子宫内异位妊娠MRI表现及临床意义

MRI Manifestation and Clinical Significance of Intrauterine Ectopic Pregnancy

目的探讨子宫内异位妊娠的磁共振成像(MRI)表现和诊断价值。方法回顾性分析41例临床最终诊断为子宫内异位妊娠的MRI及临床资料,41例患者中27例行MRI平扫,14例同时行增强扫描。结果子宫角妊娠8例,子宫颈妊娠5例,子宫颈合并子宫角妊娠1例,瘢痕妊娠27例。与临床最终诊断比较,MRI定位、定性诊断准确率分别为97.6%、95.1%;超声定位、定性诊断准确率分别为95.1%、92.7%。子宫角、子宫前壁下段肌层、子宫颈内妊娠囊共42个,以T2高信号为主,6个妊娠囊信号均匀、边界清楚,36个妊娠囊信号不均匀,其中10个边界不清;直径1~15cm不等;30个妊娠囊呈圆形,8个呈椭圆形,4个呈不规则形;相应处肌层厚度约0.2~1.2cm;5例并胎盘植入,增强扫描胎盘与肌层分界不清,边缘呈锯齿状。结论 MRI不仅能对子宫内异位妊娠准确定位诊断,且能评估妊娠囊与周围组织的关系,指导临床选择最佳的治疗方案。

Objective To investigate the manifestation and diagnostic value of magnetic resonance imaging(MRI)in intrauterine ectopic pregnancy.Methods MRI findings and clinical data of 41 patients diagnosed with intrauterine ectopic pregnancy were analyzed retrospectively.Among them,27 underwent plain scan and 14 underwent contrast-enhanced scan.Results Among the 41 cases,cornual pregnancy occurred in 8,cervical pregnancy in 5,combined cervical and cornual pregnancy in 1,and uterine scar pregnancy in 27.The accuracy rate of MRI was 97.6% for localization and 95.1%for qualitative diagnosis.The accuracy rate of ultrasound was 95.1% for localization and 92.7%for qualitative diagnosis.A total of 42 gestational sacs were located in uterine horn,at lower anterior wall of uterine muscle layer,or in the cervix,which mainly showed high signal on T2-weighted MRI.Among the 42 gestational sacs,6showed homogeneous signal and clear margin,36 showed inhomogeneous signal,and 10 showed unclear margin.The diameter of gestational sacs was ranged from 1cm to 15 cm,including 30 cases of round shape,8 cases of oval shape,and 4 cases of irregular shape.The corresponding muscle thickness was ranged from0.2to 1.2cm.Five cases were complicated by placenta accrete,and contrast-enhanced scan showed unclear boundary between placenta and muscle layer with jagged rim.Conclusion MRI can not only accurately diagnose the location of intrauterine ectopic pregnancy,but also observe the relationship of gestational sacs to surrounding tissues.Therefore,it can be used to guide clinicians to choose the best treatment option.