子宫腺肌症低场MRI、超声及分子生物学综合评价

目的：探讨低场MRI、超声及分子生物学对子宫腺肌症的综合评价。方法：选择子宫腺肌症45例,术前均行超声（经腹、经阴道途径）、低场MRI检查,以及血清CA125、CA15—3、CA19—9测定,其中17例同时行离体标本MRI检查。分析各项检查的敏感度、特异性及准确度。结果：低场MRI检查敏感度为95．6％,特异度100．0％,准确度97．5%;经阴道超声为80．0%、88．9％、84．0%;经腹部超声为68．9％、83．3％、75．3％;血清CA125为46．7％、88．9％、65．4％;CA15—3为33．3％、94．4％、60．5％;CA19—9为15．6％、97．2％、51．8％。结论：对于子宫腺肌症的诊断,低场MRI是比较理想的检查手段;CA125测定优于CA15—3及CA19—9,可作为筛选检查。     

子宫腺肌症低场MRI诊断

目的　探讨低场MRI对子宫腺肌症的诊断价值。方法　回顾分析 18例经手术病理证实的子宫肌腺症低场MR影像征象。结果　弥漫性子宫腺肌症 15例 ,T2 WI及脂肪抑制像示结合带弥漫性增厚 ,厚度为 12 .0～ 3 2 .6mm ,平均 16.2mm ,其中 11例患者子宫肌层内低信号区内夹杂斑片状高信号影 ,典型者呈“飘雪征” ,4例为较均匀的低信号。T1WI上 6例子宫肌层内见少许斑点状高信号。局限性子宫腺肌症 (腺肌瘤 ) 3例共 4个病灶 ,病灶与周围组织分界不清。T2 WI及脂肪抑制成像上示类圆形或不规则形低信号或低信号内夹杂斑点状高信号 ,T1WI上 2个病灶内见斑点状高信号。结论　低场MRT2 WI及脂肪抑制成像技术对子宫腺肌症诊断有重要价值     

低场MRI对子宫腺肌症的诊断价值

目的探讨子宫腺肌症的低场（0．35T）MRI影像特点和鉴别诊断价值。方法回顾分析了14例经手术病理证实的子宫腺肌症的影像特征。结果弥漫性子宫腺肌症11例，T2WI结合带弥漫性增厚，厚度12．1～37．4mm，平均15．4mm，其中，8例患者子宫肌层低信号病灶内可见多发斑点状高信号影，典型者呈“飘雪征”，3例患者的病灶呈均匀的低信号；局限性子宫腺肌症3例，结合带局限性增厚或外肌层结合带样信号灶，2例患者T2WI混杂有斑点状高信号。结论子宫腺肌症MRI表现具有明显特征性和鉴别诊断价值。     

低场MRI与超声对诊断子宫腺肌症的比较

目的探讨低场（0．23T）MRI与超声对子宫腺肌症的诊断价值。方法由手术和病理证实的子宫腺肌症45例和对照组子宫肌瘤36例术前均行超声（经腹、经阴道途径）、MRI检查。比较各种方法的诊断敏感性、特异性、准确性、阳性预测值及阴性预测值。结果MRI柃查对子宫腺肌症的诊断敏感性为95．56％,特异性为100％,准确性97．53％,阳性预测值为100．00％,阴性预测值为97．74;经阴道超声分别为80．0％、88．89％、83．95％、90．00％、78．05％;经腹部超声分别为68．89％、83．33％、75.31％、83．78％、68．18％。结论对于子宫腺肌症的诊断,低场MRI为最有价值的检查手段,而经阴道超声又优于经腹部超声。     

子宫腺肌病MRI诊断(附16例分析)

