子宫内膜少见原发性肉瘤的MR表现

目的探讨子宫内膜少见原发性肉瘤的MR表现及特征,并与病理学对照,以提高对该类疾病的诊断及鉴别诊断能力。方法回顾性分析经手术病理证实的6例子宫内膜少见原发恶性肿瘤的MR表现并复习相关文献。结果子宫腺肉瘤2例,平扫T1WI呈等低信号T2WI呈不均匀高信号影,结合带连续性中断,伴肌层受侵,肿块内信号不均匀可见囊变坏死。子宫癌肉瘤3例,表现为T1WI呈等低混杂信号,T2WI呈不均匀高信号影,增强后呈不规则明显强化,其中1例合并盆腔及腹膜种植转移,1例合并大量盆腔积液。子宫间质肉瘤1例,表现为宫腔内巨大软组织肿块,T1WI等、低信号,T2WI呈高信号,伴出血及坏死表现为不均匀高信号影,增强扫描后实质部分呈不规则明显强化。结论 MRI平扫及动态增强扫描并结合临床资料可以提高子宫内膜少见原发性肉瘤的诊断,但确诊仍需依靠病理学检查。     

子宫癌肉瘤的MRI表现

目的 探讨子宫癌肉瘤的MRI表现特点.方法 回顾性分析4例子宫癌肉瘤患者的MRI表现,并与病理结果进行对照.结果 4例患者均表现为子宫体积明显增大,内膜增厚呈异常信号,3例子宫肿物MRI平扫表现为T1WI等、略高混杂信号,T2WI稍高、高混杂信号,1例表现为子宫腔明显扩张,其内可见分隔,平扫宫腔内表现T1WI、T2WI高、等、低混杂信号.结论 子宫癌肉瘤在MRI上具有一定的特征性.     

子宫阔韧带平滑肌瘤的CT与MRI诊断

目的探讨阔韧带肌瘤的CT与MRI诊断与鉴别诊断。方法收集15例女性患者阔韧带平滑肌瘤CT与MRI资料,进行回顾性分析,所有病例均经手术病理证实。15例中6例接受增强平扫及CT检查,9例接受增强平扫及MRI检查。结果在CT与MRI上,15例均在盆腔内、子宫外显示肿块,实质性肿块9例,实性肿块内有不规则囊变区6例。肿块边界清楚光整,与周围组织间分界清楚10例,病灶与子宫分界不清5例。病灶实性成分CT平扫与子宫呈等密度;MRI平扫T1WI呈等信号、稍低信号,T2WI呈低、等信号。囊变区CT平扫呈稍低密度,MRI平扫呈长T1、长T2信号。增强扫描病灶明显强化,与子宫肌层强化程度基本一致。瘤内变性、坏死或液化区不强化。结论 CT、MRI发现盆腔内、子宫外边界清楚的实性或以实性为主的肿块,肿块实性成分CT平扫密度与子宫相近或相等,MRI平扫T2WI呈低信号,增强扫描强化程度与子宫肌层相当,是阔韧带平滑肌瘤较具特征的征象。当肿瘤囊变区较大,甚至病灶以囊变为主时鉴别诊断较为困难,但肿瘤实性成分的影像表现仍保持以上特点,对鉴别诊断有重要意义。     

MRI diagnosis of granulose cell tumor of the ovary

目的:探讨MRI对卵巢颗粒细胞瘤(GCTO)的诊断价值.方法:回顾性分析经手术与病理证实的20例GCTO患者的临床和MRI资料.所有病例均行MRI平扫及增强扫描.结果:20例术前MRI诊断正确16例(80％).MRI 平扫主要表现:子宫附件区边界清楚、形态较规整、包膜完整的囊性、囊实性、实性肿块.6例为囊性肿块,其中1例为单一大囊性肿块,多囊性肿块内见厚薄不一分隔,以较厚为主,囊内壁光滑,囊内容物T1WI呈等低信号,T2WI呈高信号;9例为囊实性肿块,T1WI呈等低混杂信号,T2WI呈混杂高信号,内有多发大小不等的囊性变,囊内壁光滑;5例为实性肿块,T1WI和T2WI高于同层肌肉信号.合并症:12例子宫增大,内膜增厚,3例合并子宫内膜癌(1例同时合并子宫肌瘤)、3例合并子宫肌瘤.增强扫描20例GCTO患者的肿瘤实性部分及囊壁均明显强化.结论:卵巢颗粒细胞瘤MRI表现具有一定的特征,能清晰显示其合并症,对其诊断及鉴别诊断具有重要的临床应用价值.     

