子宫腺肌症磁共振成像主要诊断征象

Major diagnostic signs of magnetic resonance imaging for uterine adenomyosis

目的探讨磁共振成像(MRI)中结合带区异常增厚、T_1加权像(WI)和(或)T_2WI高信号改变对子宫腺肌症的诊断价值。方法回顾性分析海军军医大学(第二军医大学)长海医院2013年1月至2016年1月收治的37例经病理证实为子宫腺肌症患者的MRI资料,随机选取37例同期行MRI检查的子宫及卵巢正常者作为对照。测量并比较两组患者的子宫结合带厚度最大值(JZm a x)、结合带厚度最大值与最小值的差值(JZd i f f)、JZm a x与肌层厚度最大值的比值(JZm a x/Mm a x),并比较两组JZm a x、JZ_(diff)和JZ_(max)/M_(max)的差异。绘制受试者工作特征(ROC)曲线,计算JZ_(max)、JZ_(diff)和JZ_(max)/M_(max)诊断子宫腺肌症的曲线下面积(AUC)、截断值、灵敏度、特异度及准确度。观察患者T_1W I和(或)T_2W I上子宫壁内有无高信号及其类型。结果子宫腺肌症组与对照组的JZm a x、JZd i ff和J Zm a x/Mm a x差异均有统计学意义(P均<0.01)。JZ_(max)、JZ_(diff)、JZ_(max)/M_(max)诊断子宫腺肌症的AUC分别为0.95、0.90、0.85,当JZ_(max)≥10 mm时其灵敏度、特异度和准确度分别为78.8%、97.3%和88.6%,JZ_(diff)≥3.4 mm时分别为81.8%、91.9%和87.1%,JZ_(max)/M_(max)≥61%时分别为72.7%、83.8%和78.6%。18例(48.6%)子宫腺肌症患者仅见T_2WI高信号,14例(37.8%)可见T_1WI、T_2WI均高信号,多呈飘雪征改变;线状条纹征5例(13.5%),微囊征5例(13.5%),浆膜下囊性出血征1例(2.7%)。结论 JZ_(max)≥10 mm、JZ_(diff)≥3.4 mm、JZ_(max)/M_(max)≥61%对子宫腺肌症具有较好的诊断价值,其中JZ_(max)的诊断效能最佳。T_1WI和(或)T_2WI中的飘雪征、线状条纹征、微囊征、囊性出血征诊断子宫腺肌症具有独特性。综合评估这些征象可以提高MRI的诊断价值,为早期准确诊断子宫腺肌症提供可能。

Objective To investigate the value of abnormal thickening of the junctional zone, and T1 weighted imaging（WI） and（or） T2 WI hyperintense in magnetic resonance imaging（MRI） for the diagnosis of uterine adenomyosis. Methods The MRI images of 37 cases of adenomyosis confirmed by pathology in Changhai Hospital of Navy Medical University（Second Military Medical University） from Jan. 2013 to Jan. 2016 were retrospectively analyzed, and 37 cases of normal uterus and ovary confirmed by MRI in the same period were randomly selected as controls. The maximal junctional zone thickness（JZmax）, the difference between the smallest and largest junctional zone thickness（JZdiff）, and the ratio of JZmax to maximal myometrium thickness（JZmax/Mmax） were measured and compared between the two groups. The receiver operating characteristic（ROC） curve of each parameter in diagnosis of adenomyosis was drawn, and the area under curve（AUC）, cut-off value, sensitivity, specificity and accuracy were calculated. In addition, the T1 WI and T2 WI hyperintense and their types in the uterine wall were observed. Results There were significant differences in JZmax, JZdiff and JZmax/Mmax between the adenomyosis and control groups（all P〈0.01）. The AUC for the diagnosis of adenomyosis by JZmax, JZdiff, and JZmax/Mmax were 0.95, 0.90, and 0.85, respectively. When JZmax≥10 mm, the sensitivity, specificity and accuracy were 78.8%, 97.3% and 88.6%, respectively; when JZdiff≥3.4 mm, those were 81.8%, 91.9% and 87.1%, respectively; When JZmax/Mmax≥61%, those were 72.7%, 83.8% and 78.6%, respectively. Eighteen cases（48.6%） had only T2 WI hyperintense, while 14 cases（37.8%） had both T1 WI and T2 WI hyperintense; most of them showed snowdrift sign on T1 WI and（or） T2 WI. T1 WI and（or） T2 WI showed linear stripe sign in 5 cases（13.5%）, microcapsule sign in 5 cases（13.5%）, and cystic hemorrhage syndrome in 1 case（2.7%）. Conclusion JZmax≥10 mm, JZdiff≥3.4 mm and JZmax/Mmax≥61% have significant diagnostic value in diagnosis of adenomyosis, and JZmax has the best diagnostic efficiency. Snowdrift sign, linear stripe sign, microcapsule sign and cystic hemorrhage sign on T1 WI and（or） T2 WI are unique for the diagnosis of adenomyosis. Comprehensive evaluation of the above signs can improve the diagnostic value of MRI and early accurate diagnosis of adenomyosis.