化脓性输卵管炎的MRI诊断

MRI Diagnosis of Purulent Salpingitis

目的探讨化脓性输卵管炎脓肿型与肉芽肿型的MRI表现及其诊断价值。方法回顾分析经手术病理证实的42例输卵管炎患者的临床特征及MRI表现,42例中10例为双侧发病,共计52个病灶。结果 52个病灶根据输卵管积脓扩张与实性成分分为两型:(1)输卵管扩张的脓肿型:41个。MRI表现为附件区"管状结构",呈迂曲管状、腊肠状或多房状41个,管壁分层强化3个,管腔内不完全间隔15个,T2WI见液液平面7个,囊液T1WI不均匀稍高信号17个。6例行DWI检查,结果 8个病灶均呈高信号;(2)以实性为主且输卵管扩大较轻的肉芽肿型:11个。MRI表现为附件区软组织肿块11个,细管状影10个,3例行DWI检查均呈高信号、增强后无强化,病灶位于肿块内侧,肿块远侧显示多个小囊状影6个。42例盆腔内均见不同程度炎性渗出、组织增厚及脏器水肿、粘连等征象。结论化脓性输卵管炎MRI诊断可分为脓肿型与肉芽肿型。脓肿型特征性表现为"管状结构"与管腔内脓液信号特点;肉芽肿诊断要点为肿块内弯曲短管状影与病灶远侧包裹卵巢,结合盆腔内炎性渗出、粘连,以及临床症状可提高诊断准确性。

Objective To explore MRI findings and diagnostic value of purulent salpingitis with abscess type and gran- ulomatous type. Methods The clinical features and MRI findings of 52 lesions in 42 patients with salpingitis confirmed by operation and pathology were retrospectively analyzed. Results 52 lesions were divided into two types according to the pyosalpinx expansion and solid components. （ 1 ） Abscess type with fallopian tube expansion in 41, MRI showed adnexal ＂ tubular structure＂, including a tortuous tubular, wax ptygmatic or corymbose with tube wall hierarchical intensity in 3, in- complete luminal septum in 15, fluid - fluid level on T2W scan in 7, heterogeneous slightly hyperintense signal of cystic content on T1W scan in 17. Eight lesions showed hyperintense signal on DWI scan in 6 patients. （2） Granuloma type with slightly fallopian tube expansion in 11. MRI showed adnexal masses, including thin tubule inl0, hyperintense signal with- out enhancement on DWI scan in 3, multiple small cysts in 6. Varying degrees of inflammatory responses in pelvic cavity in 42. Conclusion Purulent salpingitis on MRI scan can be divided into two types： abscess and granuloma. Abscess shows the ＂tubular structure＂ and pus signal in lumen. Granuloma shows the tortuous short tubule in mass and ovarian wrapped by lesions. Diagnostic accuracy can be improved combined with the inflammatory features in pelvic cavity.