MRI对卵巢颗粒细胞瘤的诊断价值

目的:探讨MRI对卵巢颗粒细胞瘤(GCTO)的诊断价值。方法:回顾性分析经手术与病理证实的20例GC-TO患者的临床和MRI资料。所有病例均行MRI平扫及增强扫描。结果:20例术前MRI诊断正确16例(80%)。MRI平扫主要表现:子宫附件区边界清楚、形态较规整、包膜完整的囊性、囊实性、实性肿块。6例为囊性肿块,其中1例为单一大囊性肿块,多囊性肿块内见厚薄不一分隔,以较厚为主,囊内壁光滑,囊内容物T1WI呈等低信号,T2WI呈高信号;9例为囊实性肿块,T1WI呈等低混杂信号,T2WI呈混杂高信号,内有多发大小不等的囊性变,囊内壁光滑;5例为实性肿块,T1WI和T2WI高于同层肌肉信号。合并症:12例子宫增大,内膜增厚,3例合并子宫内膜癌(1例同时合并子宫肌瘤)、3例合并子宫肌瘤。增强扫描20例GCTO患者的肿瘤实性部分及囊壁均明显强化。结论:卵巢颗粒细胞瘤MRI表现具有一定的特征,能清晰显示其合并症,对其诊断及鉴别诊断具有重要的临床应用价值。     

卵巢颗粒细胞瘤的MRI诊断

目的 分析卵巢颗粒细胞瘤的MRI特征。资料与方法 回顾性分析15例卵巢颗粒细胞瘤的MRI特征，并与手术及病理对照研究。结果 15例中，囊实性肿块8例，内有多发大小不等的囊性变，囊内壁光滑，囊内容物MRT1WI呈等低混杂信号，T2WI呈混杂高信号，囊与套间有厚壁分隔；实性肿块3例，T1WI及T2WI信号均高于肌肉；单一较大的囊性病灶4例。13例子宫均匀增大，内膜增厚，1例并有子宫内膜癌。结论 诊断卵巢颗粒细胞瘤的可靠依据为：(1)肿瘤内多发囊变，间有厚壁分隔，囊内壁光滑；(2)合并子宫体积增大，内膜增生。     

子宫内膜间质肉瘤的影像表现

目的:总结分析子宫内膜间质肉瘤的影像表现。方法:回顾性分析20例经手术及病理证实的子宫内膜间质肉瘤患者的临床及影像资料,并与病理结果对照分析。结果:20例子宫内膜间质肉瘤均经病理证实,其中低级别子宫内膜间质肉瘤11例,低级别子宫内膜间质肉瘤局部伴性索间质样分化1例,高级别子宫内膜间质肉瘤6例,低级别混合性子宫内膜间质-平滑肌肿瘤1例,未分化子宫内膜肉瘤1例。20例均为单发,其中腔内生长型6例,肌层肿块型7例,肌层浸润型3例,浆膜下型3例,宫外型1例。病灶最大径为(6.18±1.34)cm;类圆形14例,形态不规则6例;边界清晰8例,边界不清12例。12例出现卵石征,8例可见黏液样变区域,1例呈环岛征改变,7例肿块周围及内部见多发蚯蚓状、螺旋状强化血管影,6例瘤周可见T 2WI线状低信号轮廓,6例瘤周可见T 2WI结节状或蠕虫状稍高信号。增强扫描20例肿块实性成分呈渐进性、持续性强化,其中15例强化程度与子宫肌层相仿或高于肌层,5例强化程度低于肌层。结论:子宫内膜间质肉瘤的影像表现具有一定特征性,能为该病的诊断提供依据。     

