巨大子宫肌瘤的CT、MRI特征性分析

目的:探讨CT、MRI在巨大子宫肌瘤的诊断价值及巨大子宫肌瘤的CT、MRI特征。方法:回顾性总结18例经手术病理证实的巨大子宫肌瘤患者的CT和MRI表现,并将CT和MRI表现与手术病理结果进行对照。结果:肿瘤直径在15～20 Cm者8例,20～25cm者6例,25 cm以上者4例。11例位于浆膜下,7例位于肌壁间,黏膜下型无。12例CT检查5例为实性肿块,边界较清晰,平扫密度均匀,与子宫肌密度相当或偏低,7例为混杂密度灶,内可见玻璃样变性及坏死、囊变或黏液样变性,增强扫描实质部分明显强化,原低密度区不强化,1例为囊性低密度,增强扫描囊壁强化,其内无强化;6例MRI表现为肿块包膜完整,与周围脏器分界清晰,T_1WI为等或略低信号,T_2WI为中等信号,其内可见不规则高信号,注射Gd-DTPA后肿块明显强化,其内见不规则不强化灶,显示包膜更清晰,无强化。结论:CT、MRI可显示巨大子宫肌瘤较具特征的征象,特别是MRI有较好的软组织分辨力,可多方位成像,加上脂肪抑制技术,有利于显示肿块的成分与包膜,对诊断有较大的帮助。

CT and MRI characteristic analysis of giant hysteromyoma

Objective： To investigate the diagnosis and characteristics of CT and MRI in giant hysteromyoma. Methods： CT and MRI manifestation of 18 cases with giant hysteromyoma confirmed by surgical-pathologic results were analyzed retrospectively and compared with pathology. Results.. The diameter of the hysteromyoma ranged from 15 cm to 20 cm in 8 cases, 20 cm to 25 cm in 6 cases, more than 25 cm in 4 cases, 11 cases located under subserousa of uterus, 7 cases located between the myometrium, no case located in the submucosa. Among 12 cases of CT examination, there were solid masses in 5 cases with clear border and homogeneous density similar to uterus muscles; in 7 cases, the lesion showed mixed density on plain CT scan, in which there were hyalinosis, necrosis, cyst and mucilage, and the masses were obviously enhanced on contrast enhanced CT scan whereas the cystic parts were none enhanced. One case was cystic mass, with only wall enhanced. MR was obtained in 6 cases, which demonstrated masses with capsule and clear border these tumors had a signal of intermediate or slightly low intensity on T1WI,While on TzWI an intermediate signal intensity of the masses with patchy and stripe hyperintense areas were seen. The masses were obviously enhanced with patchy non-enhanced areas intravenous Gd-DTPA injection. Conclusion： The CT and MRI findings of giant hysteromyoma are characteristic, of which MRI is especially important in the diagnosis of giant hysteromyoma..