子宫腺肌症常见和不常见的MRI表现-影像FTP课件.ppt
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1、Usual and Unusual Imaging Manifestations on MRI of Adenomyosis郑州大学第一附属医院磁共振科郑州大学第一附属医院磁共振科 何杰何杰 20132013年年4 4月月1717日日子宫腺肌症常见和不常见的MRI表现Adenomyosis is a common nonneoplastic gynecologic disease characterized by the presence of ectopic endometrium within the myometrium .Adenomyosis typically affects mu
2、ltiparous, premenopausal women over 30 years of age and may cause dysmenorrhea, menorrhagia, and abnormal genital bleeding .子宫腺肌症是一种常见的非肿瘤性妇科疾病,是发生在子宫肌层的子宫内膜异位子宫腺肌症是一种常见的非肿瘤性妇科疾病,是发生在子宫肌层的子宫内膜异位症。症。其主要发生于超过其主要发生于超过3030岁,绝经前的经产妇并且可能引起痛经,月经过多和不正常岁,绝经前的经产妇并且可能引起痛经,月经过多和不正常的阴道出血的症状。的阴道出血的症状。Magnetic res
3、onance (MR) imaging is a noninvasive modality with high sensitivity and specificity for diagnosis of adenomyosis . In cases of an enlarged uterus revealed with ultrasonography, MR imaging allows differentiation of adenomyosis from leiomyoma or other pathologic conditions owing to its excellent tissu
4、e contrast resolution .磁共振(磁共振(MRMR)成像是一种非侵入性的检查方式,其在诊断子宫腺肌症上具有高的)成像是一种非侵入性的检查方式,其在诊断子宫腺肌症上具有高的灵敏度和特异度。当超声检查中发现子宫增大时,磁共振由于其出色的组织对比灵敏度和特异度。当超声检查中发现子宫增大时,磁共振由于其出色的组织对比分辨率可以把子宫腺肌症与子宫肌瘤或其他疾病鉴别出来。分辨率可以把子宫腺肌症与子宫肌瘤或其他疾病鉴别出来。 IntroductionOn T2-weighted images, typical adenomyosis appears as an ill-demarcate
5、d low-signal-intensity lesion with uterine enlargement. However, various physiologic or pathologic states may affect the MR imaging appearance of adenomyosis and may result in a tumorlike appearance 在T2WI上,子宫腺肌症的典型表现为一个边界不清的低信号强度病变伴随着子宫增大。然而,多种生理和病理改变也许会影响子宫腺肌症的MRI表现并且会导致其出现肿瘤样的表现Specific topics dis
6、cussed are MR imaging manifestations of typical adenomyosis, atypical MR imaging manifestations of adenomyosis, pitfalls in diagnosis of adenomyosis, 讨论的具体话题包括子宫腺肌症的典型MRI表现,子宫腺肌症的不典型MRI表现,子宫腺肌症的诊断误区IntroductionMR Imaging Manifestations of Typical Adenomyosis子宫腺肌症的典型MRI表现 Typical Adenomyosis At patho
7、logic analysis, adenomyosis is characterized by the presence of ectopic endometrial glands and stroma within the myometrium with hypertrophy and hyperplasia of smooth muscle Adenomyosis may affect the uterine myometrium diffusely and result in a diffusely enlarged uterus, or it may be localized as a
8、n adenomyoma. 病理分析,子宫腺肌症的特征性表现是子宫肌层内异位的子宫内膜腺体和间质的存在和平滑肌的肥大增生。 子宫腺肌症也许会弥漫性的影响子宫肌层并导致子宫弥漫性的增大,或者会作为腺肌瘤局限性的影响肌层A cut section of a diffusely adenomyotic uterus shows thickened myometrium due to the ill-defined adenomyosis; the thickened myometrium is composed of haphazardly distributed hypertrophied mus
9、cular trabeculae surrounding ectopic endometrial tissue (Fig 1) . Brownish old hemorrhagic foci corresponding to hemolysed blood and hemosiderin pigment deposits may be contained within the area of adenomyosis弥漫型腺肌型子宫的横断面显示由于界限不清的子宫腺肌病导致肌层增厚。肥厚的肌层是由随意分布的肥大性肌小梁及周围的异位子宫内膜组织所构成(图1)。褐色的旧出血灶也许对应着子宫腺肌症区域内
10、的出血和含铁血黄素沉积 Typical Adenomyosis1A1BFigure 1. Adenomyosis in a 47-year-old woman. 47岁女性,子宫腺肌症患者,(a) Photograph of the cut surface of the gross specimen shows diffusely thickened myometrium. (b) photomicrograph (hematoxylin-eosin stain) shows ectopic endometrial glands and stroma (arrow) surrounded by
11、 hypertrophied smooth muscle.a.大体标本的切面照片显示弥漫性增厚的子宫肌层 b.显微镜下照片(HE染色)显示异位的子宫内膜腺体和间质和周围的肥厚的平滑肌 Typical adenomyosis appears as an ill-demarcated low-signal-intensity area on T2-weighted images owing to abundant smooth muscle proliferation (Fig 2) .Because adenomyotic endometrium looks like the basalis e
12、ndometrium, which seldom responds to hormonal stimuli, cyclic changes including degeneration, bleeding, and regeneration are less common in adenomyosis than in endometriosis . 子宫腺肌症的典型表现是在T2WI上有一界限不清的低信号区域,这是由于丰富的平滑肌细胞增殖。因为腺肌症子宫内膜跟基底子宫内膜一样,很少对激素的刺激做出反应,所以与其他子宫内膜异位症相比,包括变性,出血,再生这样的周期性的变化较少出现在子宫腺肌症中On
