不典型子宫肌瘤的CT与超声表现

Atypical CT and Ultrasonographic Manifestations of Uterine myoma

目的 总结 13例不典型子宫肌瘤的CT与超声表现 ,以期提高其诊断与鉴别诊断的准确性。资料与方法 选择经超声、CT检查 (增强扫描 10例 ,平扫 3例 )表现不典型 ,由手术、病理诊断的子宫平滑肌肿瘤 13例 ,回顾分析其影像学与手术、病理表现。病变包括良性子宫平滑肌瘤 11例 ,恶性 2例。发病部位包括阔韧带 5例、浆膜下3例、子宫颈 1例、肌壁间和术后复发各 2例。结果 CT扫描显示肿瘤边界清楚 ,肿物向上可延伸至髂嵴水平以上 ,向后下生长位于骶前。CT增强扫描肿瘤密度明显高于或接近腰肌者 7例 ,病理显示肿瘤内均无显著变性 ;CT扫描肿瘤密度不均匀 ,超声显示肿瘤囊实性者 6例 ,病理证实肿瘤内粘液样变性 4例 ,液化坏死囊性变 2例。结论子宫平滑肌瘤的不典型影像表现主要由于肿瘤起源特殊 (子宫颈、阔韧带 )、肿瘤巨大以及变性所致 ,CT扫描可表现为边界清楚的巨大盆腹腔或腹膜后肿物 ;当肿瘤有变性时 ,肿瘤可呈不均匀强化或很少强化 ,二维超声可表现为不均匀回声甚至囊实性肿物。

Objective To summarize atypical CT and Ultrasonography (US) findings of uterine myoma in 13 cases, to improve its diagnostic accuracy.Materials and Methods Thirteen patients of pathologically proved uterine myoma who had atypical CT and US signs were selected. The lesions included 11 benign leiomyomas and 2 malignant leiomyomas, which located at the broad ligament (n=5), subserous site (n=3), cervix (n=1), intramural site (n=2), or in the pelvic cavity (n=2, postoperative recurrence). Imaging features, surgical findings and pathological results were retrospectively analyzed.Results All lesions appeared as huge, well defined masses, which extended upward above iliac crest level or posteriorly into the presacral space. The density of the lesion was higher than, or close to, that of lumbar muscles on enhanced CT scans (n=7), pathological examination showed no notable degeneration in these lesions. In the other 6 cases, the mass demonstrated heterogeneous density on CT scans, while solid cystic mixed mass on US. Pathologically, marked mucoid degeneration was found in 4, and liquefaction with necrosis in 2 cases.Conclusion The atypical imaging manifestations of the uterine leiomyoma are mainly due to the uncommon location of the lesion (cervix and broad ligament), huge size or degeneration within the tumor. On CT scan, the lesion appears as a well defined huge mass, which can be mildly or heterogeneously enhanced. On US, the tumor displays a heterogeneous or solid cystic mixed echoic texture.