MRI导引下子宫插管及输卵管造影的实验研究  

Experimental study of MRI guided uterine intubation and hysterosalpingography

作　　者：牛金亮[1] 张俊杰[2,3] 李文晋 李晓君[1] 郑洁[1] 宋志珍[1] NIU Jinliang;ZHANG Junjie;LI Wenjin;LI Xiaojun;ZHENG Jie;SONG Zhizhen(Department of Imaging,the Second Hospital of Shanxi Medical University,Taiyuan,030001,China)

机构地区：[1]山西医科大学第二医院影像科,山西太原030013 [2]山西医科大学,山西太原030001 [3]山西省肿瘤医院核磁CT室,山西太原030013 [4]山西医科大学第二医院口腔科,山西太原030001

出　　处：《中国中西医结合影像学杂志》2018年第4期363-367,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：太原市科技局科研项目(120247-15)

摘　　要：目的 :探讨MRI导引下单弯式导管插管在子宫输卵管造影中的可行性,并与X线子宫输卵管造影(X-HSG)对照,分析对比增强磁共振血管成像(CE-MRA)序列子宫输卵管造影(MR-HSG)的应用价值。方法:采用5F单弯介入导管经雌兔阴道插管,T2WI扫描确认导管到达宫口位置。CE-MRA序列扫描时采用12种不同浓度Gd-DTPA稀释液,选取最大信号强度所对应的浓度值为最佳成像浓度。经导管向插管成功的雌兔宫腔内注入选定的Gd-DTPA稀释液20~30 m L,同时行CE-MRA;随后实验动物行X-HSG检查。并由2位高年资医师对MR-HSG图像质量进行等级评分,记录动物双侧输卵管通畅或阻塞情况。采用Kappa检验分析MR-HSG与X-HSG检查结果的一致性。结果:单弯式介入导管行雌兔子宫插管成功率为100.0%。CE-MRA序列Gd-DTPA最佳稀释液浓度为25 mmol/L。CE-MRA序列MR-HSG可清晰观察输卵管的形态、走行及细节结构。2位医师对MR-HSG图像质量评分≥3分者分别占94.4%、100.0%,评分结果一致性好(K=0.800,P<0.01),图像质量可满足诊断需要。CE-MRA序列MR-HSG与X-HSG对输卵管通畅性的判断具有良好的一致性(K=0.773,P<0.01)。结论:MRI导引单弯式导管子宫插管技术是雌兔子宫输卵管造影的新方法,无创且成功率高;CE-MRA序列MR-HSG图像分辨力高、安全无创,有望成为诊断输卵管性不孕症的新方法。Objective：To explore the feasibility of single bend catheter insertion in the MRI hysterosalpingography（HSG）,and evaluate the application value of CE-MRA sequence for MR-HSG by comparing X-HSG. Methods：Using a 5 F single bend catheter through the vagina for uterine cannulation of rabbit. T2 WI scanning was using to confirm the catheter reaching the uterine orifice. Twelve different concentrations of Gd-DTPA dilution were injected,underwenting CE-MRA sequence and selecting the density value corresponding to the maximum signal intensity. The Gd-DTPA dilution of 20 ~30 m L was injected into the uterine cavity with successful catheterization,underwenting CE-MRA sequence and then X-HSG. Two experienced radiologists separately blinded evaluated and gave the scores of image quality,recording bilateral tubal patency or obstruction of all rabbits,using the Kappa test to analysis the consistency of the results of MR-HSG and X-HSG. Results：The success rate of uterine cannulation of rabbits with the single bend catheter reached 100.0%. The signal intensity was highest by using a 25 mmol/L Gd-DTPA solution on CE-MRA sequence,underwenting CE-MRA sequence for MR-HSG could clearly observe the morphology,course and details of fallopian tube. MR-HSG image quality score greater than or equal to 3 points were reached 94.4%,100%,respectively, the two physicians agreed that MR-HSG met the diagnostic needs（ K = 0. 800, P〈0. 01）. CE-MRA sequence for MR-HSG showed high consistency with X-HSG in tubal patency judgment（K=0.773,P〈0.01）. Conclusions：Uterine cannulation of rabbits with the single bend catheter is a new,efficient and non-invasive method for MR-HSG. CE-MRA sequence for MR-HSG has high image resolution,non-invasive security,is expected to become a new method for the diagnosis of tubal infertility.

关 键 词：磁共振成像 子宫输卵管造影术 动物实验 

分 类 号：R445.2[医药卫生—影像医学与核医学] R711.6[医药卫生—诊断学]