13、 T2-weighted MR images, ectopic endometrium appears as small high-signal-intensity areas like normal endometrium (Fig 2). Small cysts may also appear as high-signal-intensity spots on T2- weighted images.Sometimes, hemorrhagic foci appear as 13mm high-signal-intensity foci on T1-weighted images owin
14、g to the T1-shortening effects of methemoglobin (Fig 2)在T2WI图像上,异位子宫内膜表现为跟正常子宫内膜一样的小的片状高信号,小的囊肿也可能在T2WI上表现为点状高信号。有时候由于高铁血红蛋白T1缩短效应的影响,出血灶在T1WI上表现为1-3mm的高信号病灶 Typical AdenomyosisSusceptibility-weighted imaging is sensitive for old hemorrhagic foci, which appear as spotty signal voids owing to the T2*
15、-shortening effects of hemosiderin . At diffusion-weighted imaging, adenomyosis has low to intermediate signal intensity, a finding consistent with its benign, nonneoplastic nature (Fig 3) 磁敏感加权成像对陈旧出血灶很敏感,由于含铁血黄素T2缩短效应的影像,表现点状低信号。在弥散加权像上,子宫腺肌症表现为低到中等信号强度,这种表现其实与它是良性,非肿瘤性病变这种性质相一致However, there is n
16、o direct correlation between signal intensity at diffusion-weighted imaging and malignancy; most malignant tumors have very high signal intensity at diffusion-weighted imaging, a finding that reflects the long T2 relaxation time and restricted diffusion due to high cellularity.然而,DWI上信号强度和恶性病变之间并没有直
17、接的相关性;大多数的恶性肿瘤在DWI上有非常高的信号强度,这反映了由于长的T2弛豫时间和高的细胞密度导致的扩散受限。 Typical AdenomyosisFigure 2. Adenomyosis in a 46-year-old woman. 46岁女性,子宫腺肌症患者(a) Sagittal T2-weighted fast spin-echo MR image shows an enlarged uterus with an ill-defined low-signal-intensity lesion (arrow) in the posterior myometrium. The
18、lesion contains multiple small high-signal-intensity areas, which represent ectopic endometrial tissue and small cysts.矢状位T2加权快速自旋回波MR图像显示子宫增大,伴随一个子宫肌层后壁内界限不清的低信号强度的病变(箭头处),病变包含多个小的高信号的区域,其代表了子宫内膜异位组织和小囊肿 (b) Sagittal T1-weighted spin-echo MR image shows high-signal-intensity spots (arrow), which co
19、rrespond to some of the small high-signal-intensity areas seen on the T2-weighted image.The high-signal-intensity spots represent hemorrhage within the ectopic endometrial tissue.矢状位T1加权自旋回波MR图像显示了点状高信号,它们对应了在T2WI上看到的一些小的高信号区域。这些点状高信号代表了子宫内膜组织内的出血Figure 3. Adenomyosis in a 42-year-old woman. (a) Sag
20、ittal diffusion-weighted echo-planar MR image (b = 800 sec/mm2) shows an enlarged uterus with an ill-defined lesion of low to intermediate signal intensity (arrow) in the posterior myometrium. (b) Corresponding apparent diffusion coefficient (ADC) map shows no prominent decrease of ADC value in the
21、area of adenomyosis (arrow).a.矢状位扩散加权回波平面MR图像(b = 800 sec/mm2)显示增大的子宫伴随后壁肌层内界限不清的病变,呈低到中等信号强度(箭头)。b.相应的ADC图上在子宫腺肌症的区域内没有显示出明显的ADC值的下降Because adenomyosis may show various degrees of enhancement after administration of contrast medium, contrast-enhanced study does not contribute to diagnostic accuracy
22、 (Fig 4).Dynamic contrast-enhanced imaging may have greater accuracy than T2-weighted imaging when adenomyosis and endometrial cancer coexist (16). 因为在注射造影剂后,子宫腺肌症可能显示为不同程度的强化,所以关于其对比增强的研究对诊断的准确性没有帮助(图4)。 当子宫腺肌症和子宫内膜癌同时存在时动态对比增强图像也许会比T2加权图像更准确However, the heterogeneous enhancement of adenomyosis may
23、 cause inaccuracy when evaluating the depth of myometrial invasion by coexisting endometrial cancer; diffusion-weighted imaging may be helpful in accurately determining the depth of myometrial invasion .然而当并发子宫内膜癌时,子宫腺肌症不均质的强化可能会导致评估肌层浸润深度的不准确;扩散加权成像也许会帮助准确的确定肌层浸润深度 Typical AdenomyosisDiffusion-weig
24、hted ImagingDiffusion-weighted imaging allows visualization of the local microstructural characteristics of water diffusion. The signal intensity seen on diffusion-weighted images is a combination of the degree of water diffusion and the signal intensity of the underlying T2-weighted images.扩散加权图像能够
25、可视化水分子扩散的微观结构特征,在DWI上看的信号强度是水分子扩散程度和基础T2加权图像信号强度的结合。In oncologic imaging, various malignant tumors may show high signal intensity at diffusion-weighted imaging due to their high cellularity and long T2 relaxation time 在肿瘤成像上,由于高的细胞密度和长的T2弛豫时间,各种恶性肿瘤在DWI上显示为高信号。 ADC measurement yields quantitative in
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