目的 分析磁共振成像(MRI)技术对子宫腺肌病的诊断应用及其影像特征。方法 16例经临床证实的子宫腺肌病患者(平均年龄35岁,经产妇)和20例正常对照者(年龄相匹配的健康经产妇)均经常规矢状位、冠状位及轴位T_1与T_2加权快速自旋回波和T_2加权脂肪抑制MR成像。测量了全部病人与对照者子宫体前后、左右壁及基底顶部结合带最大厚度,并比较了两组间差异。结果 全部病人的T_2WI像上子宫肌层内见弥漫或局限囊泡状高信号,且明显高于对照组。病人组子宫体前后、左右壁及基底顶部结合带最大厚度(±SD)分别为8.8mm±4.2mm,8.6mm±4.2mm,及4.3mm±3.1mm,显著高于对照组的相应值5.3mm±2.5mm,5.2mm±2.6mm及2.8mm±1.3mm(P<0.001)。结论 子宫腺肌病不仅在矢状位与冠状位T_2加权像上有特征性表现,而且伴子宫各壁结合带的明显增厚。因此,MRI可作为诊断本病的首选方法。     

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.     

MRI诊断子宫腺肌病的价值

目的 :探讨MRI诊断子宫腺肌病的价值。材料和方法 :通过对 92例临床疑为子宫腺肌病 /子宫肌瘤的患者行MRI和超声检查 ,并与术后病理结果对比 ,以评估MRI对子宫腺肌病的诊断符合率。结果 :经术后病理检查证实 ,根据临床表现诊断子宫腺肌病准确性较差 ,痛经者 85 .6 %、月经改变 5 0 .0 % ;B超诊断子宫腺肌病的灵敏度 5 3 .4%、特异度 5 5 .9% ;MRI对该病诊断的灵敏度 94.5 %、特异度 10 0 % ;既能定性 ,又能定位 ,而且此检查无创伤 ,方便快捷。结论 :MRI为临床诊断子宫腺肌病提供了一种最有价值的检查方法 ,为及时、正确治疗该病带来了重要的临床意义。     

子宫腺肌症的MRI表现及诊断价值

目的探讨子宫腺肌症MRI特点及其诊断价值。方法回顾性分析经手术病理证实的31例子宫腺肌症的临床及MRI资料,应用自旋回波和快速自旋回波序列,常规行横断面FSE T2WI、SE T1WI及矢状面FSE T2WI扫描,其中10例病人加扫子宫解剖轴位及矢状位脂肪抑制FSE T2WI序列,分析其MR表现。结果弥漫性子宫腺肌症19例,以后壁结合带明显增厚为主的有11例。局限性子宫腺肌症12例,病变位于后壁7例,前壁4例,底部为主1例。28例T2WI呈与结合带信号相近的低信号影为主,内可见多发散在点状、小囊状高信号灶,21例T1WI呈与子宫肌层等信号,其中9例于T1WI也见点状、小囊状高信号。3例于肌层内见局限性类圆形结合带样信号。结论MRI可明确子宫腺肌症的范围及部位,脂肪抑制序列是非常有价值的检查方法。     

子宫腺肌症的MRI表现及诊断价值

子宫腺肌症的临床症状包括痛经,月经过多,异常子宫出血等。但该病的临床症状、体征和实验室指标均缺乏特征性,影像学检查在其临床术前诊断与评价中有重要作用。磁共振成像是一种无创性影像学检查手段,对子宫内膜、结合带和子宫肌层显示清晰,对该病的诊断有特异性,本文对经     

子宫腺肌症离体标本的MRI研究

目的 研究离体子宫腺肌症的MRI特征及其组织病理基础，为MRI诊断子宫腺肌症提供实验基础。资科与方法 对16个非子宫体病变、36个子宫腺肌症和30个子宫平滑肌瘤手术切除的新鲜子宫进行MRI扫描。全部标本均采用TSE序列T1WI、T2WI及IR序列T1WI，在各序列上观察正常子宫壁MRI结构及子宫腺肌症的MRI特征并与子宫平滑肌瘤比较，其结果与组织病理学对照。结果 MRI能显示正常子宫与组织学分层相关的2～4层结构。子宫腺肌症的MRI表现可以体现相关的病理基础，病灶表现为结合带弥漫性／局限性增厚或外肌层结合带祥信号灶，T2WI可混杂有局灶性高信号；当有陈旧性出血时，T1WI也可混杂局灶性高信号灶。子宫有不同程度的增大，轮廓光滑，有时可见子宫分层结构变形。根据这些特征有助与子宫肌瘤鉴别。结论 子宫腺肌症离体标本具有特征性的MRI征象，MRI在子宫腺肌症的诊断和鉴别诊断中有着重要作用。     

The utility of diffusion-weighted MR imaging in differentiation of uterine adenomyosis and leiomyoma

Purpose

To investigate the value of diffusion-weighted MR imaging (DWI), especially apparent diffusion coefficient (ADC) in the differentiation of uterine adenomyosis and leiomyoma.

