脂肪抑制序列在子宫腺肌病磁共振成像诊断中的价值

目的 :研究脂肪抑制序列 (fat suppression ,FS)在子宫腺肌病磁共振成像(MRI)诊断中的价值。方法 :对子宫腺肌病 30例行矢状面快速自旋回波 (TurboSE)T1WI、T2 WI和FS扫描 ,后者采用光谱预饱和反转恢复序列 (spectralpresaturationinversionrecov ery ,SPIR) ,包括T1/SPIR和T2 /SPIR。结果 :单独根据T2 WI或T2 /SPIR像对子宫腺肌病进行诊断 ,两者的诊断准确率差异无显著性 (P <0 .0 5 ) ,均可作为子宫腺肌病诊断的常规序列。T2 WI的表现更接近于病理 ,T2 /SPIR像则更能清楚地显示病变的边界 ,因而有利于病变径线的测量。单独根据T1WI或T1/SPIR像无助于发现子宫腺肌病低信号病变 ,对出血性异位子宫内膜岛的发现却有特异性 ,且T1/SPIR像显示得更为清晰。结论 :4种扫描序列结合有利于全面显示病变。FS在子宫腺肌病的MRI诊断中具有重要作用。     

磁共振成像在子宫内膜癌分期中的应用价值研究

目的 :探讨MRI在子宫内膜癌分期和判断子宫肌层浸润深度中的价值。方法 :经诊断性刮宫病理学证实的子宫内膜癌 30例经MRI检查后行手术治疗 ,依据FIGO分期原则 ,将MRI分期与手术后病理检查结果进行比较。MRI检查采取矢状位和轴位SE序列T1WI和T2 WI及T1和T2 频谱预饱和翻转恢复序列 (T1/SPIR和T2 /SPIR) ,其中 18例行增强后T1WI扫描。结果 :MRI分期准确率为 86 .6 % ,判断子宫肌层浸润深度的准确率为 85 .6 %。结论 :MRI对子宫内膜癌术前分期和子宫肌层浸润定位具有较高的价值。     

子宫内膜小细胞癌伴内膜样腺癌1例报道

<正>1病例简介患者,G_0P_0,59岁,因"绝经后15年,阴道不规则流血伴下腹坠痛1月"于2016年7月收入院。妇科检查无明显异常,肿瘤标记物均未升高。妇科彩超示:内膜厚1.0cm,回声不均质,宫腔上段1.4cm伊0.8cm囊实性回声,囊性部分内透声尚可,实性部分未探及明显血流信号。盆腔MRI示:宫底部宫腔内见等T1略短T2信号软组织影,DWI高信号,扫描强度与肌层强化程度相似。宫腔内见少量短T2低信号,宫腔下段及宫颈管黏膜增厚,增强扫描低强化,并见多个囊性     

重症病毒性脑炎患儿的磁共振影像特点

目的探讨儿童重症病毒性脑炎磁共振(MRI)影像的特点及其临床意义。方法回顾分析福建医科大学附属第一医院2004-06—2005-10经临床确诊的30例儿童重症病毒性脑炎MRI及临床资料，所有病例常规做SE序列：轴位、矢状位T1WI、T2WI，必要时加扫T2WI冠状位；6例加扫弥散加权成像(DWI)。 结果25例MRI影像发现异常，主要表现为T1WI呈稍低或等信号，T2WI呈稍高异常信号，DWI呈明显高信号，表观弥散系数(ADC)值降低。 结论MRI可早期发现病毒性脑炎，是病毒性脑炎影像学检查的首选方法，对病毒性脑炎的定位、早期诊断、病情严重性及预后评价具有重要价值；DWI比T2WI显示病变更清晰且能作定量评价；MRI表现病灶累及范围越广泛，则病情越重，预后越差。     

