阴道斜隔综合征影像学诊断

目的:探讨阴道斜隔综合征的影像学表现。方法:回顾性分析5例阴道斜隔综合征的临床及影像表现。结果:2例行子宫输卵管造影检查,1例显示单角子宫,1例显示双子宫,2例均显示隔后腔及阴道斜隔上的瘘管。4例行CT检查,均显示双子宫、双宫颈、双阴道,其中斜隔侧阴道远端闭锁形成隔后腔。5例均经B超、CT或静脉肾盂造影(IVP)证实伴有斜隔侧肾及输尿管缺如。5例中右侧斜隔4例,左侧斜隔1例。所有患者均为双子宫、双宫颈、双阴道,一侧阴道完全或不完全闭锁及斜隔侧肾、输尿管缺如为特征。结论:阴道斜隔综合征的影像学表现具有一定特征性,影像学检查对该病的诊断具有重要价值。     

阴道斜隔综合征的影像学特征及诊断价值

目的 探讨阴道斜隔综合征的影像学表现及其诊断价值.方法 回顾性分析13例阴道斜隔综合征患者的临床及影像学资料并复习相关文献.13例术前均行超声检查,其中8例行MRI检查,并行CT检查3例.分析斜隔的位置,隔后腔的大小,隔后腔与宫颈的位置关系,双侧附件及泌尿系的伴发改变.结果 超声、MRI检查均表现为双子宫、双宫颈、双阴道且一侧阴道闭锁,斜隔起于两侧宫颈之间,斜行附着于一侧阴道壁,遮蔽该侧宫颈;斜隔位于右侧4例,左侧9例;6例 Ⅰ 型隔后腔容积平均为255 mL,6例Ⅱ型隔后腔容积平均为74 mL,1例Ⅲ型隔后腔容积为56 mL;合并斜隔侧输卵积血2例,合并斜隔侧卵巢巧克力囊肿1例;伴斜隔侧肾缺如12例,伴斜隔侧肾发育不全1例.3例CT检查均表现为双子宫、双宫颈,一侧宫颈下方囊状低密度影及同侧肾缺如.结论 阴道斜隔综合征的影像学表现颇具特征性.超声、CT和MRI对准确诊断有一定价值.     

阴道斜隔综合征的MRI诊断

【摘要】目的：探讨MRI对阴道斜隔综合征中的诊断价值。方法：对39例阴道斜隔综合征患者的MRI图像进行回顾性分析,以手术术中所见为确诊标准。结果：39例阴道斜隔综合征中,Ⅰ型9例,Ⅱ型24例,Ⅲ型6例。斜隔发生于右侧者26例,发生于左侧者13例。同时伴有的子宫畸形为：双子宫畸形26例,双角子宫6例,完全纵隔子宫7例。36例伴斜隔同侧肾脏缺如。盆腔内其他病变：盆腔积液34例;内膜样囊肿4例;一侧输卵管积血或积液7例。本组MRI诊断Ⅰ型 或Ⅱ型共33例,其中发现斜隔上小孔从而确诊为II型的为2例,Ⅲ型6例,全部诊断准确。结论：MRI可以准确诊断阴道斜隔综合征,对该病诊断有重要的应用价值。     

阴道斜隔综合征的M RI影像表现

目的：通过MR成像对罕见阴道斜隔综合征进行全面的认识。方法回顾性分析7例阴道斜隔综合征患者（6例为青少年,1例为流产孕妇）,均行常规MRI（横断面T1WI、T2WI ,冠状面T2WI）及增强扫描。结果7例阴道斜隔综合征,MR主要表现如下：双子宫、双宫颈畸形7例;右侧斜隔5例、均合并右肾缺如,其中2例伴右侧盲端输尿管异位开口、1例子宫内膜异位膀胱后壁;左侧斜隔2例,1例左肾缺如、1例右侧盆腔异位肾;斜隔侧隔后腔积血5例,隔后腔内混杂性血性肿块1例（流产孕妇）,斜隔侧阴道扩张积液1例（误诊术后病例）;对侧阴道积液2例,阴道少许积血3例,阴道正常2例（1例误诊术后病例,1例流产孕妇）。结论阴道斜隔综合征是一种泌尿生殖系统发育畸形,M RI检查不仅较直观地显示双子宫畸形、斜隔侧隔后腔积血以及同侧肾缺如等常见情况,而且在发现异位肾、盲端输尿管异位开口以及子宫内膜异位膀胱后壁等罕见情况也具有明显的优势。     

