播散性腹膜平滑肌瘤病的影像表现和诊断  

Imaging Manifestations and Diagnosis of Disseminated Peritoneal Leiomyomatosis

作　　者：张海涛[1] 伏文皓 张繁 刘锋[1] 余水全[1] 关键[2] ZHANG Haitao;FU Wenhao;ZHANG Fan(Department of Radiology,Hospital of Traditional Chinese Medicine of Zhongshan,Zhongshan,Guangdong Province 528400,P.R.China)

机构地区：[1]中山市中医院医学影像科,528400 [2]中山大学附属第一医院医学影像科,广州510080

出　　处：《临床放射学杂志》2022年第6期1065-1070,共6页Journal of Clinical Radiology

摘　　要：目的探讨播散性腹膜平滑肌瘤病(DPL)影像表现,提高对DPL的认识及诊断水平。方法搜集2010年1月至2020年12月12例女性DPL患者影像及临床资料,病灶经手术病理证实且符合腹膜弥漫性多发性平滑肌瘤的诊断标准。12例均行CT平扫加增强扫描,其中4例同时行MR平扫加增强扫描。回顾全部病例临床及治疗史,分析影像特点。结果12例术前准确诊断4例,误诊8例。均有子宫肌瘤手术史,其中腹腔镜下肌瘤剔除术8例,子宫切除术4例;单次手术10例,3次手术和4次手术各1例。12例均表现为与子宫肌瘤类似的腹膜多发或弥漫性结节或肿块,病灶数2个以上,发生于肠系膜7例,子宫/膀胱直肠凹5例,肝周腹膜3例,大网膜3例,腹壁、盆底4例。腹腔积液2例。病灶呈类圆形或融合团块状,长径5~264 mm。CT扫描小病灶(≤3 cm)呈等或稍低密度,增强扫描明显均匀强化;较大病灶(>3 cm)呈稍低、等或稍高混杂密度,增强扫描轻中度不均匀强化或环状强化。MRI扫描T_(1)WI呈稍低或等信号,T_(2)WI呈低或不均匀低信号,小病灶强化较均匀;病灶>3 cm时呈不均匀强化。病变内呈“漩涡”或“条纹”征象7例、囊变3例、钙化1例、出血2例。结论DPL既往有子宫肌瘤手术史,根据典型的影像表现,可做出准确的术前诊断。Objective To investigate the radiographic features of disseminated peritoneal leiomyomatosis(DPL)and improve the understanding and diagnosis of DPL.Methods Imaging and clinical data of 12 female DPL patients treated between January 2010 and December 2020 were collected.In all patients,the lesions were confirmed by surgical pathology and met the diagnostic criteria of disseminated peritoneal leiomyomatosis.All 12 patients underwent plain CT scanning with contrast-enhanced scanning,and 4 further underwent plain MRI with contrast-enhanced scanning.The clinical and treatment histories of all patients were reviewed,and the radiographic features were analyzed.Results A preoperative diagnosis was made accurately in 4 of the 12 patients,whereas in 8 patients,a misdiagnosis was made.All patients had a history of leiomyoma surgery,including 8 cases of laparoscopic myomectomy and 4 cases of hysterectomy.Further,10 patients underwent one operation,1 patient underwent 3 operations,and 1 patient underwent 4 operations.All 12 patients had multiple or diffuse peritoneal nodules or masses similar to uterine leiomyoma and had more than 2 lesions.The lesions were located in the mesentery in 7 patients,the uterine/rectouterine pouch in 5 patients,the perihepatic peritoneum in 3 patients,the greater omentum in 3 patients,and the abdominal wall and pelvic floor in 4 patients.Ascites was present in 2 patients.The lesions were quasi-circular or fused masses with a length of 5-264 mm.Small lesions(≤3 cm)showed iso or low density on the CT scan and homogeneous enhancement on the contrast-enhanced scan,whereas larger lesions(>3 cm)showed a mix of low,iso,or high density,in addition to mild-to-moderate uneven enhancement or annular enhancement on the contrast-enhanced scan.The MRI scan showed slightly hypo-intense or iso-intense signals on T_(1)WI and hypo-intense or uneven hypo-intense signals on T_(2)WI,with a relatively homogeneous enhancement for small lesions and uneven enhancement when the lesion was greater than 3 cm.There were sig

关 键 词：播散性腹膜平滑肌瘤病 子宫平滑肌瘤 腹膜 多层螺旋CT 磁共振成像 

分 类 号：R735.5[医药卫生—肿瘤]