MRI联合MRA诊断子宫动静脉畸形

MRI and MRA in diagnosis of uterine arteriovenous malformation

目的探讨子宫动静脉畸形(UAVM)的磁共振成像(MRI)影像学特点。方法回顾性分析南京医科大学附属妇产医院2015年11月至2020年12月收治的15例经数字减影血管造影(DSA)证实的UAVM病例的临床及MRI资料,并进行核磁共振血管成像(MRA),观察发病部位、范围、边界、信号特征及宫旁血管等。结果15例UAVM均位于子宫肌层,边界均不清。T1WI见2例等高信号和13例等低信号,T2WI见8例稍高信号和7例等低信号,子宫肌层延续至宫旁,见增粗迂曲流空血管影,扩散加权成像(DWI)未见弥散受限,增强扫描病变区不均匀强化,动脉期见10例提前显影的静脉血管影,5例提前显影不明显,延迟期强化范围渐扩大,病变区大量增粗迂曲流空血管影。MRA重建畸形血管团最大为5.0 cm×4.5 cm×4.1 cm,见大量迂曲血管影。结论子宫肌层及宫旁多发增粗迂曲流空血管影,以及动脉期提前显影的静脉血管是UAVM典型的MRI影像特点,同时行增强MRA血管重建有助于诊断,据此能提高诊断率。

Objective To explore the MRI imaging characteristics of uterine arteriovenous malformations(UAVM).Methods The clinical and MRI data of 15 DSA-confirmed UAVM cases admitted to the Women s Hospital of Nanjing Medical University from November 2015 to December 2020 was retrospectively analyzed.The disease location,scope,border,signal characteristics and parauterine blood vessels was obseved.Results All the UAVM were located in myometrium with border irregularity.High signal intensity(n=2)and low signal intensity(n=13)on T1WI,slightly high signal intensity(n=8)and low signal intensity(n=7)on T2WI,the myometrium continued to the uterus,with thickened tortuous flow empty vascular shadow,no limited diffusion on DWI.In the enhanced scan,the lesions were heterogeneously enhanced,venous angiography were seen in advance in the arterial phage(n=10),early reinforcement was not clear(n=5),the scope of enhancement in the delayed phase was gradually expanded,and the lesion area was thickened with tortuous and empty vascular shadows.The maximum size of the malformed vascular mass reconstructed by MRA was 5.0 cm×4.5 cm×4.1 cm,and a lot of tortuous vascular shadows were seen.Conclusions The typical MRI features of UAVM are multiple thickening and tortuous empty vessels in the myometrium and adjacent uterus,as well as venous vessels developed in advance in the arterial phase.And enhanced vascular reconstruction by MRA is helpful to the diagnosis,which can help to improve the diagnostic rate.