多层螺旋CT MRI对巨大浆膜下子宫肌瘤的诊断价值

目的探讨巨大浆膜下子宫肌瘤(GSH)的影像学特点及其鉴别诊断,旨在提高术前诊断水平.方法回顾性分析经手术病理证实28例GSH的CT、MRI及增强表现,其中CT检查23例,MRI检查18例,并与病理对照.结果28例肿块与子宫关系密切,其中与卵巢分界不清12例.CT表现实性肿块16例,肿块实性部分与子宫实质密度相似,肿块内裂隙状、斑片状、片状低密度变性、坏死.囊实性肿块7例,其中囊性肿块内粗细不均的分隔5例,片状、乳头样结构2例.增强后肿块实性部分强化显著,动脉期较明显强化,且呈持续强化,低密度区域未见强化.桥接血管9例,肿块周围增粗的子宫动脉17例.MRI表现实性肿块13例,肿块实质部分呈T2较短、T1较长信号,肿块内弥漫性或灶性分布的斑片状、片状长T2、长T1信号;囊实性肿块5例,囊性肿块内有多发粗细不等的较短T2、等T1信号分隔、结节.增强后实质部分早期快速强化,注药后90s早期强化率(115±35)%,中高度强化15例,轻度强化3例.桥接血管6例,肿块周围增粗的流空子宫动脉13例.病理证实玻璃样变性15例,黏液样变性13例,伴坏死、囊变、钙化8例.结论GSH影像学特点是肌瘤易变性、坏死,实质部分密度/信号类似子宫肌层,且呈富血供,早期快速强化,桥接血管及肿块周围增粗的子宫动脉供血的显示有助于其诊断及其鉴别诊断.

Objective To investigate the imaging features and differential diagnosis of giant subserous hysteromyoma(GSH)in order to improve the level of preoperative diagnosis.Methods CT,MRI and enhanced findings of 28 cases of GSH confirmed by operation and pathology were analyzed retrospectively,including 23 cases of CT and 18 cases of MRI,and compared with pathology.Results The mass was closely related to the uterus in 28 cases,and the demarcation between the mass and the ovary was unclear in 12 cases.CT showed solid mass in 16 cases,and the density of solid part of the mass was similar to that of uterine parenchyma,with fissure,patchy and patchy low-density degeneration and necrosis in the mass.There were 7 cases of cystic solid mass,including 5 cases of uneven septum in cystic mass and 2 cases of patchy and papillary structure.After enhancement,the solid part of the mass was significantly enhanced,the arterial phase was significantly enhanced,and showed continuous enhancement,but there was no enhancement in the low density area.Bridging vessek were found in 9 cases and thickened uterine artery around the mass were found in 17 cases.MRI showed solid mass in 13 cases,the parenchyma of the mass showed slightly shorter T2 and slightly longer T1 signal intensity,difilise or focal patchy,patchy long T2 and long T1 signal intensity in the mass,and cystic solid mass in 5 cases,there were multiple slightly short T2 and iso-T1 signal separations and nodules in the cystic mass.After enhancement,the parenchyma was enhanced rapidly in the early stage,and the early enhancement rate was(115±35)% in 90 s after injection,with moderate and high enhancement in 15 cases and mild enhancement in 3 cases.Bridging blood vessels in 6 cases and thickened uterine artery around the mass in 13 cases.Pathology confirmed that there were 15 cases of vitreous degeneration,13 cases of myxoid degeneration and 8 cases of necrosis,cystic degeneration and calcification.Conclusion The imaging features of GSH are myoma variability and necrosis,parenchyma density/signal similar to myometrium,rich blood supply,and early rapid enhancement.The display of bridging blood vessels and thickened uterine artery around the mass blood are helpful for its diagnosis and differential diagnosis.