子痫脑病的影像学表现及其临床意义

目的:对子痫引起的脑后部可逆性病变(子痫脑病)的影像学表现进行分析,加深对本病的认识。方法:回顾性分析我院2015年3月至2016年3月9例子痫脑病患者的临床表现、CT检查、MRI检查资料。9例行CT检查及磁共振成像(MRI)检查,5例于314天后复查MRI。结果:9例CT平扫为不规则形低密度区;MRI平扫T1WI上低信号,T2WI及T2Fliar呈高信号,扩散加权成像(DWI)病灶呈高信号,弥散表观系数(ADC)图上呈高信号。7例增强扫描均未见强化。3例行磁共振血管成像(MRA)均未发现特殊。1例患者磁共振静脉血管成像(MRV)检查正常。经治疗后5例复查MRI,3例显示病灶完全消失,病灶范围明显缩小者2例。病变主要以双侧顶枕叶为主,其次是额叶和颞叶,基底节区和小脑半球亦有累及。临床出现抽搐9例,头痛7例、视物模糊1例,意识障碍4例。治疗后症状缓解或消失,实验室指标恢复正常。结论:子痫脑病常急性起病,收缩压及舒张压均突然增高。影像学表现非常具有特征性,MRI扩散加权成像对鉴别诊断及早期明确诊断和指导治疗有重要的意义。     

早产儿脑白质损伤早期磁共振成像改变及其高危因素分析

摘要：目的　以磁共振成像（MRI）提供的影像学资料为依据,评价早产儿脑白质损伤的早期MRI变化及其临床意义,并探讨其高危因素。方法　选取2007年9月至2009年9月中国医科大学附属盛京医院儿科收治的262例早产儿,全部在7 d内完成磁共振检查,根据MRI诊断早产儿脑白质损伤,分为病例组134例,对照组128例。并对病例组29例患儿进行二次复查。结果　（1）早产儿脑白质损伤早期,局灶性病变表现弥散加权成像（DWI）高信号,T1加权（T1WI）信号正常或稍高信号,伴有或不伴有T2加权（T2WI）低信号;弥漫性脑白质损伤仅能看到DWI弥漫性高信号,常规MRI无信号改变。复查结果,局灶性病变有两种情况：一是病灶消失,二是DWI高信号消失或稍高信号,T1WI高信号,伴或不伴有T2WI低信号;弥漫性病变,发生脑室周围白质软化,表现为T2WI高信号或高低混杂信号, DWI异常信号消失或高低混杂信号,T1WI高低混杂信号。（2）病例组与对照组在胎龄,出生体重差异无统计学意义。单因素分析：母孕期感染、双胎、代谢性酸中毒、低钙、低氧、机械通气和感染与早产儿早期脑白质损伤有统计学意义。Logistic模型多因素分析,母孕期感染、低氧和胎儿宫内窘迫是早产儿早期脑白质损伤的危险因素。结论　（1）DWI能发现早期脑白质损伤病变。（2）早产儿脑白质损伤是多种因素相互作用的结果：母孕期感染、胎儿宫内窘迫及出生后低氧与早产儿早期脑白质损伤有密切关系。（3）早产儿脑白质损伤早期临床表现缺乏特异性,建议常规行头MRI检查,且脑白质信号异常均需要动态随访观察。     

急性胆红素脑病磁共振成像特征及其与预后关系的研究

摘要：目的　探讨急性胆红素脑病的磁共振成像（MRI）特征及其与预后的关系。方法　回顾性分析2006年5月至2008年4月温州医学院附属第二医院暨育英儿童医院新生儿科11例急性胆红素脑病患儿的头颅MRI图像 ,以同期6例正常新生儿头颅MRI作对照。结果　11例急性胆红素脑病中,8例双侧苍白球在T1WI呈对称性高信号,在T2WI呈正常的稍高信号,其余3例未见明显异常。对5例急性胆红素脑病患儿进行了随访研究,初次MRI异常的3例诊断为手足徐动型脑性瘫痪,其双侧苍白球T1WI上的高信号消失, T2WI上正常的稍高信号转为对称性高信号;初次MRI正常和异常各1例,临床随访神经发育均正常。结论　双侧苍白球在T1WI呈对称性高信号是急性胆红素脑病相对特征性表现,由于病例数较少,MRI图像特征与临床预后的关系尚须进一步研究。     

