腹壁子宫内膜异位症的MRI诊断

MRI diagnosis of endometriosis in the abdominal wall

目的探讨腹壁子宫内膜异位症(abdominal wall endometriosis,AWE)的MRI表现及特点,为临床诊断提供依据。方法回顾性分析经手术病理证实的9例AWE患者的MRI资料,分析其MRI平扫及增强扫描的特征,辅以研究其DWI图像。结果 9例AWE患者中,7例单发,2例多发,9例患者共发现11处病灶;2例患者的病灶位于皮下脂肪组织内,6例患者的病灶位于腹直肌内,1例患者的病灶同时侵及皮下脂肪组织及腹直肌;实质型3例、囊肿型1例、囊实混合型5例。与周围肌肉组织相比,MRI平扫表现实质型,T_1WI呈等信号或等低信号,T_2WI脂肪抑制序列呈高低混杂信号,DWI呈略高信号;囊肿型T_1WI呈以高信号为主的高低混杂信号,T_2WI脂肪抑制序列呈高信号,DWI呈高信号;囊实混合型T_1WI呈等信号,其内混杂点状高信号,T_2WI脂肪抑制序列呈高低混杂信号,DWI呈混杂高信号。增强扫描:实质型明显强化;囊肿型未见明显强化;囊实混合型呈明显不均匀强化。AWE病灶的平均ADC值为1.29×10^(-3)/mm^2/s。结论MRI表现结合病史能对腹壁子宫内膜异位症作出明确诊断,在其定性、定位及鉴别诊断中具有重要价值。

Objective To investigate the MRI manifestations and characteristics of abdominal wall endometriosis （AWE） in order to provide the basis for clinical diagnosis. Methods The clinical findings of nine patients with pathology proven AWE were collected, and the MRI features before and after contrast enhancement assisted with DWI were analyzed. Results Seven of the AWE lesions were single and two were multiple, eleven AWE lesions were found in nine patients; In two patients, the lesions were located in the subcutaneous adipose tissue, six patients with lesions located in the abdominal rectus. One patient lesions sim- uhaneously invaded subcutaneous adipose tissue and rectus abdominis. There eases were solid type, one cases was cyst type, five were mixed cystic-solid type. Compared with muscle, the MRI findings of solid type were inhomogeneous low signal intensity on TI WI, high or low mixed signal intensities on TzWI fat suppression sequence, slightly high signal on DWI; The MRI findings of cystic type were high and low signal based on high signal on T1WI, high signal intensity on T2WI fat suppression sequence and DWI; The MRI findings of mixed type AWE were shown equal signals mixed therein punctate high signal on T, WI, high and low hybrid signal on T2WI fat suppression sequence, mixed high signal on DWI. Enhanced scan： Solid type was significantly strength- ened ; cystic had no significant strengthening ; The mixed cystic and solid was significantly heterogeneous enhancement. The mean ADC value of AWE was 1.29 ×10^-3/mm^2/s. Conclusion Combined with medical history, MRI is very useful in the diagnosis and differential abdominal AWE.