子宫腺瘤样瘤与子宫肌瘤MRI表现比较

The Comparative Analysis of MRI between Uterine Adenomatoid Tumor and Uterine Fibroids

目的比较子宫腺瘤样瘤（AT）和子宫肌瘤的MRI征象的异同,以提高对两者的鉴别诊断水平。方法回顾性分析经手术病理证实的28例（共30个病灶）子宫AT和78例（共166个病灶）子宫肌瘤患者的好发年龄和MRI表现,对比分析两者的T2WI、高信号分隔征、假包膜情况、T1WI增强的均匀度和强化比值的差异,并采用统计学方法检验。结果子宫AT和子宫肌瘤好发年龄均为中年妇女,部位以肌壁多见,平均直径约3.7～3.9 cm。子宫AT呈囊性病变伴实性结节或实性肿块,实性肿块T1WI呈等信号,19例（67.9%）T2WI呈均匀低信号,18例（64.3%）均匀强化,21例（75%）强化程度低于宫肌,仅2例（7.1%）出现假包膜。子宫肌瘤呈实性肿块,T1WI呈等信号,T2WI呈均匀或不均匀低信号;72个（43.4%）病灶内见斑片高信号、高信号分隔征,呈均匀或不均匀强化且强化程度多（81.9%,136/166）等于或高于宫肌,85个（51.2%）病灶可见假包膜。结论子宫AT的MRI表现与子宫肌瘤相似,T2WI高信号分隔征、强化程度等高于宫肌及出现假包膜或许是子宫肌瘤区分AT的特征表现,单发囊实性结节或实性结节T2WI呈均匀低信号、均匀强化且强化程度低于宫肌时需考虑到AT可能,最后确诊依靠病理检查。

Objective To investigate the MRI features of uterine adenomatoid tumor（ AT） and uterine fibroids to raise awareness and identification of them. Methods MRI findings in 28 cases of uterine ATs and 78 cases of uterine fibroids pathologically confirmed were retrospectively analyzed and compared. Results Patient age of uterine AT s and uterine fibroids were middle age,location of which was mainly in uterine body wall and the average diameter was about 3. 7 ～ 3. 9.The former could be showed as a cystic lesion with solid nodules or solid masses which showed isointensity on T1 WI,nearly homogeneous hypointensity on T2WI（ 19 /28,67. 9%） with well-defined margin but few pseudocapsule（ 2 /28,7. 1%）,nearly homogeneous moderate enhancement（ 18 /28,64. 3%） and the enhancement degree was lower than that of myometrium（ 21 /28,75%）. The latter appeared as solid mass,which showed isointensity on T1 WI,homogeneous or heterogeneous hypointensity with patch hyperintensity,sign of hyperintensity septum and pseudocapsule（ 72 /166,43. 4%）,homogeneous or heterogeneous enhancement and the enhancement degree was equal or higher than that of myometrium（ 136 /166,81.9%） with pseudocapsule（ 85 /166,51. 2%）. Conclusion The appearances of MRI between uterine ATs and uterine fibroids were similar. Sign of hyperintensity septum,pseudocapsule and the enhancement degree equal or higher than that of myometrium might be the features of uterine fibroids different from ATs. We should pay more attention to the possibility of AT for a small solid mass with well- defined margin,homogeneously hypointensity on T2 WI,lower homogeneously enhancement or cystic lesion with irregular solid nodule. Confirmation diagnosis should be based on pathological analysis.