摘要
目的探讨输卵管病变的MRI表现,提高诊断正确率。方法回顾性总结2013年8月-2018年12月我院20例(30个病灶)术前行MRI检查且经手术病理证实的输卵管病变,观察其在高场强MRI上的表现,分析误诊漏诊原因。所有患者均行盆腔轴位T1WI、T2WI、冠状位T2WI脂肪抑制和轴位T1WI脂肪抑制动态增强检查,部分患者行轴位DWI检查。结果30个病灶中输卵管炎15个,输卵管妊娠1个,输卵管子宫内膜异位3个,输卵管系膜囊肿5个,输卵管卵巢囊肿4个,输卵管扭转1个,输卵管癌1个。输卵管炎中输卵管积脓10个,输卵管积液5个。MRI主要表现为:输卵管积脓、积液为扩张扭曲的S形、C形,T1WI均为低信号,T2WI积脓为稍高信号,积液为高信号,DWI上脓肿弥散受限。输卵管妊娠T1WI为等、低信号,T2WI为高信号,DWI呈点、环状高信号,增强扫描不均匀强化。输卵管子宫内膜异位为附件区管状、多囊状T1WI高信号,T2WI高信号,周围可见极低信号。输卵管系膜囊肿为靠近卵巢,但与卵巢分界清楚的类圆形T1WI低、T2WI均匀高信号。输卵管卵巢囊肿为"鸟嘴样"或"喇叭口样"T1WI低、T2WI均匀高信号。输卵管扭转为类似于"漩涡征"的T1WI低、T2WI高信号。输卵管癌为腊肠状或管状囊实性肿块,实性部分为T1WI低、T2WI等或稍高信号,DWI弥散受限,增强扫描不同程度强化。20例患者中单侧病灶者10例,双侧病灶者10例,单侧病灶中左侧者6例,右侧者4例。20例患者中合并卵巢子宫内膜异位症者1例,卵巢囊腺瘤者2例,卵巢黄体囊肿者2例,子宫腺肌症者2例,子宫肌瘤者6例,子宫息肉者1例。30个病灶中MRI报告漏诊5个,误诊17个,诊断符合病理结果者8个,诊断正确率26.7%。结论高场强磁共振检查能很好地显示输卵管病变,掌握输卵管病变的高场强MRI表现,能够避免在临床工作中漏诊误诊。
Objective To explore the MRI manifestations of fallopian tube lesions and improve the diagnostic accuracy.Methods From August 2013 to December 2018,20 cases(30 lesions)in our hospital with preoperative MRI and confirmed by surgery and pathology of fallopian tube lesions were retrospectively summarized,the manifestations of high field intensity MRI were observed,and the causes of misdiagnosis and missed diagnosis were analyzed.All patients underwent pelvic axial T1WI,T2WI,coronal T2WI fat suppression and axial T1WI fat suppression dynamic enhancement examination,and some patients underwent axial DWI examination.Results Among the 30 lesions,there were 15 cases of salpingitis,1 case of tubal pregnancy,3 cases of tubal endometriosis,5 cases of mesosalpinx cysts,4 cases of tubal ovarian cysts,1 case of tubal torsion and 1 case of tubal cancer.In salpingitis,there were 10 tubal pus and 5 tubal effusion.The main manifestations of MRI:pyoviduct and effusion were s-shaped and c-shaped with expansion and distortion;T1WI was low signal;T2WI was slightly high signal;effusion was high signal;and the abscess dispersion on DWI was limited.Tubal pregnancy T1WI was isotropic and low signal,T2WI was high signal,DWI was point and ring high signal,the enhancement scan was not uniform enhancement.Tubal endometriosis was tubular and polycystic with high T1WI signal,high T2WI signal and extremely low signal around.Mesosalpingoid cysts were round with low T1WI and uniform high T2WI signals that were close to the ovary but clearly demarcated from the ovary.Oviduct ovarian cyst for"bird mouth"or"bell-mouth"low T1WI,T2WI uniform high signal.The fallopian tube twists into low T1WI and high T2WI signals similar to the"vortex sign".Fallopian tube cancer was a solid salami or tubular cystic mass with low T1WI,equal or slightly higher T2WI signals in the solid part.DWI diffusion was limited,and enhancement scanning was performed to different degrees.Among the 20 patients,there were 10 unilateral lesions,10 bilateral lesions,6 unilateral lesions on the left side and 4 unilateral lesions on the right side.Among the 20 patients,1 had endometriosis,2 had cystadenoma,2 had luteal cysts,2 had adenomyosis,6 had fibroids and 1 had polyps.Of the 30 lesions,5 were missed in MRI report,17 were misdiagnosed,and 8 were consistent with pathological results,with a diagnostic accuracy of 26.7%.Conclusion High-field magnetic resonance imaging can well show the fallopian tube lesions,and mastering the high-field MRI manifestations of the salpingal lesions can avoid missed diagnosis and misdiagnosis in clinical work.
作者
彭华荣
宋建勋
陈惠枚
PENG Huarong;SONG Jianxun;CHEN Huimei(Department of Radiology,Bao'an District People′s Hospital of Shenzhen City/The Second Affiliated Hospital of Shenzhen University,Shenzhen Guangdong 518101,China)
出处
《中国卫生标准管理》
2020年第9期101-104,共4页
China Health Standard Management
关键词
高场强
磁共振成像
输卵管病变
定位诊断
定性诊断
应用价值
high field strength
magnetic resonance imaging
fallopian tube lesions
positioning diagnosis
qualitative diagnosis
application value
