深部浸润型子宫内膜异位症的MRI诊断

Clinical value of 3T MRI in detecting deeply infiltrating endometriosis

目的探讨深部浸润型子宫内膜异位症的MR表现。方法回顾性分析33例病理证实为深部浸润型子宫内膜异位症的临床表现及MR特点。分别统计MRI征象中累及直肠、子宫骶韧带及阴道作为诊断深部浸润型子宫内膜异位症的准确率、敏感性、特异性及阳性预测值、阴性预测值。结果病变累及的部位包括直肠(25例)、子宫骶韧带(19例)、阴道(11例)、阴道直肠隔(1例)、膀胱底(3例)、输卵管(2例)、输尿管(2例)、子宫圆韧带(1例)、子宫颈异位囊肿(3例)。MRI诊断直肠、子宫骶韧带及阴道累及的准确率分别为93.9%、63.6%、84.8%;敏感度分别为100%、57.9%、54.5%;特异度分别为75%、71.4%、100%;阳性预测值分别为92.6%、73.3%、100%;阴性预测值分别为100%、55.6%、81.5%。直肠受累对于诊断DIE的敏感性、阴性预测值很高,准确率、阳性预测值达90%以上,仔细观察肠壁有无增厚,对于提高特异性及降低误诊率有帮助。较典型的MR征像包括直肠壁局部增厚、子宫骶韧带增粗、阴道后穹窿异常信号及向后上提,子宫直肠凹变浅,封闭并邻近结构紊乱、纠集,子宫膀胱凹腹膜增厚,输卵管增粗,扩张、积血。结论深部浸润型子宫内膜异位症MRI表现较有特异性,MRI不但可以诊断子宫内膜异位症,还可以显示病变范围,对于指导临床制定治疗方案很有价值。

Objective To evaluate MRI features of deeply infiltrating endometriosis （DIE） at 3T. Methods Thirty- three patients pathologically confirmed deep infiltrating endometrial endometriosis were retrospectively analyzed. All patients underwent MRI examination （Magnetom Trio Tim 3.0T, Siemens） and MR characteristics were carefully evaluated, especially involving rectum, uterosacral ligaments and vaginal area. The accuracy, sensitivity, specificity, the positive and negative predictive value of the three involved anatomical structure on MRI images predicting DIE were calculated. Results The involving anatomical site was as follows： rectum （25 cases）, the sacral ligament of uterus （19 cases）, vagina （I 1 cases）, vaginal-rectal septum （ 1 case）, bladder bottom （3 cases）, fallopian tubes （2 cases）, ureter （2 cases）, uterine round ligament （ 1 case） and cervical cysts （3 cases）. The MRI diagnosis accuracy of rectum, uterosacral ligaments and vaginal area involvement was 93.9%, 63.6%, 84.8% ; the sensitivity was 100%, 57.9%, 54.5% ; the specificity was 75%, 71.4%, 100%; the positive predictive value was 92.6%, 73.3%, 100%; the negative predictive value was 100%, 55.6%, 81.5%, respectively. Typical MRI signs included local thickening of rectal wall and uterosacral ligaments, abnormal signal of vaginal fornix, flattened uterine rectal sag, peritoneal thickening in uterine bladder region, as well as fallopian tubes dilatation. Conclusion The MRI findings of DIE are more specific. MRI is valuable in detecting lesions, showing the range of lesions, and providing more information for guiding clinical treatment plan.