医学精品课件：女性生殖系统德语班八年制.ppt

1、 Diagnosis of 同济医院放射科朱文珍 MD.Prof.uHysterosalpingography(HSG)及其应用u常见肿瘤及其CT/MRI诊断 Tumors of the uterus 子宫肿瘤 uterine leiomyoma 子宫肌瘤 uterine cervix cancer 宫颈癌 endometrial cancer 子宫内膜癌 Tumors of the ovary 卵巢肿瘤 cystoadenoma 囊腺瘤 cystadenocarcinoma 囊腺癌 teratoma 畸胎瘤uHSG is primarily used for the evaluation o

2、f infertility to demonstrate the morphology and patency of the uterine canal and fallopian tubes.Such as:congenital uterine abnormalities&fallopian tube obstruction.uNormally contrast injected into the uterine cavity outlines the endocervical canal,uterine cavity and lumen of the fallopian tubes wit

3、h free spill of contrast into the peritoneal cavity.uContrast agent:60%organic iodine agent.uThe uterus(子宫子宫):the uterine cavity is sharply defined and triangular in shape.uEndocervical canal:cylindrical in shape,3-4cm in length and 1-3cm in width.u宫颈与宫体长度比：1:1 1:2 1:3Normal HSGUterine fundus 宫底 子宫角

4、子宫角cornu uteriAnteversion 子宫前倾uThe fallopian tube（输卵管）:10-12cm in length extending from the cornua of the uterus.The lumen is thread-like(1-2mm)until it reaches the ampulla where it expands to 5-10mm.Patency of the fallopian tubes is confirmed by dispersal of contrast within the peritoneal cavity wi

5、th outlining of bowel loops.包括 intramural portion 间质部 isthmus 峡部 ampulla 壶腹部 fimbria 伞部 Patency of the fallopian tubes dispersal of contrast agentwithin the peritoneal cavity 双角子宫双角子宫 Bicornuate uterus with two horns,two fallopian tubes 双子宫双子宫 double uteruswith two horns,two endocervical cavitieschr

6、onic salpingitis uUnilateral or bilateral,adherence and occlusion of the lumen of the fallopian tubes 炎症造成管腔粘连与闭塞uProximum of the fallopian tubes dilation,or salpingian dropsy,no dispersal of contrast agent within the peritoneal cavity.闭塞近侧输卵管扩大,形成输卵管积水 腹腔内造影剂弥散差或无弥散.Obstruction in bilateral intramu

7、ral portionObstruction in isthmus and fimbriasalpingian obstruction and dropsy小约翰-施特劳斯-蓝色多瑙河u子宫:婴儿期:宫体/宫颈=1:2,成人为2:1.成人宫底至宫颈约78cm，RL=45cm，AP=23cm.宫颈:横径小于 3 cm.宫旁:子宫圆韧带,子宫骶骨韧带.u卵巢:杏仁状,4cm3cm1cm.Endometrium&secretion Inner myometrium(JZ)Outer myometrium FolliculiCentral stromaEndometrium&secretion Inn

8、er myometrium (JZ12mm)Outer myometriumVaginaUrinaryBladderRectumFibrous stromaOf cervixSacral spine 子宫内膜异位症（Uterine adenomyosis）u有功能的子宫内膜位于子宫腔外的部分.u含有腺体、间质及血管,受卵巢激素刺激，发生周期性出血.常见于卵巢,子宫,盆腔u临床:下腹部疼痛,月经紊乱,不孕uCT:邻近子宫及卵巢增厚,盆腔多个实性肿块,或 含液体的囊肿,出血分层.uMRI:多发囊性不同时期出血病灶,巧克力囊肿或 子宫内膜瘤;粘连,纤维化及瘢痕.腹膜腔种植于浆膜面,远处播散.单发或多

9、发大小不等的肿块.adenomyosisMultiple leiomyomas&adenomyosisuTumors of the uterus 子宫肿瘤 uterine leiomyoma 子宫肌瘤 uterine cervix cancer 宫颈癌 endometrial cancer 子宫内膜癌uTumors of the ovary 卵巢肿瘤 cystoadenoma 囊腺瘤 cystadenocarcinoma 囊腺癌 teratoma 畸胎瘤u are benign neoplasms that are derived from smooth muscle myoma cells

10、of the uterine myometrium.uThe most common uterine neoplasm and are present in greater than 20%of women older than age of 30 years.uSymptoms:pelvic mass,pain,abnormal bleeding,infertility;sometimes asymptomatic.uCategorized by location:intramural 壁间,subserosal 浆膜下,submucosal 粘膜下肌瘤.u肿块主要由漩涡状排列的平滑肌细胞构

11、成，并有不等量的胶原、细胞外基质和纤维组织。肌瘤外表有一层结缔组织束和纤维构成的假性包膜。u大肌瘤发生变性：玻璃样变性，粘液样变性，脂肪样变性。u坏死、囊变、出血、钙化。uCT:the uterus is enlarged and lobulated,wave-like contour,the mass is an isointensity lesion,calcification sometimes.Large leiomyoma:hemorrhage,cystic changes,fatty degeneration.u+C/CT&MRI:marked homogeneous enhanc

12、ement.uMRI:a circumscribed mass with well-defined margins.Characteristic low SI on T2WI(composed of compact SM myoma cells and a paucity of intercellular stroma).uThe mass was surrounded by a high SI rim on T2WI that correlates with peritumoral lymphatics,veins and edema.uLarge leiomyoma:hemorrhage,

13、cystic,fatty degeneration.variable SI when degenerated,不均匀的高信号。uexophytic leiomyomas:bridging vessel sign,indicating the mass is supplied by branches of the uterine artery.uSubmucosal intracavity leiomyoma:a broad-based stalk.Leiomyoma with calcificationLarge leiomyoma&hemorrhage and necrosisIntramu

