巨大子宫肌瘤的多层螺旋CT诊断

Multi-slice Spiral CT Diagnosis of Giant Hysteromyoma

目的探讨巨大子宫肌瘤的多层螺旋CT表现,旨在提高影像认识。方法对26例(均行MPR重建;增强扫描12例)经手术病理证实的巨大子宫肌瘤的CT资料进行回顾性分析。结果 26例患者肿瘤最大径线约9-35cm之间;位于子宫浆膜下(n=8)、子宫阔韧带(n=5)、子宫肌壁间(n=11)和子宫颈肌部(n=2);平扫7例为均质性,与子宫等密度,17例为非均质性,2例为囊实混合性;CT增强扫描11例不均匀明显强化,其内均可见多发细小血管影,1例不均匀轻度强化。合并卵巢肿瘤或囊肿6例,其中1例误诊为浆膜下子宫肌瘤;7例表现不典型;11例病理证实肿瘤内玻璃样变性,6例粘液样变性,2例囊性变性。结论巨大子宫肌瘤的多层螺旋CT表现有一定特点,掌握其影像学特点有助于提高诊断准确率;但对于部分不典型表现的子宫肌瘤的诊断,应注意鉴别。

Objective To explore CT findings of giant uterine leiomyoma and to improve its diagnostic accuracy.Methods 26 patients of pathologically-proved giant uterine leiomyoma who had typical CT signs were selected （all cases had CT MRP reconstruction; 12 cases with enhanced scan）.Results The maximal diameter of giant uterine leiomyoma ranged from 9-35 cm. The lesions located at subserous of uterus （n=8）, the broad ligament （n=5）, the myometrium （n=11）, the uterus cervix （n=2）. 7 cases demonstrated homogeneous density similar to normal uterus tissue on CT scans. 17 cases demonstrated heterogeneous density and the other 2 cases demonstrated cystic-solid mixed. 11 cases demonstrated obviously inhomogeneous enhancement with multiple small vessels observed; only 1 case demonstrated mild inhomogeneous enhancement. 6 cases were complicated by ovarian tumors or cysts, and 1 case was misdiagnosised. 7 cases demonstrated atypical CT findings. Pathology proved hyaline degeneration in 11 cases; 6 cases mucoid degeneration; 2 cases cystic degeneration.Conclusion Giant uterine leiomyoma have some characteristics in CT findings; grasps its images features is helpful for the diagnosis. However, atypical manifestation of giant uterine leiomyoma should be reminded to the differential diagnosis.