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磁共振对子宫阔韧带平滑肌瘤的诊断价值
发布时间:2020-01-06

  摘    要: 目的:分析子宫阔韧带平滑肌瘤的磁共振信号特点。方法:对我院经手术及病理证实的15例子宫阔韧带平滑肌瘤的磁共振信号特点进行回顾性分析。结果:肿瘤位于双侧的有1例,左侧6例,右侧7例,上方1例;大部分病变与周围组织分界清;MRI信号主要表现为T1WI等低信号,T2WI混杂低信号或混杂高信号,DWI低或稍高信号,脂肪抑制序列均未见明确脂肪成分,增强扫描实性部分可见强化。结论:子宫阔韧带平滑肌瘤的MRI表现具有一定的特征性,能够在术前为临床提供定位及定性诊断,但最终确诊仍需依赖手术病理。

  关键词: 磁共振成像; 子宫阔韧带; 平滑肌瘤;

  Abstract: Objective: Analysis of magnetic resonance signal characteristics of uterine broad ligament leiomyoma. Methods: The characteristics of magnetic resonance signals in 15 cases of uterine broad ligament leiomyoma confirmed by surgery and pathology were analyzed retrospectively. Results:There were 1 case on the bilateral side, 6 cases on the left, 7 cases on the right and 1 case on the top;most lesions are demarcated from the surrounding tissues; MRI signals are mainly characterized by low signals such as T1 WI, T2 WI mixed low signals or mixed high signals, DWI low or slightly high signals,fat inhibition sequences were not clear fat components, and enhanced scanning reality was partially enhanced. Conclusion: MRI findings of uterine broad ligament leiomyoma have certain characteristics and can provide clinical positioning and qualitative diagnosis before surgery, but the final diagnosis still depends on surgical pathology.

  Keyword: MRI; Uterine Broad Ligament; Leiomyoma;

  KUORENDAIPINGHUAJILIUSHIFUKELINCHUANGSHAOJIANZHONGLIU,FABINGLVYUEZHANFUKEZHONGLIUDE1‰-3‰[1]。QILINCHUANGJIYINGXIANGBIAOXIANQUEFATEZHENGXING,SHUQIANZHENDUANJIAOWEIKUNNAN。BENYANJIUGONGSHOUJI15LIJINGSHOUSHUJIBINGLIZHENGSHIDEZIGONGKUORENDAIPINGHUAJILIUHUANZHEDELINCHUANGHEYINGXIANGZILIAO,FENXIQICIGONGZHENXINHAOTEDIAN,TANTAOCIGONGZHENDUIZIGONGKUORENDAIPINGHUAJILIUDEZHENDUANJIAZHI,TIGAOGAIBINGDESHUQIANZHENDUANSHUIPING。

  1、 材料与方法

  1.1、 一般资料

  SHOUJIWOYUANZI2013NIAN9YUEZHI2019NIAN3YUEJIANJINGSHOUSHUJIBINGLIZHENGSHIDEZIGONGKUORENDAIPINGHUAJILIUGONG15LI,NIANLING39SUI-66SUI,PINGJUNNIANLING52.1SUI,LINCHUANGZHENGZHUANGYIFAXIANFUBUZHONGKUAIWEIZHU,BUFENHUANZHECHUXIANXIAFUTONG、XIAFUBUZHUIZHANGGANJIYAOTONG。

  1.2、 检查方法

  采用荷兰飞利浦公司生产的Ingenia3.0T磁共振仪,体部相控阵线圈。平扫主要序列参数包括横轴位:T1WI:TR=4ms,TE=2ms,层厚5mm,层间距-2.5mm;横轴位T2WI加脂肪抑制:TR=2800ms,TE=100ms,层厚6mm,层间距1mm;冠状位T2WI加脂肪抑制:TR=3300ms,TE=80ms,层厚5mm,层间距1mm;矢状位T2WI:TR=4800ms,TE=92ms,层厚6mm,层间距1mm;横轴位扩散加权成像(DWI):b=800,TR=6000ms,TE=61ms,层厚6mm,层间距1mm。增强扫描采用高压注射器经肘正中静脉注入对比剂钆喷酸葡胺,流速2.0ml/s,总量0.2mmol/kg,随后注入生理盐水20ml,注射对比剂2-3分钟开始扫描T1WI压脂的横轴位、冠状位及矢状位。
 