经阴道超声诊断子宫内膜病变的诊断效果

目的 研究子宫内膜病变经阴道超声诊断的效果。方法 选取80例疑似子宫内膜病变患者,经病理学检查后确诊。给予患者经阴道超声和经腹部超声检查,比较两种检查手段的诊断结果、诊断效能、子宫内膜病变类型诊断结果。结果 80例疑似子宫内膜病变患者,经病理学检查后确诊为子宫内膜恶性病变12例,良性病变68例。两种检查方式的敏感度、特异度、准确率对比,差异有统计学意义（P<0.05）。经阴道超声与经腹部超声不同病变类型检出结果对比,差异有统计学意义（P<0.05）。影像学表现：子宫内膜癌：子宫形态增大,宫腔增大。超声显示子宫内膜增厚,呈不规则低回声,回声不均匀,宫腔内出现息肉样肿物,边缘不光滑,回声不均匀及液体积聚。宫腔内有丰富的血流信号,这些信号为网状形式。血管形态分布不规则。子宫黏膜下肌瘤：超声图像清晰,黏膜下肌瘤是类圆形或扁椭圆形,宫腔内回声团较低。子宫内膜息肉：边缘有较高回声,子宫内膜息肉与子宫肌层分界清晰。结论 经阴道超声诊断子宫内膜病变诊断效果显著,诊断准确率高,在子宫内膜病变类型鉴别上具有应用优势。     

卵巢颗粒细胞瘤二例并文献复习

一、病例摘要例1：患者49岁,查体发现盆腔包块1个月余,近期患者自述有阴道不规则出血,量少,无腹痛、腹胀、下坠感等不适,妇科检查于子宫前方可触及一实性包块,边界清,活动可。2009年6月4日MRI检查发现盆腔内子宫前方、偏右侧见一实性软组织团块影,呈等T1稍长T2信号,边界清楚,周围可见低信号包膜,大小约7.3cm×5.6cm×6.2cm,其内信号不均匀,未见囊性成分,增强扫描病变明显不均匀强化。病变与子宫前壁分界尚清,膀胱受压。子宫大小约5cm×8cm,子宫内膜未见增厚。     

穿透型胎盘植入并累及膀胱超声表现及临床结局

目的:探讨穿透型胎盘植入并累及膀胱的超声表现特点。方法:2012年3月至6月我院收治不规则阴道流血可疑胎盘植入孕妇3例,年龄26～32岁,孕周17～34周,均为单胎。3例孕妇均有剖宫产史和反复流产史。所有患者均接受超声检查,例2和例3同时接受MRI检查,例1和例2同时接受膀胱镜检查。结果:(1)超声表现特点:均为完全性前置胎盘;胎盘实质中可见多个不规则胎盘陷窝,CDFI显示陷窝近子宫肌层处血流丰富,中部有时无明显血流信号;胎盘后方正常肌层消失,子宫前壁与膀胱后壁之间界限不清;例2子宫前壁与膀胱后壁之间探及筛孔样低回声,并见较丰富血流信号,相邻膀胱黏膜连续性似有中断;膀胱略充盈时经阴道超声检查较经腹超声检查图像更清晰。(2)MRI及膀胱镜检查结果:例2行MRI检查见胎盘完全覆盖宫颈内口,其内见丰富血管流空,增强扫描呈明显强化,宫腔内见混杂信号,宫体上部肌层增厚。例3 MRI结果显示胎盘增厚,覆盖宫颈内口,子宫壁肌层菲薄,胎盘与子宫肌层关系密切。例1和例2患者行膀胱镜检查显示部分膀胱后壁及三角区(输尿管嵴周围)黏膜充血明显,双输尿管口可见牵拉变形。(3)治疗及预后:3例均行剖宫取胎术,其中例1因术中出血严重,行全子宫切除。结论:当有剖宫产史和子宫疤痕的孕妇超声检查发现前置胎盘时,应高度警惕是否有胎盘植入的可能;胎盘实质和后方肌层的异常变化以及与膀胱后壁的关系是超声诊断穿透性胎盘植入及是否累及膀胱的重要观察内容。     