卵巢颗粒细胞瘤的CT、MRI诊断和误诊分析

目的 分析卵巢颗粒细胞瘤（granulosa cell tumor,GCT）的CT、MRI表现及误诊原因,提高对该肿瘤的认识.方法 回顾性分析经手术病理证实的10例GCT的CT、MRI表现.结果 10例GCT位于右侧4例,左侧6例.肿瘤最大径平均6.1 cm.全部肿瘤边界清楚,包膜完整呈圆形或卵圆形7例,不完整呈分叶状3例;肿瘤呈囊实性8例,实性2例.7例CT检查,平扫肿瘤实性成分平均CT值为35HU.3例行MRI检查,实性成分T1WI呈等信号,T2 WI呈稍高信号;囊性成分T1WI呈低信号,T2WI呈高信号.所有肿瘤实性成分增强后均呈中等程度强化.合并子宫内膜增生5例,腹水6例,同时合并子宫内膜癌及肌瘤1例.10例GCT术前均未能作出正确诊断.结论 典型的GCT多呈囊实性,包膜完整,边界清楚,增强后肿瘤实性成分中等程度强化;易合并子宫内膜增生及少量腹水.因对该肿瘤缺乏足够的认识、部分肿瘤缺乏典型的影像表现、阅片不够仔细等是导致误诊的主要原因.     

卵巢卵泡膜-纤维瘤的CT和磁共振成像表现及病理对照分析

目的探讨卵巢印泡膜一纤维瘤的CT及磁共振成像（MRI）表现特点,与病理结果进行对照,以提高对卵泡膜一纤维瘤影像表现的认识。方法回顾分析经手术病理证实的26例卵泡膜一纤维瘤患者的临床和影像资料。结果26例患者中行cT检查22例,MRI检查9例,均查者5例。其中1例患者双侧发生,27个肿瘤均呈阋形或分叶状,其中实性肿块18例．囊实性肿块9例。肿块边界均较清楚。其中13例伴有少量盐腔积液,2例伴子宫内膜增生。盆腔均未见肿大淋巴结。CT平扫显示实性肿瘤和囊实性肿瘤的实性部分的密度较子宫肌层相仿,增强后轻度强化或无强化：MRI显示病灶T1WI均呈等低信号,1例病灶T2WI呈稍高信号,8例T2WI呈低信号。镜下见肿瘤细胞呈短梭形,细胞质内含有大量脂肪小滴,细胞核未见明显核分裂。细胞呈漩涡状、束状排列,周丽被大量纤维组织分隔。结论卵巢卵泡膜．纤维瘤的影像表现具有一定的特征,对该病的术前正确诊断具有重要意义     

子宫腺肌症离体标本低场MRI研究

目的:分析子宫腺肌症离体标本的低场MRI表现,探讨子宫腺肌症的低场MRI诊断.材料和方法:采用OUTLOOK PROVIEW 0.23T MR对17例子宫腺肌症离体标本行采用矢状位T1WI、T2WI及irT2WI平扫并与病理进行对照分析.结果:子宫体积增大呈类球形,结合带增厚,厚度为10.4～28.6mm,平均15.2mm.病变主要位于子宫后壁肌层14例和前壁3例.所有标本,T2WI与irT2WI示子宫肌层内低信号区内夹杂斑片状高信号影,TIWI示子宫肌层内散在斑点状低信号影,6例标本肌层内少许斑点状高信号.T2WI/irT2WI呈高信号而T1WI呈低信号的病理上为异位的内膜岛,在T2WI与TIWI均呈高信号的为异位内膜出血灶.结论:低场MRI对子宫腺肌症诊断有重要价值,其能真实有效的反映出病变的病理特征,T2WI与irT2WI是病灶显示的敏感序列.     