磁共振对子宫阔韧带平滑肌瘤的诊断价值
 

  1.3、 图像分析

  SUOYOUDEYINGXIANGZILIAOJUNYOULIANGMINGGAONIANZIFANGSHEZHUZHIYISHIFENBIEYUEPIAN,ZHUYAOGUANCHANEIRONGBAOKUOZHONGLIUDEBUWEI、NEIBUXINHAOTEDIAN、YUZHOUWEIZUZHIDEPILINGUANXIYIJISHIXINGCHENGFENSHIFOUYOUZENGQIANG,FASHENGFENQISHILIANGRENXIESHANGJIEJUE。

  2、 结果

  2.1 、部位及与周围组织的毗邻关系

  ZHONGLIUWEIYUSHUANGCEDEZHAN6.7%(1/15),ZUOCEZHAN40%(6/15),YOUCEZHAN46.7%(7/15),SHANGFANGZHAN6.7%(1/15);YUZHOUWEIZUZHIFENJIEQINGDEZHAN73.3%(11/15),YUZHOUWEIZUZHIFENJIEBUQINGDEZHAN26.7%(4/15)。

  2.2、 内部信号特征

  T1WIDENGDIXINHAODEZHAN93.3%(14/15),T1WIHUNZADIXINHAODEZHAN6.7%(1/15);T2WIHUNZADIXINHAODEZHAN60%(9/15),T2WIJUNYUNDIXINHAODEZHAN6.7%(1/15),HUNZAGAOXINHAODEZHAN26.7%(4/15);DWIDIXINHAODEZHAN60%(915),DWISHAOGAOXINHAODEZHAN40%(6/15),ZHIFANGYIZHIXULIEJUNWEIJIANMINGQUEZHIFANGCHENGFEN。

  2.3、 强化特点

  SHIXINGBUFENKEJIANQIANGHUADEZHAN93.3%(14/15),WEIJIANQIANGHUADEZHAN6.7%(1/15)。

  3、 结论

  ZIGONGKUORENDAIPINGHUAJILIUDEMRIBIAOXIANJUYOUYIDINGDETEZHENGXING,NENGGOUZAISHUQIANWEILINCHUANGTIGONGDINGWEIJIDINGXINGZHENDUAN。

  4 、讨论

  ZIGONGJILIUSHINVXINGSHENGZHIXITONGZHONGYIZHONGCHANGJIANDELIANGXINGZHONGLIU,YOUCHENGWEIXIANWEIJILIU、ZIGONGXIANWEILIU。GENJUSHENGZHANGWEIZHIDEBUTONG,YOUKEYIHUAFENWEIJIANGMOXIAJILIU、JIBIJIANJILIU、ZHANMOXIAJILIU、GONGJINGJILIU、KUORENDAIJILIUDENG。BUTONGBUWEIDEZIGONGJILIUKEYINQIBUTONGDELINCHUANGBIAOXIAN,ZHUYAOBIAOXIANWEIYUEJINGGUODUO、XIAFUBUBAOKUAIHUOPAINIAO、PAIBIANKUNNANDENG[2]。

赢发彩票代理   KUORENDAISHIZIGONGLIANGCEYIZHUANGDEFUMOZHE,ZUOYOUGEYI,BAGUPENFENWEIQIANHOULIANGGEJIANGE。KUORENDAISHIGONGPANGPINGHUAJILIUZUIHAOFADEWEIZHI。YIWANGCHANGWEISHIJIANHUOSHOUSHUSHIOURANFAXIAN,JINNIANLAISUIZHECHAOSHENGDENGYINGXIANGJIANCHADEJINBU,WENXIANBAODAOZENGDUO。ZHONGLIUDUOFASHENGYUYICEKUORENDAI,YIKEFASHENGYUSHUANGCE,ZHIDIZHONGDENGHUOPIANYING,BAOMODUOJIAOWANZHENG。DAYUEYIBANDEKUORENDAIPINGHUAJIZHONGLIUKEFASHENGBIANXING、YEHUA、HUAISIHUONANGBIAN。ZHONGLIUJIAOXIAOSHI,DUOWUMINGXIANZHENGZHUANG,YINCILINCHUANGYIBANFAXIANJIAOWAN。

