MSCT对侵犯心血管系统的子宫静脉内平滑肌瘤病诊断的价值探讨

目的探讨侵犯心血管系统的子宫静脉内平滑肌瘤病MSCT诊断价值。方法回顾性分析4例经病理证实的侵犯心血管系统的子宫静脉内平滑肌瘤病的临床特点及MSCT表现并复习相关文献。结果4例病例CT平扫均表现为子宫及子宫旁团块影,增强扫描病灶呈明显不均匀强化,其内可见增粗、迂曲的子宫或卵巢静脉影,子宫旁病灶由下至上向髂内静脉、髂总静脉、下腔静脉、右心房(室)蔓延,形如麻绳、拐杖头,其中1例可见瘤体进入肺动脉。结论"麻绳"征、"拐杖头征"作为侵犯心血管系统的子宫静脉内平滑肌瘤病较为特殊的影像学,结合子宫及子宫旁肿块影及临床病史,可以在术前对侵犯心血管系统的子宫静脉内平滑肌瘤病作出正确的诊断,并对术前手术评估及手术方案的选择提供重要的参考价值。

The Value of MSCT in the Diagnosis of Uterine Intravenous Leiomyomatosis Invading the Cardiovascular System

Objective To investigate the diagnostic value of MSCT in uterine intravenous leiomyomatosis invading the cardiovascular system.Methods Retrospective analysis of the clinical features and MSCT manifestations of 4 cases of pathologically confirmed uterine leiomyomatosis invading the cardiovascular system,and review related literature.Results In 4 cases,the plain scan of uterus and parauterine masses were observed.The enhanced scanning lesions showed obvious uneven enhancement.The thickened and tortuous uterus or ovarian veins were seen.The parauterine lesions were from the bottom to the upper internal iliac vein,common iliac vein,inferior vena cava,and the right atrium(ventricle)spread,shaped like a hemp rope and a crutch head.In 1 case,the tumors was seen to enter the pulmonary artery.Conclusion"Hemp rope"sign,"crutch head"sign as a special imaging of uterine intravenous leiomyomatosis invading the cardiovascular system,Combined with uterine and para-uterine masses and clinical history,it is possible to make a correct diagnosis of uterine venous leiomyomatosis invading the cardiovascular system before surgery,and provide important reference value for preoperative surgical evaluation and surgical options.