Materials and methods

17 patients with uterine leiomyoma and 22 patients with uterine adenomyosis underwent diffusion-weighted imaging (DWI) in addition to routine MR imaging. The ADC values, as well as ADC D-value (defined as the ADC value of high signal intensive foci minus the ADC value of lesion tissues the difference in value), were measured and compared to investigate whether they could help in the differentiation of uterine adenomyosis and leiomyoma. Histopathologic examination was conducted as the golden standard.

Results

For high signal intensive foci within the lesions, uterine adenomyosis demonstrated significantly lower mean ADC value than uterine leiomyoma (1.582 vs. 2.122 × 10⁻³ mm²/s, P = 0.001). For lesion tissues, uterine adenomyosis demonstrated significantly higher mean ADC value than uterine leiomyoma (1.214 vs. 0.967 × 10⁻³ mm²/s, P = 0.001). However, there was overlap between uterine adenomyosis and leiomyoma in both measurements. Mean ADC D-value was significantly lower in uterine adenomyosis than in uterine leiomyoma (0.369 vs. 1.096 × 10⁻³ mm²/s, P = 0.000). ADC D-value had no overlap between uterine adenomyosis and leiomyoma.

Conclusion

DWI can be applied for the further differentiation of uterine adenomyosis and leiomyoma, in addition to routine MR imaging. ADC D-value may be a more useful tool than ADC value in the differentiation.     

MR imaging of uterine inversion

Inversion of the uterus is a postpartum complication that is an obstetric emergency. This report describes a case of inversion of the uterus in which clinical evaluation was inconclusive, and magnetic resonance (MR) of the pelvis revealed findings virtually pathognomonic of incomplete inversion of the uterus with far greater conspicuity than on corresponding ultrasound. The MR findings directly resulted in earlier therapeutic intervention with a possible decrease in morbidity.     

新生儿急性胆红素脑病的低场磁共振表现

目的 探讨急性胆红素脑病在低场磁共振的MRI表现.方法回顾分析15例急性胆红素脑病患儿的头颅MRI图像,同期的8例正常新生儿头颅MRI作对照.结果 15例急性胆红素脑病中,10例双侧苍白球T1WI呈对称性高信号,T2WI呈正常的稍高信号,其余5例未见明显异常.结论 低场MRI可较好地显示高胆红素血症对基底节苍白球的损伤,双侧苍白球T1WI对称性高信号是新生儿急性胆红素脑病的重要特征.     

子宫腺肌症的MRI表现及其病理学对照研究

目的：研究MRI在子宫腺肌症诊断中的应用价值。方法：对30例子宫腺肌症患者行矢状面快速自旋回波（Turbo SE)T1WI,T2TI,T1和T2频谱预饱和翻转恢复序列（T1SPIR和T2SPIR）扫描，必要时辅以横断面或冠状面扫描。所有病例均经手术病理证实。结果：弥漫型子宫腺肌症12例，在T2WI上表现为子宫结合带弥漫性增厚，厚度10－35mm，平均18mm，6例病变呈均匀低信号；6例病变内有散在的点高信号区，其中5例在T1WI仍表现为高信号。局限型子宫腺肌症（腺肌瘤）18例共23个病灶，在T2WI上表现为肌层内卵圆形，不规则形或类圆形肿块，呈与结合带信号相近的低信号，直径2．0－7.5cm，平均3.9cm，除1个病灶与周围肌组织有较清楚的界限外，其余病灶均与周围肌组织分界不清，15个病灶内有散在点状高信号区，其中12个在T1WI上也呈高信号，MRI上弥漫增厚的结合带和局限性低信号肿块，病理学上为异位内膜岛周围增生肥大的平滑肌，其内散在的点状信号区异异位内膜岛。仅在T2WI表现高信号的为示出血的内膜岛，在T1WI和T2WI均为高信号的为出血的内膜岛。结论：MRI是诊断子宫腺肌症的优越的无创性检查方法，T2WI最佳扫描序列，T2WI与T1WI，T1SPIR，T2SPIR4种序列相结合可大大提高断诊准确率。     