CT,MRI, and FDG-PET imaging findings of low-grade extrauterine endometrial stromal sarcoma arising from the mesentery: A case report

Endometrial stromal sarcoma is a rare uterine mesenchymal neoplasm, and extrauterine endometrial stromal sarcoma is even rarer, with a limited number of case reports. In the present report, we present a case of low-grade extrauterine endometrial stromal sarcoma originating from the mesentery in a 49-year-old woman, without endometrial stromal sarcoma in the uterus or evidence of endometriosis. The tumor was diagnosed using recombination of the JAZF1 gene by fluorescence in situ hybridization. Computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography showed a 13 cm, primarily polycystic, mass containing a contrast-enhancing solid component with restricted diffusion and mild 18F-fluorodeoxyglucose uptake. A large cystic component may be a characteristic feature of extrauterine endometrial stromal sarcoma, given the low pressure from the surrounding tissues.     

Extra-uterine endometrial stromal sarcoma arising from deep infiltrating endometriosis

We present a compelling case of a 45-year-old female with a history of endometriosis and leiomyomas, who presented to her gynecologist with chronic pelvic pain complaints.Both a transvaginal ultrasound (US) and an MRI (magnetic resonance imaging) were ordered. The US demonstrated multiple uterine lesions, likely fibroids, and an endometrioma within the right ovary. The MRI of the pelvis with and without gadolinium identified a mass within the right ovary with homogenous intermediate T2-signal, restricted diffusion, and delayed enhancement relative to the myometrium. Several irregular-shaped lesions were also noted within the external myometrium, anterior pelvic wall, and the peritoneum, which were intermediate signal on T2-weighted images, restricted diffusion, and an enhancement pattern similar to the myometrium.The patient underwent a right adnexectomy. The histopathology findings were consistent with a low-grade endometrial stromal sarcoma (low grade-ESS) arising from the endometrial stroma of the right ovary. A debulking surgery confirmed the involvement of external myometrium, anterior pelvic wall, and the peritoneum secondary to a low-grade ESS without the endometrial cavity's involvement.The underlying hypothesis is that the endometriosis stroma from extra-uterine structures such as the right ovary, pelvic and anterior peritoneum, and external myometrium may have subsequently resulted in a low-grade ESS.Low-grade extra-uterine ESS without endometrial involvement is a rare entity. Based on our literature search, this is one of the few reports covering the radiological features of low-grade extra-uterine ESS arising outside the uterus with a concomitant deep infiltrating endometriosis, but without the involvement of the endometrial cavity.     

Endometrial stromal sarcoma of the uterus: MR and US findings

We describe the MRI and US features of two patients with endometrial stromal sarcoma of the uterus. Both lesions appeared as voluminous polypoid masses within an expanded endometrial cavity on both US and MRI. They had mixed echotexture and heterogenous signal intensity on both T1- and T2-weighted sequences. T2-weighted images were most helpful in detecting the endometrial nature of the disease and its relationships with surrounding myometrium. Received: 29 March 1999; Revised: 10 August 1999; Accepted: 11 August 1999     

子宫内膜间质肉瘤的MRI表现

目的 分析子宫内膜间质肉瘤(ESS)的MRI表现特点,探讨MRI在其临床应用中的价值.方法 收集本院经手术病理证实的ESS 13例,术前均行MRI平扫及扩散加权成像(DWI)扫描,其中10例同时行增强扫描,结合手术后病理结果分析其MRI表现.结果 13例病例中,位于宫腔6例、子宫肌层4例、子宫右侧壁及阔韧带1例、宫颈1例、阴道顶端及盆腔内1例.在MRI平扫上表现为突向宫腔或位于肌层的息肉状或多发结节状肿块,呈长T1长T2信号,在DWI序列上均表现不同程度的高信号,10例增强扫描后实性部分中度至明显不均匀强化,时间-信号强度曲线6例呈平台型,4例呈持续上升型.结论 ESS的MRI表现具有一定的特征性,DWI及动态增强检查有助于本病的诊断及鉴别诊断.     

