剖宫产术后子宫瘢痕早期妊娠的MRI表现及病理对照  

MRI characteristics and pathological comparison of cesarean scar pregnancy during the first-trimester

作　　者：程小杰[1] 陈丽[2] 肖丽[3] 简继华[4] 程若勤[4] 陆涤宇[1] 

机构地区：[1]武汉市中心医院核医学科,湖北武汉430014 [2]武汉科技大学附属天佑医院超声影科 [3]武汉市中心医院妇产科,湖北武汉430014 [4]武汉科技大学附属天佑医院放射科

出　　处：《实用放射学杂志》2015年第1期102-105,共4页Journal of Practical Radiology

摘　　要：目的：探讨剖宫产术后子宫瘢痕早期妊娠（CSP）的 MRI 表现及病理对照。方法回顾性分析23例手术和病理证实为CSP 患者的临床资料、MRI 特征及病理表现。结果23例（100%）病理标本显微镜下均可见子宫肌层中的绒毛及蜕膜组织,12例（52.2%）病理标本显微镜下可以见到瘢痕处子宫平滑肌组织不完整。21例子宫下段前壁可见手术切口瘢痕,在 T1 WI 和 T2 WI 均为低信号。12例妊娠囊临近瘢痕处大部分突入宫腔,10例妊娠囊位于子宫下段前壁瘢痕处,1例妊娠囊位于瘢痕周围肌层内。妊娠囊呈类圆形22例,大小约1.8 cm×215;1.2 cm～6.4 cm×215;2.7 cm。8例妊娠囊在 T1 WI 上呈均匀低信号、T2 WI 均匀高信号,15例在T2 WI 及 STIR 上呈混杂高信号,9例妊娠囊内见少许稍短 T1出血信号,3例妊娠囊在 DWI 上呈不均匀高信号。18例病灶边界清楚,与瘢痕周围肌层分界清楚,5例与瘢痕处肌层分界不清。5例增强扫描中3例妊娠囊囊壁呈环形强化。结论CSP 的 MRI 表现具有一定的特征性,MRI 检查能较好地反映 CSP 的病理学特征,对早期 CSP 的明确诊断和治疗方法的选择具有重要参考价值。Objective To study the MRI findings and pathologic characteristics of cesarean scar pregnancy during the first-trimes-ter.Methods Clinical data,MRI findings and pathologic manifestations of 23 CSP patients confirmed by surgery and pathology were analyzed retrospectively.Results On pathologic specimens by the microscope,villi and decidua tissue were found in the myometrium of all 23 cases （100%）,and smooth muscle tissue in the uterus scar was incomplete in 12 cases （52.2%）.The incision scars were found in the uterine lower antetheca in 21 cases,which showed low signal on T1 WI and T2 WI.A majority of the gestational sac pro-truded into intrauterine in 12 cases.The gestational sac located in the scar of lower uterine antetheca in 10 cases and in the myometri-um around the scar in 1 case.The gestational sac of 22 cases were quasi-round with the size between 1.8 cm×215;1.2 cm and 6.4 cm×215; 2.7 cm.The gestational sacs showed homogeneous low signal on T1 WI and high signal on T2 WI in 8 cases,heterogeneous high signal on T2 WI and STIR sequence in 1 5 cases,a little short T1 signal of bleeding in 9 cases,and heterogeneous high signal on DWI sequence in 3 cases.The gestational sac borders were well-defined in 18 cases and blurred in 5 cases.Among 5 cases performed by enhanced MRI,there were 3 cases which gestational sac walls were ring-shaped enhanced.Conclusion MRI findings of CSP had certain char-acteristics and could reflect the pathological characteristics of CSP.MRI had important reference value in early diagnosis of CSP and the choice of treatment.

关 键 词：子宫瘢痕妊娠 磁共振成像 病理学 

分 类 号：R714.2[医药卫生—妇产科学] R445.2[医药卫生—临床医学]