子宫内膜间质肉瘤与特殊类型良性平滑肌瘤MR影像学特征差异的探索  

Differences of MR Imaging Features Between Endometrial Stromal Sarcoma and Variant Types of Benign Leiomyomas

作　　者：周延[1] 陈永晔 刘剑羽[1] 韩钦[2] 刘岩 Zhou Yan;Chen Yongye;Liu Jianyu(Radiology Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院放射科,北京100191 [2]北京大学第三医院妇产科,北京100191 [3]北京大学第三医院病理科、北京大学医学部病理学系,北京100191

出　　处：《中国微创外科杂志》2023年第4期284-289,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)与特殊类型良性平滑肌瘤[包括富于细胞性平滑肌瘤(cellular leiomyoma,CL)、奇异核平滑肌瘤(leiomyoma with bizarre nuclei,LBN)以及静脉内平滑肌瘤病(intravenous leiomyomatosis,IVL)]的MR影像学特征差异。方法回顾性分析2010年1月~2022年10月我院手术病理资料,纳入ESS 10例和特殊类型良性平滑肌瘤24例(非IVL和IVL各12例,其中非IVL组包括8例CL和4例LBN)。由2位放射科医生评估术前MR图像,包括肿瘤中心位置、径线大小、边缘模糊范围、“蠕虫样延伸”征、弥散加权成像(diffusion weighted imaging,DWI)明显弥散受限区占比,测量肿瘤DWI信号强度和表观弥散系数(apparent diffusion coeffecient,ADC)值,以肿瘤测值比正常组织相应测值计算标化值。结果与非IVL和IVL相比,ESS肿瘤中心较多位于宫腔(3/10 vs.0/12和0/12,P=0.045),肿瘤短径较短[4.9(0.7~9.7)cm vs.8.3(3.8~14.4)cm和6.3(1.6~8.2)cm,P=0.031],肿瘤边界模糊区占比较高[65%(0%~100%)vs.0%(0%~50%)和35%(0%~100%),P=0.000],肿瘤内DWI明显弥散受限区占比较高[70%(0%~100%)vs.10%(0%~100%)和0%(0%~0%),P=0.000]。ESS、非IVL和IVL肿瘤DWI信号强度和标化值依次降低(P=0.002、0.002),ADC值和标化值依次增高(P=0.000、0.000)。“蠕虫样延伸”征在IVL中占比最高(11/12),其次为ESS(5/10),非IVL最低(2/12)(P=0.001)。结论ESS与部分特殊类型平滑肌瘤亚型(CL、LBN以及IVL)的MR影像学表现具有特征性差异,ESS和CL、LBN以及IVL的差别主要表现在更易出现“蠕虫样延伸”征和DWI弥散受限。Objective To evaluate the differences of MR plain scanning feature between endometrial stromal sarcoma(ESS)and variant types of leiomyoma(VLM),including cellular leiomyoma(CL),leiomyoma with bizarre nuclei(LBN)and intravenous leiomyomatosis(IVL).Methods Surgical and pathological data in our hospital from January 2010 to October 2022 were analyzed retrospectively,including 10 cases of ESS and 24 cases of VLM(12 cases of non-IVL and 12 cases of IVL,including 8 cases of CL and 4 cases of LBN in the non-IVL group)confirmed by surgery and pathology.Two radiologists evaluated the following MR imaging characters:tumor center location,diameters,edge,“worm-like extension”,and proportion of obvious restricted diffusion area on diffusion weighted imaging(DWI).The tumor DWI signal intensities(TuDWI)and apparent diffusion coeffecient(ADC)values(TuADC)were measured,and the standardized values were calculated by divided TuDWI and TuADC by that of normal tissue.Results As compared with non-IVL and IVL groups,the ESS group had more tumor center located in the uterine cavity(3/10 vs.0/12 and 0/12,P=0.045),shorter short diameter[4.9(0.7-9.7)cm vs.8.3(3.8-14.4)cm and 6.3(1.6-8.2)cm,P=0.031],and higher proportion of fuzzy tumor boundary[65%(0%-100%)vs.0%(0%-50%)and 35%(0%-100%),P=0.000].The proportion of DWI obvious diffusion restricted area in the ESS group was relatively high[70%(0%-100%)vs.10%(0%-100%)and 0%(0%-0%),P=0.000].The DWI signal intensity and standardized value of ESS,non-IVL and IVL tumors decreased sequentially(P=0.002 and 0.002),and the ADC value and standardized value increased sequentially(P=0.000 and 0.000).The proportion of“worm like extension”sign in IVL was the highest(11/12),followed by ESS(5/10),and that in non-IVL was the lowest(2/12)(P=0.001).Conclusions MR plain scanning showed distinguishable imaging characters between ESS and some VLM subtypes(CL,LBN,and IVL).Comparing with CL,LBN,and IVL,ESS is more likely to show“worm like sign”and limited diffusion in DWI.

关 键 词：子宫肉瘤 子宫内膜间质肉瘤 子宫平滑肌瘤 静脉内平滑肌瘤病 磁共振成像 

分 类 号：R737.33[医药卫生—肿瘤] R445.2[医药卫生—临床医学]