Herlyn-Werner-Wunderlich综合征的影像特征

目的 探讨Herlyn-Werner-Wunderlich综合征(HWWS)的影像特征.方法 回顾性分析经临床诊断的11例HWWS患者资料,行腹、盆腔CT和(或)MRI检查,分析其影像特征.结果 11例患者腹、盆腔CT和(或)MRI上均表现为双子宫、双宫颈、双阴道并一侧肾缺如,其中左侧5例,右侧6例.8例合并斜隔侧子宫、宫颈内积血、积液,左侧5例,右侧3例,CT平扫表现为稍高密度,增强后无强化,MRI T1WI呈高信号,T2WI呈低或混杂信号.2例合并子宫多发肌瘤(肌壁间).1例合并右侧卵巢子宫内膜异位.1例合并阴道癌并淋巴结转移.结论 HWWS的影像表现具有特征性,影像学检查特别是MRI可以提供更多的信息.     

阴道斜隔综合征的MR影像特征

目的探讨阴道斜隔综合征(Herlyn-Werner-Wunderlich综合征)的MR影像特征及鉴别诊断。方法回顾性分析经宫腔镜、腹腔镜及手术证实的14例先天性阴道斜隔病人的MRI影像和临床资料,依据美国生育学会(AFS)阴道发育异常分类对阴道斜隔综合征进行影像学诊断及分型。结果本研究确诊阴道斜隔综合征14例,其中2例为阴道斜隔Ⅱ型,其他均为阴道斜隔Ⅰ型。MRI均表现为双子宫、双宫颈畸形,且同时合并有患侧肾脏缺如,患侧宫颈与其相通的阴道积血、扩张,T_1WI呈高信号,T_2WI呈低或混杂信号。结论阴道斜隔综合征的MRI影像表现有一定特征,MRI能更准确地评估其类型及相关并发症并做出客观诊断,可作为术前影像评估的最佳有效的检查方法。     

肾盂输尿管重复畸形的影像学评价

目的:分析肾盂输尿管重复畸形的影像学表现,评价各种影像学检查方法的诊断价值。方法:回顾分析13例经手术病理证实肾盂输尿管重复畸形的影像学资料(其中1例为双侧),13例均行静脉肾盂造影(IVU)和MRI平扫及磁共振水成像(MRU),其中4例行逆行造影,5例行CT扫描。结果:13例共14只肾盂输尿管重复MRI均能诊断,仅其中2例输尿管无积水扩张者未显示重复输尿管之汇合处,诊断准确率84.6%(11/13);13例IVU明确显示4例重复畸形,2例延迟显影才能诊断,6例肾盂输尿管重复未显影未能明确诊断,1例双侧重复畸形仅显示其中1侧,诊断符合率46.2%(6/13);4例逆行造影显示2例,1例输尿管下端肿瘤梗阻,另1例完全重复输尿管异位开口均插管失败,成功率50%(2/4);5例CT明确诊断4例,1例上段肾盂囊状扩张无肾盏误诊为囊肿,诊断符合率80%(4/5)。结论:肾盂输尿管重复畸形类型多样,依有无并发症而病理和影像不一,各种影像学检查方法各有其利弊,肾功能不良或伴输尿管异位开口者以CT和MRI结合MRU较适合。     

MRI及超声对先天性阴道畸形及处女膜闭锁的诊断分析

目的:探讨先天性阴道畸形及处女膜闭锁的MRI及超声影像表现,分析其特点,提高对该病的认识。方法:12例经临床证实的先天性阴道畸形和处女膜闭锁病例,对其MRI、超声影像资料进行回顾性分析,分别计算准确率,应用卡方检验统计两者准确率差异性。结果:先天性阴道畸形(7例),为副中肾管发育畸形,先天性无阴道畸形伴痕迹子宫或无子宫2例,为Mayer-Rokitansky-Kstner-Hauser(MRKH)综合征;阴道斜隔综和征2例,超声误诊1例;阴道闭锁2例,其中1例为宫颈发育不良伴阴道闭锁;阴道横隔1例;处女膜闭锁5例。MRI诊断准确率为100%(12/12),超声诊断准确率为83.3%(10/12),两者统计学无明显差异(P0.05),但MRI检查较超声准确率高。结论:先天性阴道畸形和处女膜闭锁的MRI及超声影像表现有一定特征,超声可作为首选的筛查检查方法,进一步MRI检查可以提高诊断准确率。     