Role of magnetic resonance imaging (MRI) in evaluation of the extension of endometrial carcinoma

The extent of endometrial carcinoma in Magnetic Resonance Imaging (MRI) was compared with that of histopathological findings. There was a significant positive correlation between the MRI values and the measured tissue specimen values for the minimum thickness of the residual myometrium (r = 0.8608; p less than 0.001). Twenty patients in the present study were divided into two groups according to myometrial invasion. Six patients (Group A) met the following criteria: (1) the area occupied by a high intensity lesion in the uterine body in the sagittal image is 50% or less, (2) the area occupied by a high intensity lesion in the uterine body in the transverse image is 50% or less, (3) the minimum thickness of the myometrium is 0.5 cm or more, and (4) the maximum-minimum ratio of myometrial thickness is 0.5 or more. Fourteen patients (Group B) did not meet these conditions. Myometrial invasion of carcinoma exceeding 1/3 of the myometrial thickness was not observed in any patient in Group A. A significantly greater percentage (86%) of Group B patients had myometrial invasion. Vessel permeation of carcinoma and metastasis was detected in 5 and 2 patients in Group B, respectively, but no patient in Group A had either vessel permeation or metastasis. A junctional zone was seen in 10 of 20 patients, and the carcinomatous lesions were limited to the endometrium in 2 patients, in which the junctional zone was not disrupted. In the other 8 patients, the localization of disruption of this zone corresponded to that of myometrial invasion. The sensitivity, specificity, and accuracy of MRI evaluation in the presence or absence of cervical involvement were 0.71, 0.92 and 0.85, respectively.     

Spectrum of MR features in adenomyosis

Magnetic resonance (MR) imaging is a highly accurate non-invasive technique for the diagnosis of adenomyosis. Typical MR features include either diffuse or focal thickening of the junctional zone or an ill-defined area of low signal intensity in the myometrium on T2-weighted MR images. Occasionally, the islands of ectopic endometrial tissue can be identified as punctate foci of high signal intensity. Less commonly, adenomyosis can present as a well-circumscribed form known as adenomyoma, adenomyotic cyst characterized by the presence of haemorrhagic cyst, or adenomyomatous polyp protruding into the uterine cavity. The MR appearances of adenomyosis may occasionally fluctuate in response to hormonal stimulation and treatment. MR imaging is helpful not only in monitoring the treatment effect of hormonal therapy, but also in predicting therapeutic effect. In cases of endometrial cancer in the uterus with adenomyosis, evaluation of myometrial invasion may become difficult. Rarely, endometrial cancer may arise directly from adenomyosis resulting from malignant transformation of endometrial glands, creating diagnostic challenges. Differential diagnosis of adenomyosis on MR imaging include physiological myometrial contraction and almost all myometrial lesions, and they should be carefully differentiated from adenomyosis by identifying typical clinical and MR features in these lesions. Precise knowledge of the spectrum of MR features in adenomyosis greatly helps in determining an accurate diagnosis and appropriate management of the patients.     

Is magnetic resonance imaging a useful aid in confirming the diagnosis of nonmetastatic gestational trophoblastic neoplasia?

