妊娠滋养细胞肿瘤的MRI表现

MRI Features of Gestational Trophoblastic Neoplasia

目的:分析妊娠滋养细胞肿瘤的MRI表现,探讨MRI的诊断价值。方法:63例经病理组织学及临床随访证实的滋养细胞肿瘤患者,经盆腔MRI平扫及增强扫描,回顾性分析其影像表现。结果:①63例子宫体均有不同程度增大。②61例病灶表现为子宫肌层及宫腔内肿块(1例侵蚀性葡萄胎突破浆膜层),2例为子宫外肿块,均为绒癌(1例为左侧输卵管肿块,1例为直肠子宫陷凹肿块)。52例肿块内伴有出血,约占82.5%。伴有宫腔内肿块的29例均显示结合带中断。③总共54例妊娠滋养细胞肿瘤在子宫肌层内或宫旁可见流空血管影,占85.7%(54/63),其中包括95.1%(39/41)的侵蚀性葡萄胎和168.2%(15/22)的绒癌,流空血管影的发生在侵蚀性葡萄胎和绒癌中具有显著差异(P<0.01)。④增强扫描表现:肿块呈内部少量结节状或条纹状强化,增强扫描显示肿块范围更加清晰。结论:妊娠滋养细胞肿瘤的MR1表现具有特征性,对于临床定性、定位诊断均有较高参考价值。

Purpose： To analyze the MR appearancs of gestational trophoblastic neoplasia （GTN） and to investigate the diagnostic value of MRI. Methods： The images of 63 cases of gestational trophoblastic neoplasia confirmed by histopathology and clinical follow-up results were retrospectively analyzed. The images included conventional images and contrast-enhanced images. Results： （1） Uterine was enlarged to different extent in 63 cases. （2） Sixty-one cases showed with intrauterine and myometrium mass （1 case of invasive mole broke through serosal layer）, 2 cases of choriocarcinoma showed with extrauterine mass （1 mass located in left fallopian tube and 1 mass in rectouterine pouch）. Fifty-two cases showed with intratumoral hemorrhage, accounting for 82.5% of total cases. The junctional zone was disrupted in 29 cases with intrauterine mass. （3） Flow void signals of myometrial and para-uterine vessels were detected in 54 cases of 63 gestational trophoblastic tumors （85.7%）, including 39 cases of invasive mole（95.1%） and 15 cases of choriocarcinoma（68.2%）. The incidence of vascular flow void signal showed with significant difference between invasive mole and choriocarcinoma （P 〈0.01）. （4） The enhancement pattern of the mass was like nodosity or striature, the enhanced scan showed the range of mass more clearly. Conclusion： MRI findings of gestational trophoblastic neoplasia are characteristic and have a higher reference value in clinical qualitation and localization diagnosis.