腹直肌子宫内膜异位症的MRI诊断与鉴别诊断  

MRI value in the diagnosis and differential diagnosis of rectus abdominis endometriosis

作　　者：黄晓健 胡茂清[1] 陈炫幸 HUANG Xiaojian;HU Maoqing;CHEN Xuanxing(Department of Radiology,Jiangmen Central Hospital,Jiangmen 529030,China)

机构地区：[1]广东省江门市中心医院放射科,广东江门529030

出　　处：《中国中西医结合影像学杂志》2021年第6期580-583,共4页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:探讨MRI对腹直肌子宫内膜异位症的诊断与鉴别诊断价值。方法:回顾性分析12例经手术病理证实的腹直肌子宫内膜异位症患者的临床及MRI资料,其中10例有剖宫产史,2例有子宫肌瘤切除史;12例于术后5~14个月出现临床症状和体征,11例有疼痛或压痛,其中7例为周期性加重。12例均行1.5 T MRI平扫及增强扫描,5例行DWI检查。结果:12例病变均为单发,局限于腹直肌内3例,达腹直肌鞘膜4例、腹壁脂肪3例、腹膜2例;呈圆形或类圆形囊实性结节或肿块,直径1.2~5.2 cm。T_(1)WI呈高信号9例,其中6例呈繁星状高信号、3例呈片状高信号,提示含出血灶;T_(1)WI呈等低混杂信号3例。脂肪抑制T_(2)WI序列病灶呈高低混杂信号,其中2例边缘见环形低信号影,提示含铁血黄素沉积。DWI均呈高信号,病灶范围较增强扫描小。增强扫描病灶实性部分明显强化,病灶范围较平扫大,边界不清。结论:腹直肌子宫内膜异位症的出血及纤维化具有特异性影像表现,结合病史及临床症状,可作出定性诊断。Objective:To explore the value of MRI in the diagnosis of rectus abdominis endometriosis.Methods:Retrospective analysis of the clinic data and MRI findings of 12 patients with rectus abdominal endometriosis confirmed by pathology was made.Ten cases had a history of cesarean delivery,and 2 cases had operations in treatment to hysteromyoma.All patients had clinical symptoms 5~14 months after operation,among them,11 cases had pain or tenderness and 7 with periodical aggravation.12 cases underwent plain and contrast-enhanced scanning with a 1.5 T MRI scanner,and 5 underwent DWI.Results:All cases were solitary,in which,the lesions were confined to the rectus abdominis in 3 cases,the lesions reached to the rectus sheaths in 4 cases,abdominal wall fat in 3 and peritoneum in 2.The lesions presented round or suborbicular cystic-solid tumor with diameter of 1.2~5.2 cm.Typical signs of bleeding presented stellate high signal in 6 patients and patch-like high signal in 3 patients on T_(1)WI,and other 3 cases presented iso-hypo-signal on T_(1)WI.All lesions presented mixed signal on fat saturation T_(2)WI,and 2 cases with circular low signal at the edge of the lesions.All lesions appeared high signal on DWI with area smaller than that on T_(1)WI contrast-enhanced scanning.On contrast-enhanced imaging,the solid part of lesions showed obvious enhancement with unclear boundary.Conclusions:MRI can show the specific imaging manifestations of bleeding and fibrosis in rectus abdominal endometriosis,which can make qualitative diagnosis combined with the history and clinical symptoms.

关 键 词：子宫内膜异位症 腹直肌 磁共振成像 诊断 鉴别 

分 类 号：R711.71[医药卫生—妇产科学] R445.2[医药卫生—临床医学]