Magnetic Resonance Imaging (MRI) of the pelvis was performed in 25 patients with rising or persistently elevated levels of human chorionic gonadotrophin (hCG) after hydatidiform mole evacuation to determine whether this type of imaging would help confirm a diagnosis of neoplasia based on hCG measurement alone. All patients had low risk disease. The images were assessed for the presence of a myometrial mass, increased uterine vascularity, increased myometrial signal and the integrity of the junctional zone.
A myometrial mass was present significantly more frequently in patients with high hCG compared to those with low hCG ( P = 0.017). The junctional zone also was disrupted more frequently in patients with an hCG greater then 1500 mIU/ml although this finding is not specific for trophoblastic neoplasia. There was no correlation of the presence of vascularity or of increased myometrial signal with the level of hCG. Patients with an hCG of less than 700 mIU/ml showed only occasional MRI abnormality. One patient with an abnormal MRI during an hCG plateau achieved spontaneous regression. MRI frequently shows abnormalities of uterine architecture, but provides no superior clinical information than sequential hCG. The MRI appearance may be abnormal with spontaneous hCG remission while at persistent low levels of hCG when chemotherapy is clearly indicated the MRI appearances of the uterus show no abnormality.     

Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma

OBJECTIVES: To retrospectively evaluate the accuracy of magnetic resonance (MR) imaging for the prediction of depth of myometrial invasion in the preoperative assessment of women with endometrial carcinoma. METHODS: We retrospectively reviewed the medical records and MR imaging reports of 120 women with pathologically-proven endometrial carcinoma who underwent preoperative pelvic MR imaging between June 1997 and February 2006. Tumor signal intensity, the appearance of the junctional zone (JZ), the presence of large polypoid tumors and leiomyomas were analyzed. Univariate logistic-regression analysis was performed to identify associations between incorrect MR staging and the study variables. RESULTS: Data from 120 patients were registered for the current study and analyzed. The sensitivity, specificity and accuracy of the MR imaging in assessment of myometrial invasion among patients with endometrial carcinoma were: 50.6%, 89.2% and 62.5% respectively. MR differentiation of deep myometrial invasion from superficial disease had an 83.3% accuracy (100 of 120 cases). Isointense JZ to myometrium (P<0.001), and the presence of polypoid tumors (P=0.037) on MR imaging were significantly associated with an underestimation of myometrial invasion by endometrial carcinoma. CONCLUSIONS: Isointense JZ to myometrium and polypoid tumors are difficult to accurately evaluate for myometrial invasion of endometrial carcinoma by MR imaging.     

Histopathological study of placental bed biopsy in placenta previa

BACKGROUND: To study placental bed biopsy changes in placenta previa and normally implanted placenta. SUBJECT AND METHOD: Fifty placental bed biopsies from 50 patients with placenta previa and 50 placental bed biopsies from normally implanted placenta were taken at cesarean section. Placental bed biopsy was stained with hematoxyline and eosin for histological examination. Both the groups were compared for trophoblastic invasion and vascular changes of placental bed spiral arteries. Statistical analysis was done by Chi-square test. RESULTS: Placenta bed biopsy was representative in 42/50 (84%) biopsy samples of the study group (placenta previa) and 35/50 (70%) of the control group (normally located placenta). Trophoblastic giant cell migration into decidua was present in 100% of representative samples of both the groups while migration into myometrium was seen in 66.67% and 51.14% of samples of study and control group. Average number of trophoblastic giant cells per sample was significantly higher in placenta previa (decidua 41.3%, myometrium 52%) than the control group (decidua 17.4%; myometrium 14.5%). Trophoblastic giant cell infiltration into myometrial spiral arterioles was higher in placenta previa (81.83 cells per vessel). Percentage of myometrial spiral arterioles showing physiological changes was significantly higher in the study group (50.39%) compared to the control group (21.14%). Incidence of inflammatory cell infiltration was higher in the study group (42.86%). Hemorrhage into decidua and myometrium were seen in biopsy samples of the placenta previa. CONCLUSION: Placenta previa is associated with significantly higher trophoblastic giant cell infiltration and physiological changes of the myometrial spiral arterioles.     

