直结肠子宫内膜异位症的MRI诊断

MRI diagnosis of rectosigmoid endometriosis

目的探讨直结肠子宫内膜异位症的MR表现。方法对53例手术病理证实的直结肠子宫内膜异位症进行回顾性分析,评估内容包括MRI征象、临床表现及手术病理所见,并统计MRI诊断直结肠子宫内膜异位症的准确性、敏感性、特异性及阳性预测值、阴性预测值。结果全部病例中直结肠壁局部增厚47例,在T1WI上为等信号,在T2WI为低信号,增强扫描轻度强化。直肠子宫陷凹变浅或消失,其内可见异常信号影,包括22例可见斑块,18例结节,13例索条影。子宫后倾后屈35例,直结肠成角前移20例,阴道后穹窿向后上牵拉15例。MRI诊断直结肠子宫内膜异位症的准确性、敏感性、特异性及阳性预测值、阴性预测值分别为93.65%、96.23%、80.00%、96.23%、80.00%。结论直结肠子宫内膜异位症MRI表现较有特异性,MRI具有良好的诊断价值。

Objective To investigate the MRI features of endometriosis involving the rectum and sigmoid colon. Methods MRI of 53 pathologically proved deep pelvic endometriosis involving the rectum and sigmoid colon was analyzed respectively and correlated with clinical, operative and pathological findings. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MRI were calculated. Results Focal thickening of the rectosigmoid wall was seen in 47 patients with T1 isointensity,T2hypointensity and slight contrast enhancement. The pouch of Douglas was narrowed or obliterated by plaquelike（22）, nodular（18） or stripe-like（13） abnormal signal intensities. Other features included retroflexed uterus（35）, anterior displacement of rectosigmoid angle（20） and posterior superior traction of the posterior vaginal fornix（15）. The MRI diagnostic accuracy,sensitivity, specificity, positive predictive value and negative predictive value were 93.65%, 96.23%, 80.00%, 96.23% and 80.00%,respectively. Conclusion MRI features are diagnostic in rectosigmoid endometriosis.