子宫癌肉瘤的CT、MRI影像学分析

CT and MRI Analysis of Uterine Carcinosarcoma

目的探讨分析子宫癌肉瘤的CT、MRI表现特点,提高其影像学诊断的正确率。方法回顾性分析我院2010年1月至2016年8月经病理证实的17例子宫癌肉瘤患者的CT、MRI表现。结果根据肿瘤形态分为两型,I型表现为宫腔或宫颈管内不规则或类圆形巨大肿块(7例);II型表现为息肉状或不规则较小肿块,或单纯性子宫内膜增厚,与子宫内膜癌酷似(10例)。其影像学特征:⑴平扫呈等密度或等信号,偶见混杂信号,T2WI呈稍高或混杂信号,子宫肌层受侵时T2WI上低信号结合带消失或中断。⑵增强扫描多低于子宫肌层强化程度。⑶DWI呈高信号,ADC平均值较高,测得为(1.02±0.3)×10-3mm2/s。⑷瘤内常见流空血管影,多伴有囊变及坏死。结论子宫癌肉瘤的形态、瘤内流空血管影及较高的ADC值,将有助于与子宫内膜癌鉴别,MRI对瘤内囊变、坏死、出血的诊断以及肿瘤浸润深度的评估有着重要意义。

Objective To investigate and analysis the CT and MRI features of uterine carcinosarcoma and to promote diagnostic accuracy of the disease.Methods Clinical data,CT and MR imagings of 17 uterine carcinosarcoma patients confirmed by pathology were reviewed and analyzed retrospectively.Results All the cases presented with two patterns,type I showed large irregular or round-like mass occurred in uterine cavity or cervical canal(n=7),type II showed polypoid or irregular smaller lumps,or simple endometrial thickening,which were similar to endometrial carcinoma(n=10).The radiographic features are as follows:⑴moderate density on plain CT scans,isointensity or sometimes mixed signal intensity on unenhanced T1-weighted imagings and intermediate or heterogeneous signal intensity on T2-weighted images;the disappearance or discontinuity of junctional low-intensity band on T2-weighted imagings indicating myometrium invasion,⑵common hypointense or low-density relative to adjacent myometrium on contrastenhancement imagings,⑶heterogeneous hyperintensity on diffusion-weighted imagings with higher mean ADC value of(1.02±0.3)×10-3mm2/s,⑷intratumoral flow voids and cystic necrosis likely to be found.Conclusion Characteristics of uterine carcinosarcoma including patterns of the tumor,intratumoral flow voids and higher ADC values will do help in differential diagnosis with endometrial carcinoma.MRI is of great significance in diagnosis of intratumoral hemorrhage and cystic necrosis,as well as assessment of the depth of tumor invasion.