Uterine adenomyosis: a need for uniform terminology and consensus classification

Modern imaging techniques allow non-invasive diagnosis of adenomyosis, a relatively common disorder characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with hyperplasia of the adjacent smooth muscle. The study of adenomyosis is greatly hampered by a lack of clear terminology and the absence of a consensus classification of the lesions. Any classification of adenomyosis must begin with an evaluation of the myometrium underlying the endometrium, the so-called junctional zone, since homogeneous thickening of this zone has become the standard criterion for non-invasive diagnosis. Although transvaginal sonography is useful for the detection of adenomyosis, the technique is highly operator dependent. Magnetic resonance imaging provides superior soft tissue resolution and currently represents the most accurate technique for non-invasive diagnosis. Adenomyosis represents a spectrum of lesions, ranging from increased thickness of the junctional zone to overt adenomyosis and adenomyomas, which in turn can be subclassified. It is increasingly recognized that adenomyosis is often associated with pelvic endometriosis yet the contribution of myometrial lesions to clinical symptoms, such as infertility and pain, remains poorly understood. Moreover, recent studies indicate that adenomyosis is a progressive disease that changes in appearance during the reproductive years. A consensus classification of uterine adenomyosis is urgently required.     

Exaggerated placental site reaction detected during caesarean delivery: a case report

Exaggerated placental site (EPS) reaction is an exuberant physiologic process in which intermediate trophoblasts infiltrate the underlying endometrium and myometrium at the implantation site. During a caesarean section, we noted a polypoid well shaped smooth lesion, about 3 cm in diameter on the anterior wall of the uterus apart from the placenta. The histopathologic examination revealed an exuberant proliferation of trophoblastic cells in the placental site, a low Ki-67 labelling index and the absence of mitotic activity. Distinguishing EPS reaction from the other intermediate trophoblastic tumours is critical, as the latter may likely involve surgical intervention and/or chemotherapy, although no specific treatment and follow-up is required for EPS reaction. It is necessary to be aware of this pathology and take biopsies from suspicious lesions in the placental site for pathologic examination.     

Clinical application of magnetic resonance imaging (MRI) in uterine disease

We investigated the value of MRI in investigating uterine anatomy and disease. 1. Normal uterus: The signal intensity and endometrial thickness changed during the menstrual cycle. Endometrial thickness in the secretory phase was 12.8 +/- 3.6 mm, significantly greater than in the proliferative phase (5.4 +/- 0.7 mm, p less than 0.01). In contrast, endometrial thickness was reduced in postmenopausal women (4.1 +/- 0.9 mm) and was never over 6 mm. 2. Uterine disease: a. T2-weighted images were useful in differentiating leiomyoma and adenomyosis. Leiomyomas appeared as well-circumscribed nodules with sharp margins, while adenomyosis was seen as a low signal intensity area with an irregular border extending beneath the endometrium. b. In endometrial carcinoma, endometrial thickening with a high signal intensity was a characteristic of T2-weighted images, the maximal thickness being 16.5 +/- 6.9 mm. Moreover, endometrial carcinomas invading over 1/3 of the myometrium showed the following features: (1) The ratio of maximal endometrial thickness to uterine cross sectional diameter was over 50%. (2) The minimal myometrial thickness was under 5.0 mm. (3) The minimal to maximal myometrial thickness ratio was under 50%. Furthermore, cervical extension could be detected in all cases of endometrial carcinoma extending to the myometrium in T2-weighted images.     

Spontaneous intramyometrial pregnancy mimicking an intramural myoma: a diagnostic challenge

This study describes the diagnosis and treatment of a spontaneous intramyometrial pregnancy by a case report and review of the literature at a university hospital center. A 24-year-old woman presented with a spontaneous intramyometrial pregnancy without any previous uterine surgery. Successful laparoscopic resection and myometrial correction were performed. The presence of trophoblastic tissue was confirmed and the myometrium revealed complete healing at postoperative MRI. Intramyometrial pregnancy can occur without previous uterine surgery or uterine manipulation and may be difficult to diagnose. Conservative laparoscopic excision is possible without damage to myometrial integrity.