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目的分析子宫腺肌病的磁共振成像技术(MRI)影像学特征,评估MRI在其诊断及临床应用中的价值。方法回顾性分析山西医科大学第二临床医院磁共振室2011年1月-2011年11月40例经手术病理学证实的子宫腺肌病的MRI表现,所有病例均与术前B超及手术病理结果进行对照。结果①40例中,弥漫性子宫腺肌病18例,表现为子宫体积增大,T1WI病灶呈等信号,T2WI上表现为低信号的结合带弥漫性增厚,增厚的结合带与子宫肌层间分界欠清晰。11例T2WI的低信号病灶中可见点状高信号灶,其中5例在T1WI上可见类似高信号。②局限性子宫腺肌病22例,表现为子宫肌层内可见与结合带信号相近的低信号肿块影,19例T2WI低信号肿块影内可见高信号点状病灶,其中13例T1WI上可见相似点状高信号,3例T2WI呈较均匀低信号肿块影。22例局限性子宫腺肌病中,14例位于子宫后壁,6例位于子宫前壁,2例位于子宫底部。③40例中,21例合并其它妇科疾病,其中子宫平滑肌瘤11例,子宫内膜异位症(卵巢巧克力囊肿)9例,宫颈Nabothian囊肿5例,其中4例同时合并两种以上妇科疾病。④40例均行术前妇科B超检查,诊断正确23例,12例误诊,5例漏诊。MRI正确诊断37例,3例误诊为子宫肌瘤。结论 MRI是诊断子宫腺肌病的优越的无创性检查方法,可以清晰的显示病灶,做出明确诊断,对于指导子宫腺肌病的临床诊断及鉴别诊断起重要作用。
Objective To analyze the magnetic resonance imaging (MRI) features of adenomyosis and evaluate the value of MRI in its diagnosis and clinical application. Methods Retrospectively analyzed the MRI findings of 40 cases of adenomyosis confirmed by surgery and pathology from January 2011 to November 2011 in the Second Clinical Hospital of Shanxi Medical University. All the cases were associated with preoperative ultrasonography and surgical pathology Results were compared. Results ①40 cases, diffuse adenomyosis in 18 cases, showing the uterus increased volume, T1WI lesions were equal signal, T2WI showed low signal on the junction with diffuse thickening, thickening of the junction with the myometrium The boundary is not clear. Eleven cases of T2WI low signal lesions seen in the punctate high signal foci, of which 5 cases of T1WI in the visible similar high signal. ② The limitations of adenomyosis in 22 cases, showed the myometrium and the binding band signal similar to the visible low signal mass shadow, 19 cases of T2WI low signal mass in the shadow of high signal point lesions can be seen in 13 cases of T1WI visible similar Dot-like high signal, 3 cases of T2WI was more uniform low signal mass shadow. Of the 22 patients with localized adenomyosis, 14 were located in the posterior wall of the uterus, 6 in the anterior wall of the uterus and 2 in the uterus. Among the 40 cases, 21 cases were complicated by other gynecological diseases, including 11 cases of uterine leiomyoma, 9 cases of endometriosis (ovarian chocolate cyst), 5 cases of cervical Nabothian cyst, and 4 of them combined more than two kinds of gynecological diseases. ④40 cases were performed preoperative gynecological B-ultrasound, correct diagnosis of 23 cases, 12 cases of misdiagnosis, 5 cases of missed diagnosis. The correct diagnosis of MRI in 37 cases, 3 cases misdiagnosed as uterine fibroids. Conclusion MRI is an excellent and noninvasive method for the diagnosis of adenomyosis, which can clearly show the lesion and make a definite diagnosis. It plays an important role in the clinical diagnosis and differential diagnosis of adenomyosis.