MRI对剖宫产瘢痕妊娠的诊断价值

目的：探讨MRI在剖宫产瘢痕妊娠诊断与治疗中的价值。方法：回顾性分析22例经手术及病理证实的剖宫产瘢痕妊娠患者的临床及MRI表现。结果：22例均清楚显示孕囊,孕囊位于子宫前下壁峡部剖宫产瘢痕部位。其中5例孕囊完全植入肌层,子宫前下壁菲薄前凸,呈反“3”字或“C”字型;17例孕囊向子宫肌层浸润同时又向宫腔内生长,子宫前下壁不同程度变薄。孕囊呈圆形或卵圆形15例,形态不规则7例,在T1wI上以等低信号为主,部分孕囊可呈混杂斑片状高信号,在T1wI上呈混杂高信号,周围可见低信号包膜,其中14例包膜完整,8例不完整。手术瘢痕表现为子宫肌层连续性中断,局部向内凹陷或变薄,MRI表现为务状长T1、短T2异常信号。11例行超声监测下宫腔镜孕囊切除术,6例经阴道子宫瘢痕妊娠物切除联合子宫修补术;3例经开腹手术妊娠物切除,2例行子宫切除。结论：子宫瘢痕妊娠的MRI表现具有一定特征性,可为诊断及治疗方案的选择提供有价值的信息。     

Uterine endometrial stromal sarcoma located in uterine myometrium: MRI appearance

Two cases of uterine endometrial stromal sarcoma whose main mass was located in uterine myometrium are reported. They mimicked uterine leiomyoma with cystic degeneration or uterine leiomyosarcoma. Endometrial stromal sarcoma should be suggested in the differential diagnosis of mass lesion in uterine myometrium. Received: 9 March 1999; Revised: 2 September 1999; Accepted: 25 November 1999     

巨大子宫肌瘤的CT、MRI特征性分析

目的:探讨CT、MRI在巨大子宫肌瘤的诊断价值及巨大子宫肌瘤的CT、MRI特征。方法:回顾性总结18例经手术病理证实的巨大子宫肌瘤患者的CT和MRI表现,并将CT和MRI表现与手术病理结果进行对照。结果:肿瘤直径在15～20 Cm者8例,20～25cm者6例,25 cm以上者4例。11例位于浆膜下,7例位于肌壁间,黏膜下型无。12例CT检查5例为实性肿块,边界较清晰,平扫密度均匀,与子宫肌密度相当或偏低,7例为混杂密度灶,内可见玻璃样变性及坏死、囊变或黏液样变性,增强扫描实质部分明显强化,原低密度区不强化,1例为囊性低密度,增强扫描囊壁强化,其内无强化;6例MRI表现为肿块包膜完整,与周围脏器分界清晰,T_1WI为等或略低信号,T_2WI为中等信号,其内可见不规则高信号,注射Gd-DTPA后肿块明显强化,其内见不规则不强化灶,显示包膜更清晰,无强化。结论:CT、MRI可显示巨大子宫肌瘤较具特征的征象,特别是MRI有较好的软组织分辨力,可多方位成像,加上脂肪抑制技术,有利于显示肿块的成分与包膜,对诊断有较大的帮助。     

子宫切口妊娠的MRI表现

目的探讨剖宫产后子宫切口妊娠（cesarean scar pregnancy,CSP）的MRI表现及诊断价值。方法回顾性分析8例经手术病理证实的子宫切口妊娠患者的MRI表现,将MRI影像表现与手术及病理结果进行比较,总结其MRI特点。结果 8例子宫切口妊娠MRI均清楚显示孕囊,位于子宫峡部前壁切口瘢痕处,孕囊向子宫肌层浸润同时向宫腔内生长,局部子宫峡部前壁明显变薄。其中7例孕囊为圆形或椭圆形,呈T1WI低信号、T2WI高信号囊状信号特征,囊壁光滑。其中1例孕囊表现为包块影,形态欠规则,T1WI上呈等信号,T2WI呈混杂信号,包块内及宫腔内见少量积血。结论子宫切口妊娠MRI表现具有一定特点,对临床早期明确诊断及治疗具有重要价值。