MRI对恶性妊娠性滋养层细胞肿瘤的诊断价值  

The value of MRI in diagnosis of malignant gestational trophoblastic neoplasia

作　　者：杨昂[1] 张雪林[1] 张玉忠[1] 

机构地区：[1]南方医科大学南方医院医学影像中心,广州510515

出　　处：《中华放射学杂志》2007年第10期1090-1092,共3页Chinese Journal of Radiology

摘　　要：目的探讨恶性妊娠性滋养层细胞肿瘤(MGTN)的 MR 诊断价值。方法回顾性分析9例经临床和手术病理证实的 MGTN 的临床和影像资料,分析 MRI 表现并与超声结果进行比较,对人绒毛膜促性腺激素β亚单位(β-HCG)水平与病灶大小及子宫大小的关系进行相关性分析。结果8例病灶位于子宫内,1例位于附件区。7例子宫内病灶位于肌层内或弥漫侵犯子宫全层并呈等 T_1、长 T_2 信号改变。5例病灶内可见多个囊变区,其中3例呈特征性的"蜂窝"状改变。8例子宫内病灶均可见相邻结合带中断或显示不清。6例可见宫旁和肌层内血管有不同程度增多扩张并迂曲。子宫大小(30～224 cm^3,中位数为93 cm^3)和病灶大小(0.3～56.0 cm^2,中位数为8.3 cm^2)均与β-HCG 水平(114～208 333 U/L,中位数为17 850 U/L)呈正相关(r 值分别为0.924和0.859,P<0.05)。超声未发现的1例肌层病灶及3例子宫外侵犯病灶均在 MRI 上显示。结论 MGTN 病灶多位于子宫肌层,伴有结合带中断及宫旁或肌层血管扩张,病灶呈"蜂窝"状改变为特征性表现。子宫大小和病灶大小可以作为病情监测的指标。Objective To explore the value of MR imaging in the diagnosis of malignant gestational trophoblastic neoplasia （MGTN）. Methods The clinical and imaging data of 9 cases of MGTN confirmed by clinical information and surgical pathology were retrospectively analyzed. MR imaging features were compared with sonographic findings, and the relationship between the level of human chorionic gonadotrophin （β-HCG）and the lesion size, uterus volume, and vasodilatation were tested. Results The lesions were located within the uterus in 8 cases, and in the appendix in 1 case. In 7 of 8 intrauterine cases the lesions situated in the myometrium or diffusely invaded all layers of uterus with equal T1 and long T2 signal imaging appearance respectively. Multiple cystic areas were noted within 5 lesions, and 3 cases showed characteristic honeycomb-like appearance. Local or diffuse disruption of the uterine zonal architecture was found in 8 intrauterine cases. Tortuous dilation of myometrial and para-uterine vessels was present in 6 cases. The uterine volume was positively correlated with β-HCG level （ r = 0. 924, P 〈 0. 05 ） and the lesion sizes also showed positive correlation with β-HCG level （ r = 0. 859, P 〈 0. 05 ） . One lesion in myometrium and 3 lesions with extra-uterine invasions which were missed on ultrasound were clearly identified on MR imaging. Conclusions The MGTN lesions located mainly in the myometrium, commonly associated with disruption of the uterine zonal architecture, dilation of myometrial or para-uterine vessels, and the characteristic honeycomb-like manifestation. The uterine volume and lesion size can be monitor indices of the status of illness.

关 键 词：滋养层肿瘤 磁共振成像 

分 类 号：R737.33[医药卫生—肿瘤]