低度恶性子宫内膜间质肉瘤的MR I诊断

目的：探讨低度恶性子宫内膜间质肉瘤(LGESS)的 MRI特点,提高对其诊断的准确性。方法回顾性分析经手术病理证实的4例LGESS病例的临床及MRI资料。全部病例均行MRI平扫。结果4例均表现为子宫不同程度的增大。病变直径5~12.1 cm,平均9 cm。3例位于宫腔内并累及子宫肌层,呈实性,结合带中断或消失,其中1例侵及膀胱、右侧输尿管、右侧输卵管及右侧卵巢；1例位于子宫肌层内,呈囊性,可见分隔和清晰的边界。3例实性肿瘤 MRI平扫表现为 T1 WI等信号,T2 WI稍高信号,1例信号欠均匀,其内及边缘可见增粗流空血管影；1例囊性肿瘤 MRI平扫表现为 T1 WI低信号,T2 WI高信号,内分隔呈低信号。3例合并子宫肌瘤,1例伴盆腔淋巴结转移。结论子宫内膜间质肉瘤好发于宫腔内,少数发生于子宫肌层,肿瘤多呈实性,也可呈囊性,多向子宫肌层浸润生长,肿瘤于T1 WI呈等或低信号,T2 WI呈高信号,信号可不均匀,其在 MRI 上有一定的特点,能为该病的正确诊断提供帮助。

MRI findings of low-grade endometrial stromal sarcoma

Objective To investigate the MRI characteristics of low-grade endometrial stromal sarcoma (LGESS),and to improve the accuracy of the diagnosis.Methods The clinical and MRI data of 4 cases with LGESS confirmed by surgery and pathology were analyzed retrospectively.All cases underwent conventional MRI scans.Results All 4 cases had enlarged uterus in different degrees. The average diameter of lesions was 9 cm (range from 5 cm to 12.1 cm).Uterine cavity masses were found in 3 cases,all of which were solid masses and invaded into myometrium exhibiting disconnection or disappearance of the connection band of uterus,and one of which involved the bladder and right ureter,oviduct and ovary.The solid tumors in 3 cases showed isointensity on T1 WI and slight hyperin-tensity on T2 WI,1 of which was heterogenous with dilated vascular void signal in the inner and peripheral portion.In addition, myometrial mass was found in 1 case,which was cystic with septum and clear boundaries.The cystic tumor showed hypointensity on T1 WI and hyperintensity on T2 WI with hypointensive internal septum.There were 3 cases accompanied with uterine leiomyoma, and 1 case with pelvic lymph node metastasis.Conclusion Most of endometrial stromal sarcomas are located in uterine cavity,a few in myometrium.The tumors are solid,few can also show cystic,showing invasive growth into myometrium.The manifestation of low-grade endometrial stromal sarcoma has a certain characteristics on MRI,which is low or iso-signal intensity on T1 WI and high signal intensity on T2 WI,the signal intensity may be heterogeneous,so MRI can provide help for the correct diagnosis of the disease.