恶性滋养细胞肿瘤的超声及MRI诊断价值

目的：探讨超声及MRI检查在恶性滋养细胞肿瘤的诊断价值，提高对本病的认识。方法：搜集经临床病理及随访证实的恶性滋养细胞肿瘤24例，其中侵蚀性葡萄胎21例，绒毛膜癌3例。年龄21—52岁，平均37．3岁。回顾性分析其超声及MRI表现特点。结果：24例中，超声均显示子宫不同程度增大，内膜毛糙及不规则增厚21例；侵犯肌层，回声不均匀15例；宫腔内呈“蜂窝征”或“雪花征”回声14例，宫旁侵犯2例。MIU亦均显示子宫不同程度增大；21例内膜完整性破坏，肌层不规则增厚；官腔内信号较混杂，在T2WI及STIR序列呈高、低混杂的“蜂窝征”或“葡萄串征”，未侵犯肌层3例；宫旁侵犯而显示盆腔内肿块形成5例；5例动态增强后部分病灶早期强化。结论：超声、临床表现及血HCG三者结合可明确诊断；MRI有利观察肌层、宫旁侵犯，可为手术提供清晰的解剖图示。

Diagnostic value of MRI and ultrasonography in malignant trophoblastic tumor

Objective：To investigate the diagnostic value of uhrasonography and MRI in malignant troplioblastic tumor so as to improve file knowledgement of it. Methods：24 cases （age from 21 to 52 years, mean 37.3 years） with malignant trophoblasfic tumor proved by clinical pathology were collected in the study. 21 cases were invasive mole, 3 eases were choriocarcinoma. All cases had undergone plain MRI scan and 5 cases were examined by contrast-enhanced scanning. Their uhrasonography and MRI features were retrospectively analyzed. Results：AU eases showed the uterus increased with varying degree on Ultrasound. 21 cases endometrium thickened irregularly, muscular layers with abnormal echo were irregularly destroyed. Intrauterine echo was “cellular levy”or “snowflake sign” in 14 eases, Parametrinm was violated in 2 eases. The uterus in all cases increased with varying degree on MRI, The endometrial integrity and muscular layers in 21 eases were destroyed irregularly, the signal in uterus cavity was heterogeneous, some showed high-and low-mixed signal like “honeycomb” and “grape” on T2-weighted and fat-suppression images, 3 eases without muscular layer violated. 5 eases displayed violated parametrium and pelvic masses. 5 eases with dynamic contrast-enhanced showed that part of the lesions were enhanced in the earlyphase. Condusion： Combined ultrasonography and clinic, blood HCG can give a define diagnesis. MRI is helpful for the observation of muscle and parametrium violations and can provide a clear anatomy icon for the operation.