CT及MRI在盆腔内子宫外平滑肌瘤诊断中的应用价值

Application value of CT and MRI in diagnosis of pelvic and extrauterine leiomyoma

目的探讨CT、MRI在盆腔内子宫外平滑肌瘤诊断中的应用价值。方法将2018年2月至2021年1月首都医科大学附属北京朝阳医院怀柔医院收治的47例盆腔内子宫外平滑肌瘤患者作为研究对象,对其术前CT、MRI检查结果进行回顾性分析。结果47例盆腔内子宫外平滑肌瘤均在盆腔内、子宫外显示肿块,肿块边界清楚光整。CT平扫肿块密度较均匀,或夹杂低密度区或囊变区,肿块实性部分在增强扫描中强化明显。肿块在T1WI序列中呈现稍低信号或等信号,合并变性的肿块在T2WI序列中呈现不均匀高信号,DWI扩散受限,增强扫描可见不同程度的囊状或不定形的不强化变性区,呈现"沼泽湿地征"。MRI在诊断盆腔内子宫外平滑肌瘤上的误诊率为14.89%,明显低于CT的36.17%,差异有统计学意义(P<0.05)。结论CT、MRI检查均检出盆腔内、子宫外的以实性为主的肿块,其中MRI上"沼泽湿地征"是平滑肌瘤变性的特征性表现。盆腔内子宫外平滑肌瘤的影像学表现多样,CT、MRI在其诊断上误诊难以避免。提高对盆腔内子宫外平滑肌瘤的影像学表现和误诊因素的认知,有助于减少术前误诊的发生。

Objective To explore the application value of CT and MRI in the diagnosis of pelvic and extrauterine leiomyoma.Methods A total of 47 patients with pelvic and extrauterine leiomyoma who were admitted to Huairou Hospital of Beijing Chaoyang Hospital Affiliated to Capital Medical University from February 2018 to January 2021 were selected as the research objects,and the preoperative CT and MRI results were retrospectively analyzed.Results A total of 47 patients of pelvic and extrauterine leiomyoma were observed with pelvic and extrauterine masses with clear and smooth boundary.The mass density was uniform in the plain CT scan,or mixed with low-density areas or cystic areas,and the solid part of the mass was enhanced significantly in the enhanced CT scan.The masses showed slightly low signal or equal signal in the T1 WI sequence,while the masses with degeneration showed uneven high signal in the T2 WI sequence and limited diffusion in DWI.Different degrees of cystic or amorphous non-enhanced degeneration areas were observed on the enhanced scan,presenting the"swamp sign".The misdiagnosis rate of MRI in pelvic and extrauterine leiomyoma was 14.89%,which was significantly lower than that of CT(36.17%),and the difference was statistically significant(P<0.05).Conclusion CT and MRI examination show solid masses in pelvic cavity and outside uterus,and the"swamp sign"on MRI is the characteristic manifestation of leiomyoma degeneration.The imaging manifestations of pelvic and extrauterine leiomyoma are diverse,and misdiagnosis by CT and MRI is inevitable.The improvement of understanding of the imaging manifestations and misdiagnosis factors of pelvic and extrauterine leiomyoma is helpful to reduce the occurrence of preoperative misdiagnosis.