子宫内膜浆液性乳头状癌的MRI表现

目的:探讨子宫内膜浆液性乳头状癌(UPSC)的MRI表现。方法:回顾性对比分析我院经手术病理证实的19例UPSC及38例子宫内膜样腺癌(EAC)患者的MRI表现。结果:UPSC患者的平均发病年龄(59.0岁)大于EAC患者(51.8岁);在T₂WI上,UPSC信号较EAC更不均匀(发生率分别为84.21%和44.74%),囊变坏死(分别为42.11%和5.26%)、出血(分别为21.05%和0)的发生率更高,且病灶中可见小梁样低信号影(发生率分别为31.58%和0);UPSC的ADC值较EAC低,两者分别为(0.68±0.15)、(0.84±0.15)×10^-3mm²/s;UPSC的≥1/2肌层浸润深度比例较EAC高(分别为57.89%和42.11%);UPSC以进行性强化为主(84.21%),而EAC以早期强化为主(78.95%);以上结果两者差异均有统计学意义(P值<0.05)。UPSC与EAC病灶的最大径均值分别为(5.1±3.8)、(3.2±1.9)cm,两者的病灶形态均以肿块型为主,强化程度均以中度-明显强化为主,以上结果两者差异均无统计学意义(P值均>0.05)。结论:相对于EAC,UPSC具有肌层浸润程度深,病灶内易囊变坏死及出血,并可见特异性小梁状短T₂信号结构,DWI上扩散受限更明显,增强呈进行性强化等MRI表现。

MRI manifestations of uterine papillary serous carcinoma

Objective:To investigate the MR findings of uterine papillary serous carcinoma(UPSC).Methods:We retrospectively reviewed the MR imaging findings of 16 patients with histologically proven UPSC and 32 patients with endometrial adenocarcinoma(EAC).Results:The mean onset age was 59.0 years for UPSC and 51.8 years for EAC,respectively(P<0.05).On T₂WI,UPSC lesions showed more heterogeneous signal intensity than that of EAC(84.21%vs 44.74%,P<0.05).The incidence of cystic degeneration/necrosis and hemorrhage in UPSC mass was higher than that of EAC(42.11%vs 5.26%,and 21.05%vs 0,respectively,both P<0.05).Hypointense trabecular meshwork was more common in the UPSC lesions than EAC(31.58%vs 0,P<0.05).The ADC value of UPSC was(0.68±0.15)×10^-3mm²/s,which was significantly lower than that of EAC(0.84±0.15)×10^-3 mm²/s(P<0.05).The proportion of invasion equal to or more than half of the myometrium in UPSC lesion was higher than that of EAC(57.89%vs 42.11%,P<0.05).UPSC lesions mainly showed wash-in appearance enhancements,while EAC lesions frequently showed wash-out appearance(84.21%vs 78.95%,P<0.05).The mean maximum diameter of the lesions in UPSC and EAC were(5.1±3.8)cm and(3.2±1.9)cm,respectively(P>0.05).The growth pattern of the lesions in both tumors was mainly mass type(P>0.05).After administration of Gd-DTPA,both UPSC and EAC lesions showed moderate to intense enhancement(P>0.05).Conclusion:Compared with EAC,UPSC showed deeper myometrial invasion,more cystic degeneration/necrosis,hemorrhage,specific hypointense trabecular meshwork on T₂WI,lower ADC values on DWI,and wash-in appearance enhancement of the lesions.