子宫输卵管声学造影对不孕症的应用分析

目的探讨经阴道子宫输卵管声学造影对不孕症患者输卵管通畅情况的诊断价值。方法回顾分析119例经阴道超声行子宫输卵管声学造影（SSG）和腹腔镜检查的病例资料。结果子宫输卵管声学造影诊断输卵管内部通畅情况的总符合率为84.3%;诊断盆腔粘连的灵敏度为96.3%。结论经阴道子宫输卵管声学造影具有无创、简便、有效等优点,可作为不孕症输卵管通畅性检查的首选。     

盆腔脂肪过多症的影像学诊断

目的：探讨盆腔脂肪过多症的影像诊断。材料与方法：回顾性分析６例盆腔脂肪过多症的影像学表现。６例均经ＣＴ和超声检查,其中３例还作了钡灌肠检查,２例行静脉肾盂造影检查。结果：（１）钡灌肠和静脉肾盂造影显示膀胱输尿管下段以及直肠、乙状结肠远端推移受压;（２）超声检查显示盆腔内良性、实性占位性病变;（３）ＣＴ扫描可显示出脂肪组织密度。结论：ＣＴ扫描诊断盆腔脂肪过多症可作为首选影像学检查方法。     

四肢良性纤维组织细胞瘤的影像与病理对照研究

目的探讨四肢良性纤维组织细胞瘤(BFH)的影像学表现与病理特点,从而提高影像诊断的准确性。方法选取21例经手术病理证实的原发长骨良性纤维组织细胞瘤患者的临床表现及影像学资料,其中19例位于下肢,2例位于肱骨。MRI检查13例,CT检查11例,X线摄影检查9例。结果大部分病例呈不同程度膨胀性改变,边缘可见完整或不完整硬化边,少数膨胀不明显。X线摄影表现中7例伴有骨皮质变薄,1例骨皮质中断,3例病灶内可见骨性分隔和骨嵴。CT表现中大部分密度尚均匀,3例密度不均,可见斑片状高密度影,5例病灶内可见骨性分隔或骨嵴,5例病灶边缘可见扇贝样压迹,1例伴有病理性骨折;MRI因肿瘤内部成分不同而表现多样,大部分T₁WI呈等低信号,T₂WI呈稍高信号或混杂高信号;6例病灶周围可见不同程度骨髓及软组织水肿征象;镜下表现为旋涡状排列的梭形纤维母细胞,内可见泡沫细胞和多核巨细胞。结论 BFH好发于四肢长骨,影像表现具有一定特征性,其影像学表现与病理密切相关,综合分析临床和影像学特征,可提高其诊断准确性。     

Obstructed uterovaginal anomalies: demonstration with sonography. Part II. Teenagers

The sonograms of 13 patients with obstructed uterovaginal anomalies were reviewed to determine the role of sonography in diagnosis and management. In a retrospective analysis, the authors were able to define the cause of the obstruction and the upper level and length of the obstruction by combining the sonographic findings with those from the physical examination (ie, bulging hymen, blind vaginal pouch, no vaginal depth, normal vagina) or by combining transabdominal sonography with simultaneous digital insertion into the vaginal orifice. When the sonogram demonstrated hematometrocolpos or hematocolpos, the lesion was due to an imperforate hymen (n = 1) or high, middle, or low transverse vaginal septum (n = 7). When the sonogram demonstrated a hematometra, the lesion was due to Mayer-Rokitansky-Küster-Hauser syndrome with functioning uterine anlage(n) (n = 2), cervical dysgenesis (n = 1), and an obstructed uterine horn (n = 2). The presence and patency or absence of the cervix was established. Since the differentiation between a transverse vaginal septum, Mayer-Rokitansky-Küster-Hauser syndrome with active anlagen, and cervical dysgenesis with absent vagina cannot be made clinically, sonography provides important presurgical information.     