14、ral&subserosal leiomyoma,multiplelow SI on T2WISubmucosal intracavity leiomyoma:a broad stalk.Multiple subserosal leiomyomas:bridging vessel signMultiple leiomyomas&adenomyosisuThe third most common gynecological malignancy in women.uRisk factors:infection with human papilloma virus,sexual activity

15、with multiple partners,low socioeconomic statusu The mean age of women with CC is 50 years.u85%are squamous cell Ca,15%adenocarcinomas.uClinical symptoms:bleeding or a vaginal discharge.uMRI is the most important imaging modality for the diagnosis and staging.uCC appears as a mass of isointensity on

16、 TIWI,and higher SI on T2WI than the adjacent fibrous cervical stroma but of lower SI compared with the endometrial and endocervical glands.uMarked enhancement.期：肿瘤完全局限于宫颈；期：肿瘤延伸超过宫颈，但不达盆壁和阴道下1/3；期：肿瘤延伸至盆壁或阴道下1/3；期：肿瘤延伸超过盆腔或侵犯膀胱、直肠；宫颈癌侵犯膀胱后壁、直肠周围脂肪及肛提肌u:invasion of the posterior wall of the bladder,

17、perirectal fat infiltration,and levator ani muscleInvasion of the distal vagina&lymphatic Mets.侵及子宫体uThe most common gynecological malignancy.uThe peak age range is 55 to 65 years.uCause:excessive estrogen stimulation of the endometrium.Pregnancy is protective against EC.uClinical symptoms:postmenop

18、ausal bleeding.u On T2WI,appears as a heterogenneous endometrial mass that is hyperintense to adjacent myometrium and can have hypointense/hyperintense/isointense componentes relative to normal endometrium.uJunctional zone is not intact and invasive.Myometrial invasion.u+C:hypovascular,hypoenhancing

19、 tumor relative to the normal enhancing hyperintense myometrium.uBenign tumor,including serous cystadenoma (浆液性囊腺瘤)and mucinous cystadenoma(粘液性囊腺瘤).u20 50 Years.uClinical presentation:腹痛，腹部包块(Abdominal pain and mass)月经紊乱(Menstrual disorders)u浆液性囊腺瘤Serous cystadenoma:单房多见,囊壁薄,内壁光滑,囊内充满淡黄色清澈液体;多房囊内可见乳

20、头,乳头可伴有沙砾样钙化.u粘液性囊腺瘤mucinous cystadenoma:多房性,体积大,囊壁厚,囊内含胶胨样黏液,少见乳头.uCT:盆腔内较大的囊性或囊实肿块,单房或多房 (generally big cystic and solid mass,over 10cm)水样密度或较高密度.The intensity/SI is similar to cyst.壁和内隔多较薄且均匀一致，少数较厚.cystic wall and internal septa are thin.The wall of serous cystadenoma is thin and uniform,unilocu

21、lar or multilocular;The wall of mucinous cystadenoma is thicker,usually multilocular,有乳头状软组织突起(papillary projection).+C：囊和内隔强化.uMRI:边界清楚的囊性或囊实肿块,T1WI-低信号(serous fluid,浆液)或高信号(mucus,黏液)T2WI-高信号,+C：囊和内隔强化.mucinous cystadenoma(粘液性囊腺瘤).A large mass with hyperintensity in pelvic cavity mucinous cystadeno

22、ma(粘液性囊腺瘤)serous cystadenoma (浆液性囊腺瘤)The remaining ovarymucinous cystadenoma (粘液性囊腺瘤)userous cystadenocarcinoma(浆液性囊腺癌)：占卵巢恶性肿瘤的4060%，5%双侧 。囊实性，有许多大小不等的囊，内有陈旧出血。囊壁有乳头状突起。umucinous cystadenocarcinoma(粘液性囊腺癌)：占卵巢恶性肿瘤的1520%，25%双侧.多房性，囊内有乳头状增生。u临床：早期无症状，发现时多为晚期。表现为腹部迅速生长的肿块，压迫症状，多有血性腹水 hemorrhagic ascit

23、es，消瘦 maransis、贫血 anaemia、乏力acratia等.uCT:盆腔较大单侧或双侧不规则囊实性肿块，多发的大小不等、形态不规则的低密度囊,囊壁和囊内分隔厚薄不均，有明显软组织密度的肿瘤实体.+C：肿瘤间隔、囊壁和肿瘤实体显著强化.周围蔓延.uMRI:不规则囊实性肿块.T1WI-低信号或高信号，T2WI-高信号.u carcinomatosis and peritoneaal inplants(腹膜腔种植转移):enhanced peritoneum,multinodular mass,transfer to greater omen,Ascites(腹水)u淋巴转移、血行转移

24、:Lymphatic Metastasis,Hematogenous metastasis.HydronephrosisUreter expansionu卵巢的良性肿瘤,20%.u肿瘤来自三个胚层,呈囊性,壁厚,内含脂肪、毛发、牙齿、骨骼及浆液成份。Benigh mature cystic teratomas contain a variable combination of mature mesodermal,endodermal and ectodermal tissues.uCT/MRI：不均质囊性肿块，内含脂肪、软组织成分和钙化。可见脂肪-液平面或液-液平面，也可见壁结节。The hallmark for the diagnosis of mature cystic teratoma is the presence of intratomoral fat or lipid;fat-fluid and fat-fat levels maybe present.MR fat suppression and in phase/out of phase methods.结肠癌双侧卵巢转移多囊卵巢综合征uHSG及其应用？u子宫常见肿瘤及其CT/MRI诊断？u卵巢常见肿瘤及其CT/MRI诊断？