  CHAOSHENGSHIFUKEJIBINGDESHOUXUANJIANCHAFANGFA,DIANXINGDEKUORENDAIPINGHUAJILIUBIAOXIANWEIGONGTIPANGDIHUISHENGZHONGKUAI,BIANJIEQINGCHU,NEIBUHUISHENGSHANGJUNYUNHUOZHEBUJUNYUN[3]。CTPINGSAOZHONGLIUYUZHENGCHANGZIGONGJICENGMIDUYIZHI,ZENGQIANGSAOMIAOYUZIGONGJICENGTONGBUQIANGHUA,YINCICTDUIZHONGLIUDEZHENDUANYUJIANBIEZHENDUANYEYOUYIDINGDEJUXIANXING[4,5]。YOUYUMRIDERUANZUZHIFENBIANLVJIAOGAO,KEYIQINGCHUDEFENBIANZIGONGDENEIMO、JIEHEDAI、JICENG,BINGQIEKEXINGDUOZHOUWEI、DUOCANSHUCHENGXIANG,ZENGQIANGSAOMIAOGUANCHAZHONGLIUXUEGONGTEDIAN,YINCIMRIGENGYOULIYUPANDUANZHONGLIUDEWEIZHIYUXINGZHI。

  DIANXINGKUORENDAIPINGHUAJILIUDEMRBIAOXIANWEIZHONGKUAIZAIT1WICHENGDENGDIXINHAO,YUZIGONGJICENGXIANGSI,T2WIBIAOXIANWEIDENGXINHAOHUOSHAODIXINHAO,DWICHENGDENGHUOSHAOGAOXINHAO,ZHUSHEGAPENSUANPUJIAANZHUSHEYE(Gd-DTPA)HOUZHONGKUAINEISHIXINGCHENGFENMINGXIANQIANGHUA,BINGBIANYUZHOUWEIZUZHIFENJIEQING[6]。BENZUYANJIUZHONG14LIBIAOXIANT1WIDENGDIXINHAO,9LIBIAOXIANWEIT2WIHUNZADIXINHAO,5LIBIAOXIANWEIT2WIHUNZAGAOXINHAO,ZHIFANGYIZHIXULIEJIAOZIGONGJICENGXINHAOGAO,WEIJIANZHIFANGCHENGFEN,14LIZENGQIANGSAOMIAOSHIXINGBUFENKEJIANQIANGHUA,QIANGHUACHENGDUMINGXIANDIYUZIGONGJICENG,YUWENXIANBAODAOJIBENXIANGFU。

  图1 63岁女性患者图例
图1 63岁女性患者图例

赢发彩票代理   ZHU:aWEIHENGZHOUWEIT1WIXULIE,BINGBIANCHENGDENGXINHAO;bWEIHENGZHOUWEIT2WIXULIE,BINGBIANCHENGHUNZADIXINHAO;cWEIDWIXULIE,BINGBIANCHENGSHAOGAOXINHAO;dHENGZHOUWEIT2YAZHIXULIE,BINGBIANCHENGHUNZAXINHAO;eWEIHENGZHOUWEIZENGQIANGXULIE;fWEIGUANZHUANGWEIZENGQIANGXULIE,BINGBIANYUZHOUWEIZUZHIFENJIEQING,KEJIANQIANGHUA,DIYULINJINZIGONGJICENGQIANGHUACHENGDU。

  参考文献

  [1]陈忠年,杜心谷,刘伯宁.妇产科病理学[M].上海:上海医科大学出版社,1996.
  [2]苏应宽,刘新民.妇产科手术学[M].北京:人民卫生出版社,1992.
  [3]黄安茜.子宫阔韧带肌瘤超声诊断体会[J].浙江中西医结合杂志,2005(8):508.
  [4]水巍,卢晓玲,王培军.阔韧带平滑肌瘤的CT与MRI诊断[J].中华临床医师杂志(电子版).2012(7):255-259.
  [5]高胜,罗松源,蒙柳东.子宫阔韧带平滑肌瘤的CT表现[J].中国中西医结合影像学杂志,2014,12(2):179-180.
赢发彩票代理   [6]李云,李彩,赵沅杰.子宫阔韧带平滑肌瘤MRI诊断价值[J].泰山医学院学报,2016,37(10):1116-1118.

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