OHVIRA syndrome presenting with acute abdomen: a case report and review of the literature

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) or Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital urogenital anomaly. A 13-year-old female presented with acute abdominal pain and dysmenorrhea. Ultrasonography and magnetic resonance imaging showed uterus didelphys, hematometrocolpos, obstructed hemivagina, and right renal agenesis. Hemivaginal septal resection and anastomosis between the obstructed hemivagina and the normal vagina was tried, but it was not possible. Unilateral hysterectomy was performed. HWW syndrome may present with acute abdomen and is usually treated with vaginal septum resection and drainage of the hematometrocolpos.     

MRI of vaginal conditions

Magnetic resonance imaging (MRI) has become an important part of the assessment of suspected vaginal pathology. This pictorial review demonstrates the MRI features and some of the histopathological findings of a variety of vaginal conditions. These may be congenital (total vaginal agenesis, partial vaginal agenesis, longitudinal vaginal septum, transverse vaginal septum), benign (Bartholin's cyst, diffuse vaginal inflammation, invasive endometriosis, ureterovaginal fistula, post-surgical appearances with the formation of a neovagina and adhesions) or malignant, usually due to extension or recurrence from another pelvic malignancy. In this paper, examples of the above are described and illustrated together with examples of the much rarer primary vaginal malignancies.     

基底细胞痣综合征影像表现

目的:探讨基底细胞痣综合征(BCNS)的临床及影像学表现.方法:搜集6例经病理和临床综合诊断证实的BCNS患者的临床和影像资料进行回顾性分析,总结分析其影像学表现.结果:6例(6/6)均有颌骨囊肿和颅内异常钙化灶,分别伴有皮肤多发基底细胞痣或手掌、足底点状凹陷4例(4/6),脊椎侧突或椎体融合4例(4/6)、肋骨分叉3例(3/6),透明隔囊肿1例(1/6),特殊面征4例(4/6),口腔症状6例(6/6),生殖系统发育异常或肿瘤2例(2/6),双眼分离性斜视1例(1/6).结论:BCNS以颌骨囊肿为主要表现,常伴有其他器官的变异或病症,影像诊断为该病的确诊提供重要依据,对临床制定治疗方案具有重大临床意义.     

A novel image-guided balloon vaginoplasty method to treat obstructive vaginal anomalies

Obstructive anomalies of the vagina that impair uterovaginal outflow and lead to hematocolpos have conventionally been corrected with surgery, but emerging nonsurgical therapies may offer an attractive alternative. The present report describes a method of serial balloon dilation over a transvaginally inserted guide wire to create a durable outflow tract from the uterus to the lower vagina. This technique was successfully used to treat one case each of vaginal atresia and transverse vaginal septum without the immediate need for surgery.     

Vaginal masses: magnetic resonance imaging features with pathologic correlation

The detection of vaginal lesions has increased with the expanding use of cross-sectional imaging. Magnetic resonance imaging (MRI)—with its high-contrast resolution and multiplanar capabilities—is often useful for characterizing vaginal masses. Vaginal masses can be classified as congenital, inflammatory, cystic (benign), and neoplastic (benign or malignant) in etiology. Recognition of the typical MR imaging features of such lesions is important because it often determines the treatment approach and may obviate surgery. Finally, vaginal MR imaging can be used to evaluate post-treatment changes related to previous surgery and radiation therapy. In this article, we will review pertinent vaginal anatomy, vaginal and pelvic MRI technique, and the MRI features of a variety of vaginal lesions with pathological correlation.     

Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography.

The purpose of this study was to compare the relative accuracy of magnetic resonance (MR) imaging (n = 26), endovaginal sonography (EVS) (n = 14), and hysterosalpingography (HSG) (n = 20) in the classification of müllerian duct anomalies in 26 patients. There were 24 cases of surgically proved anomaly, and two patients had normal uteri (one with a vaginal septum). MR imaging allowed diagnosis of 24 of 24 cases (accuracy, 100%), and EVS was correct in 11 of 12 cases (accuracy, 92%). HSG was correct in only four cases. In the diagnosis of septate uterus, MR imaging demonstrated a sensitivity and specificity of 100% and EVS demonstrated a sensitivity of 100% and a specificity of 80%. Both MR imaging and EVS demonstrated a sensitivity and specificity of 100% in distinguishing those anomalies that did not require surgery. The high accuracy of MR imaging and EVS permit noninvasive differentiation of uterine anomalies and can spare women diagnostic laparoscopy, promoting cost-effective diagnosis.