三期增强CT对静脉内平滑肌瘤病的诊断价值  

The value of three-phase contrast-enhanced CT in the diagnosis of intravenous leiomyomatosis

作　　者：张宇 王鹤翔[2] 刘松[2] 李杰[2] 陈宝锦 郝大鹏[2] ZHANG Yu;WANG Hexiang;LIU Song;LI Jie;CHEN Baojin;HAO Dapeng(People’s Hospital of Xixiu District Anshun City Guizhou Province, Anshun 561000, P.R.China;Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, P.R.China;Department of Imaging, Shandong Provincial Hospital Affliliated to Shandong First Medical University, Jinan 250021, P.R.China)

机构地区：[1]贵州省安顺市西秀区人民医院,贵州安顺561000 [2]青岛大学附属医院放射科,山东青岛266003 [3]山东第一医科大学附属省立医院影像科,山东济南250021

出　　处：《医学影像学杂志》2021年第5期842-845,共4页Journal of Medical Imaging

摘　　要：目的探讨静脉内平滑肌瘤病(IVL)患者的三期增强CT影像学特点及临床诊断价值。方法回顾性分析经病理证实的15例IVL患者的三期增强CT表现。观察病灶的形态、延伸路径、病变与血管壁关系、病变的增强程度和模式。结果15例病灶均侵犯下腔静脉,13例患者合并子宫肌瘤,子宫增大,不均匀强化。14个病灶通过髂静脉伸入下腔静脉,1个病灶通过双侧髂静脉伸入下腔静脉。6例病灶累及右心。增强CT发现全部IVL均表现为不均匀增强病灶,与静脉系统的强化血液相比密度相对较低,病变与血管壁间有清晰间隙。冠状位和矢状位图像中病变是连续的,呈“丝瓜瓤”样改变。当右心受累时,病变显示出特征性的“拐杖头”或“蛇头”样改变。病变在轴位增强CT图像呈“筛孔”样改变。结论三期增强CT在显示IVL“丝瓜瓤”和“筛孔”样外观方面具有独特的优势,可进行准确的术前诊断。三期增强CT能显示病灶全方位的延伸路径,在手术计划制定和肿瘤随访中有重要的临床价值。Objective To characterize the three phase contrast-enhanced computed tomography(CT)imaging findings of 15 patients with intravenous leiomyomatosis(IVL)and to assess the clinical advantages in the diagnosis of IVL.Methods Fifteen patients with pathologically proven IVL underwent CT imaging.Assessed image features included morphology,extension pathway,relationship between lesion and vessel wall and the degree and pattern of enhancement of the mass.Results All the lesions were involved the inferior vena cava,thirteen patients with remaining uterus myoma showed enlargement heterogeneous contrast of the uterus.Fourteen masses were extending into inferior vena cava through the iliac veins and other one lesion through the bilateral iliac veins.Six patients had masses involved the right heart.All the IVL demonstrated heterogeneously enhancemnet on post contrast-enhanced CT and appeared relatively lower density compared to the enhanced blood in the venous system.In the coronal and sagittal image,tumor lesions were continuous and showed a“luffa vegetable sponge”on post-processing coronal or sagittal images,when the right heart were involved,the lesion displayed characteristic of“walking stick head”or“snake head”tumor masses.The lesion looked like a“sieve pore”on axial contrast-enhanced CT images.Conclusion Three-phase contrast-enhanced CT imaging has unique advantages in the showing“luffa vegetable sponge”and“sieve pore”like appearance of IVL,which can make an accurate preoperative diagnosis.Three-phase contrast-enhanced CT can show fullscale extension pathway of lesion all of these having great significance in making surgical plan,and the follow up of the lesion.

关 键 词：体层摄影术 X线计算机 静脉内平滑肌瘤病 下腔静脉 

分 类 号：R814.42[医药卫生—影像医学与核医学] R732[医药卫生—放射医学]