异位妊娠的MRI表现及其病理基础  

Magnetic resonance imaging and pathological features of ectopic pregnancy

作　　者：江魁明[1] 王亚[1] 麦慧[1] 李水婷[1] 侍丽[1] 肖湘生[2] 

机构地区：[1]广州医学院第三附属医院放射科,510150 [2]第二军医大学长征医院影像科

出　　处：《中华生物医学工程杂志》2012年第6期490-494,共5页Chinese Journal of Biomedical Engineering

基　　金：广州荔湾区科技和信息化局计划项目（20121214025）

摘　　要：目的探讨异位妊娠的MRI表现及其病理基础。方法回顾分析37例经手术、病理证实的异位妊娠（EP）的临床资料。所有病例确诊EP后均于术前行盆腔MRI平扫和增强扫描，同时测量子宫内膜厚度，并与35例正常宫内孕（EIUP）子宫内膜厚度比较。结果37例EP均为输卵管妊娠，其中右侧25例，左侧12例；35例为自然妊娠EP，2例为辅助生殖技术后复合妊娠；37个异位孕囊均呈囊实性表现或实性肿块，直径（3．6±1．8）cm；22例孕囊内片状软组织结构，呈等T1长T2信号，27例异位孕囊囊胚内或周围见片状短T1短T2信号；增强扫描T1WIEP孕囊壁呈连续或中断的环形强化，壁厚，强化强度类似子宫蜕膜，其中26例强化的孕囊壁呈分层状；35例单纯EP子宫内膜厚度[（O．36±0．11）cm]，与宫内早孕[（0．40±0．10）cm]比较差异无统计学意义（P〉0．05）。37例EP病理：输卵管腔内均见大量血块、胎盘绒毛和滋养叶细胞，其中6例切开的输卵管腔内见羊膜囊和胚胎结构。结论宫旁囊实性或实性肿块、出血，异位孕囊囊壁呈连续或中断的分层状的蜕膜样强化和显著的子宫蜕膜反应是输卵管妊娠特征性的MRI表现，MRI能于术前做出EP的明确诊断。Objective To investigate the magnetic resonance imaging （MRI） manifestations and pathological features of ectopic pregnancy （EP）. Methods Profiles of 37 cases with EP confirmed by surgery and pathology were retrospectively analyzed. All the patients were subjected to plain and contrastenhanced pelvic MRI prior to surgery. The endometrial thickness was assessed for comparison with 35 normal controls who had early intrauterine pregnancy （EIUP）. Results Of 37 cases with EP diagnosed as tubal pregnancy, 25 were rightsided and 12 were leftsided. Thirty- five cases with EP were confirmed as spontaneous pregnancy, and 2 developed heterotopic pregnancy following assisted conception. All ectopic gestational sacs were featured by cystic sac-like structures or solid mass, with a diameter of（3.6± 1.8） cm. Soft tissue structures, suggested by normal T1 and prolonged T2 signals, were shown in 22 cases. Transient T1 and T2 signals were present within or surrounding the gestational sacs in 27 cases, who were characterized by continuous or interrupted ring-shaped decidua-like enhancement on T1WI scanning. The contrast-enhanced layered gestational sacs were identified in 26 cases. There was no marked difference in the endometrial thickness between 35 cases with EP[ （0.36±0.11） cm] and those with EUIP [ （0.40±0.10） cm]. Pathologic findings, including massive hemorrhagic clots, placental villi and trophocytes, were noticeable in 37 cases with EP, of whom 6 cases presented amniotic sacs and embryonic structures in the incised fallopian tubes. Conclusion Tubal pregnancy, featured by parametrial cystic sac-like structures or solid mass, acute hemorrhage, continuous or interrupted layering decidua-like enhancement of heterotopic gestational sacwalls and impressive uterine decidual response on MRI, may be readily diagnosed prior to the surgery.

关 键 词：妊娠 异位 妊娠 输卵管 磁共振成像 

分 类 号：R714.22[医药卫生—妇产科学]