多排CT下腔静脉成像对子宫静脉内平滑肌瘤病的诊断意义

Intravenous leiomyomatosis: clinical findings and detailed multi-detector CT features

目的：由于子宫静脉内平滑肌瘤病（IVL）属于少见病例,其CT影像学表现有一定的特征性,回顾性分析IVL的多排CT特征及其临床表现,评价其对手术治疗的指导意义。方法：回顾性总结分析2005年至2013年间,通过外科手术及病理证实的9例IVL的患者的临床资料,多排CT特征以及病理结果。多排CT扫描参数：管电压100~120 k V,管电流400~450 m As,层厚0.5~0.75 mm,间隔0.25~0.60 mm。监测层面放在下腔静脉右心房入口区域,手动触发开始扫描。结果：9例患者中,4例患者为子宫切除术后,1例为多发子宫肌瘤并伴子宫腺肌病。多排CT均显示蛇形的下腔静脉内充盈缺损延伸入右心房,其中1例病变延伸入右心室、肺动脉。8例病例侵犯单侧宫旁血管,1例病例侵犯双侧子宫血管,6例肿瘤沿着子宫静脉、髂静脉生长,3例病例显示病变同时波及卵巢静脉和髂静脉,9例病变均波及下腔静脉和右心房,其中1例肺动脉受累。1例患者发生肺内多发转移。结论：IVL的多排CT表现有一定特征性,9例患者均显示下腔静脉内充盈缺损延伸入右心房,CTV检查清晰地显示了IVL向子宫外生长的途径,有助于手术方案的制定。

Objective：Intravenous leiomyomatosis is a rare, benign, smooth muscle tumor originating in the uterus that may extend through the inferior vena cava into the right-sided heart. The purposes of this study were to characterize the MDCT features of IVL and to correlate the clinical findings and therapic importance. Methods： Between 2005 and 2013, 9 female patients with suspected IVL underwent cardiac surgery and histologic confirmation of the tumor. The clinical data, MDCT findings, and histologic results were retrospectively reviewed. MDCT scanning parameters： tube voltage 100 -120kV, tube current 400 -450mAs, slice thickness 0. 5 -0. 75mm, slice interval 0. 25 -0. 60mm. The trigger was placed at the entrance of inferior vena cava to the right atrium and started manually. Results： Among nine patients, Four patients （44. 4% ） had undergone myomectomy or hysterectomy, one patient had multiple uterine myoma and adenomyosis. MDCT findings ineluded six patients with homogenous masses extending from uterus veins to iliac veins, inferior vena cava to right atrium, one extended to pulmonary artery, three patients involved both ovarian vein and iliae vein, all nine patients involved inferior vena eava and right atrium. No masses appeared to adhere to the right atrium, right ventricular or pulmonary arterial walls, or tricuspid valve. One had multiple metastasis to both lungs. Conclusion ： There are characteristic features of the IVL tumors in the MDCT findings. Snake like filling defect extending from the inferior vena cava to the right atrium were seen in all patients. CTV examination showed dis tinct growth pathways and involved areas of IVL, which is of importance to the operation scheme.