MRI及动态增强扫描在子宫内膜息肉样病变中的诊断及病理分析

The diagnostic value of conventional MR and dynamic contrast-enhanced scan in polypoid lesions of the uterus

目的探讨子宫息肉样病变中MRI及动态增强扫描的诊断价值及相应的病理基础。方法回顾性分析经术后病理证实的子宫内膜息肉样病变52例,将病灶MRI平扫及增强扫描图像与术后病理结果进行对照。采用Fisher精确概率法对囊变区、纤维核及完整结合带在子宫内膜息肉样病变中的出现频率进行分析比较。结果 29例子宫内膜恶性息肉病变在MRI子宫结合带中断或模糊征象出现的概率均较子宫内膜息肉及子宫黏膜肌瘤高,差异具有统计学意义(P值均<0.05)。肿块内囊变影及不定形纤维核影见于子宫内膜息肉,2种征象在子宫内膜息肉中的出现概率均较子宫内膜恶性息肉样病变及子宫黏膜肌瘤高,差异具有统计学意义(P值均<0.05);MRI对所有52例子宫内膜息肉样病变定性诊断的敏感度为82.7%,特异度为100%,准确度90.4%;对子宫内膜恶性肿瘤分期诊断的准确度为95.0%。结论MRI平扫及增强扫描能较好的反映子宫内膜息肉样病变的良恶性病变特征,具有很好的临床应用价值。

Objective To investigate the diagnostic value of conventional MR and dynamic contrast-enhanced scan in polypoid lesions of the uterus. Methods A retrospective analysis of the endometrial polyps confirmed by pathology in 52 cases was conducted. Enhanced MR scan images and postoperative pathological results were compared. The frequency of cystic lesions,fibrous nuclei and intact bands in endometrial polyp lesions were analyzed by Fisher exact probability method. Results The probability of 29 cases of endometrial malignant polypoid lesions of uterus in MR connected with the interruption or fuzzy signs was lower than that of endometrial polyps and uterine fibroids mucosa,the difference was statistically significant（P〈0. 05）. Cystic mass shadows and amorphous fibers were found in endometrial polyps and nuclear imaging,2 signs in endometrial polyps were lower than the probability of occurrence of endometrial malignant polypoid lesions and uterine fibroids mucosa,the difference was statistically significant（P〈0. 05）. Sensitivity of MR of all the 52 cases of the qualitative diagnosis of endometrial polyps was 82. 7%,the specificity was 100%,the accuracy was 90. 4%; accuracy for diagnosis and staging of endometrial cancer was 95%. Conclusion MR plain scan and enhanced scan can better reflect the benign and malignant lesions of endometrial polypoid lesions,and has a good clinical value.