静脉内平滑肌瘤病超声与CT特征

Ultrasonic and CT features of intravascular leiomyomatosis

目的观察静脉内平滑肌瘤病(IVL)的临床、超声与CT特征表现。方法回顾性分析55例经术后病理证实的IVL患者的临床及影像学特征,对比超声、CT诊断IVL的准确率。结果Ⅰ期IVL超声多表现为子宫肿物呈“蠕虫”或条索串珠样向宫旁延伸,血流信号丰富;CT多表现为子宫或盆腔低密度肿物,伴子宫静脉或卵巢静脉内肿物。Ⅱ~Ⅳ期IVL超声表现为生殖静脉、髂静脉、下腔静脉、右心甚至肺动脉内条索状肿物沿静脉走行,内见血流信号;增强CT肿物呈“丝瓜络”样不均匀强化。超声与CT诊断IVL的准确率分别为49.09%和58.18%,CT诊断准确率高于超声(P<0.05);超声和CT诊断Ⅱ~Ⅳ期IVL的准确率均高于Ⅰ期(P均<0.05)。超声与CT联合诊断IVL准确率达74.55%。结论IVL影像学表现具有一定特征性,联合超声与CT可显著提高诊断IVL的准确率。

Objective To observe ultrasonic and CT features of intravascular leiomyomatosis(IVL).Methods Data of 55 patients with pathologically confirmed IVL were retrospectively analyzed,the clinical and imaging features were observed,and the accuracy of ultrasound and CT for diagnosing IVL were compared.Results The ultrasonic characteristics of stageⅠIVL were uterine masses“worm”like or string beaded extending to the side of the uterus,with abundant blood flow within the masses.CT showed low-density masses of uterus or pelvis,accompanied by masses in uterine veins or ovarian veins.For stageⅡ-ⅣIVL,the ultrasonic findings were characterized by the presence of ribbon-shaped mass in the genital vein,iliac vein,inferior vena cava,right cardiac and even pulmonary artery along the vein with blood flow signals,which on enhanced CT present as uneven enhancement of the mass like“loofah sponge”.The diagnostic accuracy of CT and ultrasound for IVL was 58.18%and 49.09%,respectively,of CT was higher than of ultrasound(P<0.05).The diagnostic accuracies of ultrasound and CT for stageⅡ-ⅣIVL were both higher than that for stageⅠIVL(both P<0.05).The diagnostic accuracy of IVL raised to 74.55%with combination of ultrasound and CT.Conclusion The imaging findings of IVL had certain characteristics.Combing ultrasound and CT could significantly improve the diagnostic accuracy of IVL.