子宫内膜病变的CT诊断价值

目的 探讨子宫内膜病变CT增强扫描的表现，评价CT在子宫内膜病变诊断及内膜癌分期中的价值。资料与方法 回顾性分析50例经病理证实的子宫内膜病变的CT增强表现，包括内膜癌43例，恶性中胚叶混合瘤、非霍奇金淋巴瘤(NHL)各1例，内膜增生4例，息肉1例。对43例子宫内膜癌进行分期对比。结果 50例病变CT检出47例(94％)，未显示3例(6％)，定性诊断正确37例(74％)。43例内膜癌诊断正确35例(81．4％)，3例未显示，3例漏诊；分期正确27例(62．8％)，低估病变10例(23．3％)，高估病变6例(14．0％)。病变表现：全部病变为密度低于子宫肌壁的软组织影，边缘不清晰、分叶或不规则49例，密度均匀27例，不均匀23例，伴有子宫前后径增大35例(70％)，内膜增厚47例(94％)。肌壁内缘模糊、不规则、肌层变薄、厚薄不均19例；官颈大、密度变低或不均匀7例；子宫外缘模糊1例，盆腔、腹膜后淋巴结转移6例，肺或卵巢转移各1例，均为子宫内膜癌外侵表现。结论 CT扫描对子宫内膜病变的诊断及分期均有价值。

Evaluation of CT Scanning in the Diagnosis of Endometrial Diseases

Objective To evaluate CT scanning in diagnosing endometrial diseases and in staging endometrial carcinoma. Materials and Methods CT findings in 50 patients with pathologically-proved endometrial diseases were retrospectively analyzed. The endometrial diseases included carcinoma (n=43), malignant mesodermal-mixed tumor (n=1), non-Hodgkin lymphoma (n=1), hyperplasia (n=4), polyp (n=1). Staging of carcinoma was made in 43 cases with endometrial carcinoma. Results Of 50 cases, the lesion was detected in 47 (94%) and not displayed in 3 (6%) on CT scans, with the correct qualitative diagnosis in 37 (74%). Of 43 endometrial carcinoma cases, correct diagnosis was made in 35 (81.4%), the tumor was not showed in 3 and miss diagnosed in 3. The staging of the carcinoma was correct in 27 cases (62.8%), while underestimated occurred in 10 cases (23.3%) and overestimated in 6 (14.0%). On CT scans, the lesions presented as soft-tissue mass with the density lower than that of myometrium. The lesion's border was blurred, lobulated or irregular (n=49), the lesion's density was homogeneous (n=27) or inhomogeneous (n=23). Enlarged anteroposterior diameter of the uterus was seen in 35 cases (70%), and thickened endometrium in 47 cases (94%). The myometrial involvement included irregular or blurred inner border of the myometrium, and thinning or uneven thickness of the myometrium (n=19). Enlarged cervix with lower or inhomogeneous density was seen in 7 cases. Other findings included ill-defined uterus border (n=1), metastatic lymphadenopathy in pelvis or retroperitoneal region (n=6), pulmonary (n=1) and ovarian (n=1) metastases.Conclusion CT scanning is valuable for both the diagnosis and the staging of endometrial diseases.