?)The purpose of the study is to evaluate cesarean scars and uterus in women with prior cesarean section,by 3D T2-weighted MRI and transvaginal ultrasonography(TVUS).Additionally,to analysis and compare the three diameters of cesarean scars and uterus on the images obtained from the two methods.Explore the correlation between the measured values of the anatomical structures and the clinical factors.Evaluate the function values of cesarean scars and uterus on resolve diffusion tensor imaging(DTI).The existence,direction,and frequency of uterine peristalsis were observed by the uterine CINE sequence.The correlation and difference between scar and uterine shapes,FA,ADC values of scars and uterus and uterine peristalsis of two years after operation and one year results were compared.Methods:This study was performed from 2015 to 2017 in a university hospital.The inclusion criteria were:20-45 years old woman,one year ± one month after prior cesarean section.46 volunteers(age range 26-43 years;mean±SD,33.5±3.5years)completed pelvic 3.0T MR scan(3.0T Skyra scanners,Siemens,German)and TVUS examination in the ovulatory period 1 year after p-CS and 15 among them completed pelvic 3.0T MR scan again 2 years after p-CS.3.0T MRI sequences include T2WI,T2-3D SPACE,resolve DTI,and CINE sequence.The height,thickness of the scar,thickness of the normal wall of the uterine anterior wall and the length,anteroposterior diameters of the uterus were measured in the sagittal plane of the uterus,the scar width was measured in the axial plane of uterus,uterine left and right diameter was measured in coronal plane of the uterus.The scar and uterus structures were outlined on the b0 images of the DTI tensor sequence,and the FA,ADC values were synchronization generated on the FA,ADC maps.Variables are in line with the normal distribution,statistical methods included variance analysis,paired sample T test,independent sample T test and Pearson correlation analysis.Results:The thickness of the scar and Uterine anterior myometrium thickness measured by T2-3D SPACE MRI was less than the TVUS measurement results(P<0.05),Scar height,width,and the three diameters of uterus measured by T2-3D SPACE MRI were greater than TVUS measurements(P<0.05).It was found that the scar thickness and relative thickness were smaller in the single cesarean group than the double cesareans group.The MRI indicate scar thickness of the volunteers whose menstruation come to regular is larger than those without menstruation in one year(P<0.05).The relative scar thickness of volunteers in emergency caesarean section is less than selective operation(P<0.05).The uterine three diameters were larger in those whose menstruation had come to regular than those without menstruation.The scar FA value was significantly larger than The FA values of uterine anterior and posterior junctional zone and myometrium,junctional zone and anterior myometrium(P<0.05).The scar ADC value was significantly smaller than The ADC values of other structures.The ADC values of uterine posterior myometrium were lager in the single cesarean group than the double cesareans group(P<0.05).The ADC values of uterine anterior junctional zone were smaller in volunteers who had stopped lactation than those in lactation period(P<0.05).The FA values of uterine posterior junctional zone were smaller in those whose menstruation comes to regular than those without menstruation(P<0.05).The uterine peristalsis was evaluated by the CINE sequence.83.7%volunteers were found to have uterine peristalsis,which were mainly from cervix to fundus at the frequency of 6.6±2.5 times/3min.15 volunteers re-obtained the MR scan in two years after cesarean sections.The three diameters of the scar and relative thickness of the scar were of no significant difference to those of one year.The thickness of uterine anterior myometrium and the length of uterus in two years were significantly larger than that of one year(P<0.05).The scars were thicker in volunteers who had anteposition of uterus than those who had retroposition of uterus in two year results(P<0.05).The FA values of uterine posterior junctional zone measured in two years were significantly larger than one year(P<0.05).FA and ADC values of scars and other uterine structures had no significant difference between two year and one year results.The occurrence rate and direction of uterine peristalsis had changed in two years compared with one year.The frequency of uterine peristalsis in two years was less than one year.Conclusion:There were some difference in evaluation the scar and uterine shape by T2-3D SPACE MRI and TVUS.Times of cesarean sections,whether the volunteers experienced an emergency operation and uterine positions had influences on the scar thickness.Size of uterus was correlated with the menstrual status.The size of scars had no significant difference between two year and one year measurements.FA and ADC values showed significant difference between scars and other remote uterine structures,and showed no apparent difference between two year and one year results.Compared with one year peristalsis,the frequency became less in two year.