MR imaging of uterine cervical carcinoma

We retrospectively analyzed the magnetic resonance (MR) imaging findings of 20 consecutive patients with primary untreated carcinoma of the cervix who underwent surgery and one patient who underwent percutaneous needle biopsy of enlarged pelvic lymph nodes. Most of the patients were clinical Stage IB. The clinical assessment of the parametria in these patients was more accurate than the MR assessment of the parametria (95 versus 79%). Magnetic resonance was valuable for detecting metastatic pelvic lymphadenopathy. Enlarged pelvic lymph nodes (greater than 1.5 cm in diameter) were demonstrated by MR in all three patients with histologic verification of metastatic lymphadenopathy. In summary, the major therapeutic value of MR in patients with untreated cervical carcinoma is in assessing the pelvic lymph nodes. In patients with clinical Stage IB disease, MR assessment of the parametria does not add useful additional information.     

MR imaging of uterine sarcomas.

OBJECTIVE: The MR imaging appearances of uterine sarcomas are not well described in the literature. We describe the MR imaging features of uterine sarcomas. MATERIALS AND METHODS: MR images from all patients with histologically proven uterine sarcomas scanned between 1993 and 2000 were reviewed. Tumor size, its relationship to the uterus, signal characteristics, and enhancement pattern after IV injection of gadolinium were noted. RESULTS: Twenty-five scans from 22 patients were reviewed. Findings from the scans included 11 leiomyosarcomas, five mixed müllerian tumors, two rhabdosarcomas, and four endometrial stromal sarcomas. Two patterns of disease were observed, including a characteristic large heterogenous pelvic mass (n = 17) and an endometrial mass indistinguishable from endometrial carcinoma (n = 8). On T2-weighted images, the large masses were characteristically of low or intermediate background signal intensity with pockets of very high T2 signal. The areas of high T2 signal corresponded to cystic necrosis in the tumor. Pockets of high T1-weighted signal corresponded to hemorrhage. Gadolinium enhancement was present in the solid components of all tumors. This pattern was observed in all recurrent sarcomas. Some correlation was shown between the histologic subtypes and the MR imaging appearances. CONCLUSION: Uterine sarcomas show two patterns on MR imaging. The most common presentation is a large heterogenous mass. However, sarcomas can mimic endometrial carcinoma.     

MR imaging of diffuse adenomyosis changes after GnRH analog therapy

PURPOSE: To evaluate uterine changes on MRI before and after GnRH analog (GnRHa) treatment in diffuse adenomyosis. MATERIALS AND METHODS: Thirty-one patients with MRI features suggestive of diffuse adenomyosis received GnRHa for 6 months. Diffuse adenomyosis was sub-classified as: symmetric (symmetric/ entire widening of the junctional zone [JZ]) and asymmetric (asymmetric/ partial widening of JZ). Pre- and post-high signal intensity (SI) foci and JZ width, and post-demarcated change (interface of adenomyosis with the myometrium became more discrete with a concomitant decrease in JZ width) were analyzed. RESULTS: Before therapy, 15 of 18 asymmetric contained high SI foci compared to none of symmetric. After therapy, JZ width decreased (P < 0.0001). Eight asymmetric and none of symmetric showed demarcated change with resolved high SI foci. CONCLUSION: Our results suggest the use of GnRHa is associated with a decrease of JZ width in adenomyosis. Asymmetric adenomyosis with high SI foci appears to be the most sensitive to hormonal therapy.