CT在子宫内膜癌诊断中的作用

The Role of CT in the Diagnosis of Endometrial Carcinoma

目的 评价CT对子宫内膜癌各期的诊断价值 ,讨论子宫CT扫描的技术问题。材料与方法 8例子宫内膜癌均经手术和病理证实 ,且手术前 1周内行CT扫描 ,其中 4例加作增强扫描。它们的临床分期是Ⅰa期 2例 ,Ⅰb期 3例 ,Ⅲ期 1例 ,Ⅳ期 2例。CT测量子宫内膜增厚标准 :生育期妇女子宫内膜厚度 >10mm ,绝经后 >5mm ;子宫体增大标准 :前后径 >5 0mm。结果 Ⅰa期 2例CT全部诊断正确 (2 /2 ) ;Ⅰb期 3例中 ,1例CT诊断正确 (1/3 ) ,1例因子宫内膜厚度和子宫体前后径均正常 ,和 1例因诊断时没有考虑子宫内膜增厚的指标 ,CT均诊断为未见异常 (2 /3 ) ;Ⅲ期 1例CT诊断正确 (1/1) ;Ⅳ期 2例中 ,1例CT诊断正确 (1/2 ) ,另 1例因没有充分认识子宫内膜增厚的意义 ,CT误诊为附件结核、大量腹水。结论 CT可以对子宫内膜癌作出比较理想的评价 ,保持膀胱的过度充盈 ,保证子宫处于直立位置 ,以及子宫增强CT扫描均有助于提高CT对子宫内膜癌诊断的确定性。

Objective To evaluate CT in the diagnosis of endometrial carcinoma with different stages, and to discuss the scanning technique of uterus. Materials and Methods CT scanning was performed in 8 patients with surgically and pathologically proved endometrial carcinoma one week before the surgery. Four cases underwent enhanced CT scan in addition. Of 8 cases, 2 were in stage Ⅰa, 3 in stage Ⅰb, 1 in stage Ⅲ and 2 in stage IV. CT findings were compared with the surgical and pathological results for each case. The endometrium was judged as thickened when its thickness was >10mm in women in child bearing period, and >5mm in post menopause women. The uterus was considered enlarged if the uterine anteroposterior diameter was >5cm.Results Both cases in Ia stage were diagnosed correctly with CT. Of 3 cases in Ⅰb, correct diagnosis was made in 2, while missed diagnosis in 1 case, as in whom both the uterine thickness and anteroposterior diameter were within the normal limits. Correct diagnosis was also made in the only case of stage Ⅲ and 1 case of stage IV, while the other case in stage Ⅳ was misdiagnosed as adnexal tuberculosis due to author's ignoring of the significance of endometrial thickening. Conclusion CT can accurately evaluate endometrial carcinoma. Excessive filling of the bladder, upright position of the uterus and enhanced CT scanning are helpful for improving CT diagnosis of endometrial carcinoma.