弥散加权成像对子宫肉瘤及良性肌瘤的鉴别诊断  

The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas

作　　者：张洁[1] 薛华丹[1] 金征宇[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院放射科,北京100730

出　　处：《实用放射学杂志》2013年第11期1790-1793,1802,共5页Journal of Practical Radiology

摘　　要：目的 评估弥散加权成像（diffusion-weighted imaging,DWI）以及表观弥散系数（apparent diffusion coefficient,ADC）测量在子宫肌层良恶性肿瘤,主要是子宫肉瘤和子宫肌瘤的诊断价值.方法 共收集手术病理证实50例子宫肌层肿瘤患者,其中肉瘤19例（包括子宫平滑肌肉瘤12例,子宫内膜间质肉瘤7例）,子宫肌瘤31例（包括富细胞型14例,变性型17例）.对所有患者行盆腔常规MR序列及DWI扫描,测量肿瘤及同层面正常子宫肌层的平均ADC值,并对两者MR图像特点进行评估.结果 子宫平滑肌肉瘤、子宫内膜间质肉瘤、富细胞型子宫肌瘤、变性型子宫肌瘤及正常子宫肌层的ADC值分别为0.80±0.15,0.83±0.21,0.79±0.17,1.32±0.23,1.45±0.13（×10-3mm2/s）,子宫肉瘤组和子宫肌瘤组的ADC值均低于正常子宫肌层,差异具有统计学意义（t值分别为2.374和3.438,P〈0.05）,子宫肉瘤组的ADC值低于变性型子宫肌瘤,差异具有统计学意义（t=2.996,P〈0.01）.子宫内膜受累及肿瘤边缘不规整只出现在子宫肉瘤患者.2组患者的DWI信号强度存在差异（P〈0.01）.结论 DWI有助于显示子宫肌层肿瘤.通过DWI信号和ADC值测量可以将子宫肉瘤和变性型子宫肌瘤进行鉴别.对于同为DWI高信号、ADC值降低的子宫肌层肿瘤,其形态学特征对良恶性判断有一定帮助.Objective The usefulness of diffusion-weighted imaging （DWI） and quantitative measurement of apparent diffusion coefficient （ADC） values were investigated in this study, to differentiate benign and malignant tumors of the myometrium, mainly sarcomas and leiomyomas. Methods MR images including DWI were obtained in 50 surgically treated patients, including 19 uterine sarcomas （12 leiomyosarcomas and seven endometrial stromal sarcomas） and 31 uterine leiomyomas {14 cellular leiomyomas and 17 degenerated [eiomyomas）. Qualitative analysis of conventional sequence images and I）WI images and quantitative measurement of ADC values were performed for each myometrial tumor. Results The mean AI）C values （10^-3 mm^2/s） of leiomyosarcomas, endomet rial stromal sarcomas, cellular leiomyomas, degenerated leiomyomas and normal myometrium were 0.80 ± 0. 15,0.83 ± 0.21,0.79±0. 17,1.32±0.23,1.45±0. 13 （× 10^-3 mm^-2/s） ,separately. The mean ADC value of both sarcomas and leiomyomas was lower than those of normal myometrium significantly （t=2. 374, 3. 438, P〈0.05）, and the mean ADC value of sacomas was lower than those of degenerated leiomyomas（t=2.996, P〈0.01）. Endometrial involvement and irregular edge were only found in sarcomas. DWI signal intensity was different in sarcomas and leiomyomas（ P〈0.01 ）. Conclusion DWI and ADC measurement can facilitate differentiating sarcomas from degenerated leiomyomas. The morphological features may aid the diagnosis of myometrium tumors which manifest high signal intensity on DWI and low ADC value.

关 键 词：子宫 肉瘤 弥散加权成像 表观弥散系数 

分 类 号：R737.33[医药卫生—肿瘤] R445.2[医药卫生—临床医学]