子宫动静脉畸形伴右侧卵巢静脉异常引流1例

A case of uterine arteriovenous malformation and abnormal right ovarian venous drainage

目的探讨多种影像学检查诊断子宫动静脉畸形(UAVM)的临床价值。方法回顾性分析1例经手术病理证实的伴有右侧卵巢静脉异常引流的UAVM病人的临床特征及影像学表现,并复习相关文献。结果二维超声显示子宫肌壁回声不均,子宫肌壁多发迂曲条带状无回声区;彩色多普勒超声显示无回声区内丰富彩色血流信号;频谱多普勒超声显示同时存在动脉、静脉频谱波形。盆腔CT平扫无明显异常;盆腔CT血管成像显示子宫内多发迂曲扩张畸形血管影,以双侧髂内动脉为供血动脉;双侧卵巢静脉均增粗,右侧卵巢静脉于第2腰椎水平汇入右肾静脉。容积再现(VR)及最大密度投影(MIP)成像显示双侧增粗扩张的引流静脉。盆腔MRI平扫显示子宫体积增大,内见不规则混杂信号影,T1WI以等/低信号为主,T2WI以混杂高信号为主,伴有迂曲扩张流空血管影,病灶内见片状高信号出血灶;盆腔时间-空间标记反转脉冲(Time-SLIP)无对比剂血管成像显示UAVM供血动脉远端的动脉血成分呈高信号。结论联合多种影像学检查诊断子宫动静脉畸形不仅能显示罕见异常引流,评估UAVM,而且Time-SLIP无对比剂血管成像可以明确畸形血管团供血动脉远端动脉血成分,为后期的介入及手术治疗提供指导。

Objective To explore the clinical value using multiple imaging techniques to diagnose uterine arteriovenous malformation(UAVM).Methods A retrospective analysis was conducted on the clinical characteristics and imaging findings of one case of UAVM with concurrent abnormal right ovarian venous drainage,confirmed by surgical pathology.Relevant literature was also reviewed.Results Two-dimensional ultrasound revealed heterogeneous echoes in the myometrium with multiple tortuous strips of anechoic areas.Color doppler ultrasound indicated abundant blood flow signals within the anechoic areas.Spectral doppler ultrasound demonstrated both arterial and venous spectral waveforms.Pelvic CT scan showed no apparent abnormalities.However,pelvic CT angiography showed multiple tortuous and dilated malformed vessels within the uterus,supplied by the bilateral internal iliac arteries;additionally,bilateral ovarian veins were enlarged,with the right ovarian vein draining into the right renal vein at the level of the second lumbar vertebra.Volume reproduction(VR)and maximum density projection(MIP)imaging showed enlarged and dilated bilateral draining veins.Pelvic MRI scan presented an enlarged uterus with irregular mixed-signal opacities,primarily iso/hypointense on T1WI and mixed hyperintense on T2WI,accompanied by tortuous and dilated flow void vessels and patchy hyperintense hemorrhagic foci within the lesions.Moreover,pelvic time-spatial labeling inversion puise(Time-SLIP)non-contrast angiography showed hyperintensity in the distal arterial blood components supplying the UAVM.Conclusion Combined multiple imaging techniques could visualize the rare abnormal drainage patterns and aid in the assessment of UAVM,moreover Time-SLIP non-contrast angiography can clearly depict arterial blood components in the distal arteries supplying the malformed vascular mass,providing valuable guidelines for subsequent interventional and surgical treatments.