子宫恶性肿瘤的MRI诊断.ppt

,2009-8-7,子宫恶性肿瘤的MRI诊断MRIofUterineMalignantNeoplasm,2009-8-7,Hospital,2,子宫恶性肿瘤的流行病学现状EpidemiologyofUterineMalignantNeoplasm子宫恶性肿瘤包括子宫颈癌、子宫内膜癌、滋养细胞恶性肿瘤、子宫肉瘤等Uterinemalignantneoplasmincludescervicalcarcinoma,endometrialcarcinoma,uterinesarcomaandmalignanttrophoblastictumor,etc.,2009-8-7,Hospital,3,nnnn,全球妇女恶性肿瘤发病率的第三位TheNo.3femalemalignanttumorintheworld我国妇科恶性肿瘤发病率的前两位ThetoptwocommonfemalecancerinChina女性恶性肿瘤死亡率的第二位ThesecondmortalityinfemalemalignanttumorinChina每年约有3万名妇女死于宫颈癌About30,000femalesdied,子宫颈癌CervicalCarcinoma,2009-8-7,Hospital,4,nnn,全球妇女恶性肿瘤发病率的第四位Thefourthmostcommonfemalecancerintheworld每年的平均病例数是30年前的40倍之多Theyearlyaveragenumberofendometrialcarcinomaisnearlyfourtytimesasmuchasthose30yearsago随着我国妇女内分泌代谢性疾病的增加，子宫内膜癌呈对数速度增长Withendocrinopathymorbidityrising,thenumberofendometrialcarcinomaisincreasingaccordingtologarithmfashion,子宫内膜癌Endometrialcarcinoma,2009-8-7,Hospital,5,nnn,占子宫恶性肿瘤的2%4%Accountingfor24%ofalluterinemalignancies占生殖道恶性肿瘤的1%Accountingfor1%ofallmalignanciesinfemalereproductivetract临床罕见、恶性程度较高Averyrareandhighmalignancyinfemalereproductivetract,子宫肉瘤Uterinesarcoma,2009-8-7,Hospital,6,子宫恶性肿瘤的临床检查方法Clinicalexaminationofuterinemalignantneoplasm,2009-8-7,Hospital,7,临床检查Clinicalexaminationp普通妇科检查：简单，但具有明显的局限性Gynecologicalexamination:simple188:1577-1587,T2WI,T2WI,2009-8-7,Hospital,34,子宫内膜癌a期-Stageaendometrialcarcinoma,双侧卵巢受侵tumorinvadingtheovaries,T2WI,T2WI,Hospital,35,子宫内膜癌b期-Stagebendometrialcarcinoma肌层受侵大于1/2伴阴道扩散Deepinvasion50%ofthemyometrialthicknessofendometrialcarcinoma,(arrow).Thespreadofthevagina2009-8-7,T2WI,2009-8-7,Hospital,36,Riccardoet.al,子宫内膜癌c期-Stagecendometrialcarcinoma肌层受侵大于1/2伴闭孔内淋巴结转移Deepinvasion50%ofthemyometrial,thicknessofendometrialcarcinoma(arrow)andinternalobturatorlymphnodemetastasis,T2WIRadiology200418(10).1148,2009-8-7,Hospital,37,T2WI直肠受侵Involvementofrectum,T2WI,子宫内膜癌a期-StageaendometrialcarcinomaT2WI,T1WI,2009-8-7,Hospital,38,JpnClinicalRadol50（11）1514-1515,Involvementofbladder,子宫内膜癌a期-StageaendometrialcarcinomaT2WIT2WI膀胱受侵,2009-8-7,Hospital,39,子宫内膜癌b期-Stagebendometrialcarcinoma宫颈受侵、腹部多发转移Invasionintocervicalandabdomenmetastasis,2009-8-7,Hospital,40,（二）子宫颈癌Cervicalcarcinoma,2009-8-7,Hospital,41,nnn,病因:尚不清，可能与妇女性生活、生育史、生殖道病毒或细菌感染、性病、种族、地理和营养状况等相关Etiology:notclearly,mayberelatedwithsexuallife,reproductivehistory,reproductivetractvirusorbacterialinfection,sexuallytransmitteddiseases,race,geographyandnutrition肿瘤来源:95%为宫颈鳞状上皮；5%为宫颈管腺上皮Oncologyresource:95%fromcervicalsquamouscell;5%fromthecervicalepithelium好发部位：鳞状上皮和柱状上皮间的移行区Ocurrencesite:transitionalzonebetweensquamousepitheliumandcolumnarepithelium,子宫颈癌的临床特征ClinicalCharactersofCervicalCarcinoma,2009-8-7,Hospital,42,nn,临床表现：阴道出血是主要征象，可以是自然出血或接触性出血，合并感染时白带增多Clinical:themainsymptom:vaginalbleedingwithnaturalorcontactbleeding,whitedischargeinfection扩散方式：深部浸润、直接蔓延、淋巴转移，血行转移少Thespreading:deepinfiltration,directspreading,lymphnodemetastasis,hematogenousmetastasis,43,n,期：限于宫颈Stageconfinedtothecervixa:早期镜下浸润a-Diagnosedonlybymicroscopy;novisiblelesions,a1期:微灶浸润深度小于3mm,宽度小于7mma1-stromalinvasionlessthan3mmindepthand7mmorlessinhorizontalspreada2期:融合性浸润，深度在3-5mm，宽度7mma2-stromalinvasionbetween3and5mmwith,horizontalspreadof7mmorless2009-8-7Hospital,子宫颈癌的临床分期StagingofCervicalCarcinoma采用国际妇产科联盟分期标准FromInternationalFederationofGynecologyandObstetrics,FIGO,2009-8-7,Hospital,44,b期：浸润深度5mm，宽度7mmb-visiblelesionoramicroscopiclesionwithmorethan5mmofdepthorhorizontalspreadofmorethan7mmb1期：病灶可视最大径40mmb2-visiblelesionmorethan4cm,n,期：癌灶超越宫颈Stageinvolvedincervix,a:癌肿未达到骨盆壁，累及阴道上部2/3anoparametrialinvasion,butinvolvedinupper2/3ofvaginab:宫颈旁组织浸润b-parametrialinvasion,2009-8-7,Hospital,45,n,期：癌肿累及阴道下1/3和/或达到骨盆壁StageIII-extendstopelvicwallorlowerthirdofthevagina,a期：癌肿累及阴道下1/3a-involveslower1/3ofvaginab期：骨盆壁累和/或肾盂积水或无功能肾B-extendstopelvicwalland/orcauseshydronephrosisornon-functioningkidney,n,期：癌肿累及真骨盆以外部分或累及膀胱或直肠(a)，到达远处器官(b),a-invadesmucosaofbladderorrectumand/orextendsbeyondtruepelvisb-distantmetastasis,2009-8-7,Hospital,46,2009-8-7,Hospital,47,2009-8-7,Hospital,48,2009-8-7,Hospital,49,http:/www.scielo.br/scielo.php?script=sci_arttexthyper-signalonT2WI,子宫颈癌的MRI特征MRICharactersofCervicalCarcinoma癌肿的MRI表现MRICharactersoflesion,2009-8-7,Hospital,51,nn,T2WI:癌肿与正常宫颈基质低信号及宫旁脂肪间隙有良好对比T2WI:goodcontrastbetweenthetumorandnormalcervicalstromawithlowsignal增强扫描可依据早期强化的癌肿清晰显示病灶的边缘及其浸润的深度Confinedinmucosa:theinvasiondepth5mm，宽度7mmStromalinvasionmorethan5mmindepthandmorethan7mminhorizontalspread,T1WI,T2WI,2009-8-7,Hospital,55,浸润深度5mm，宽度7mmStromalinvasionmorethan5mmindepthandmorethan7mminhorizontalspread,子宫颈癌Ib期-StagebcervicalcarcinomaT2WI,T2WI,2009-8-7,Hospital,56,子宫颈癌a期34岁-Stageacervicalcarcinomaina34-year-oldwoman,T2WI,T2WI,T2WI,T1WI,癌肿累及阴道上部2/3involvedinupper2/3of,vagina,2009-8-7,Hospital,57,子宫颈癌b期47岁-Stagebcervicalcarcinomaina47-year-oldwoman,宫颈旁组织浸润parametrialinvasion,T2WI,T2WISala,E.etal.Am.J.Roentgenol.2007;188:1577-1587,58,子宫颈癌b期-Stagebcervicalcarcinoma,宫颈旁组织浸润,parametrialinvasion2009-8-7,T2WI,T2WI,T2WIHospital,T2WI,Hospital,59,2009-8-7Copyright2007bytheAmericanRoentgenRaySociety,子宫颈癌IIb期42岁-StageIIbcervicalcancerin42-year-oldwoman,T2WI宫颈旁组织浸润parametrialinvasion,T2WISala,E.etal.Am.J.Roentgenol.2007;188:1577-1587,2009-8-7,Hospital,60,子宫颈癌IIIa期45岁-Stageacervicalcancerin45-year-oldwomanT2WI累及阴道下1/3extendstothelower1/3ofvaginaT2WI,2009-8-7,Hospital,61,子宫颈癌IVa期39岁-Stageacervicalcancerin39-year-oldwoman,T2WI累及直肠extendstorectum,T2WISala,E.etal.Am.J.Roentgenol.2007;188:1577-1587,Hospital,62,2009-8-7Copyright2007bytheAmericanRoentgenRaySociety,子宫颈癌IVa期-Stageacervicalcancer,累及膀胱extendstorectumandbladder,T2WISala,E.etal.Am.J.Roentgenol.2007;188:1577-1587,2009-8-7,Hospital,63,（三）子宫肉瘤UterineSarcoma,2009-8-7,Hospital,64,nnn,病因：尚不清Etiology:unclear肿瘤来源:子宫平滑肌、子宫内膜间质、血管、纤维组织OncologySource:uterinesmoothmuscle,endometrialstromal,vascular,fibroustissues病理分类：子宫平滑肌肉瘤、子宫内膜间质肉瘤、混合型同源mullerian肉瘤、混合型异源mullerian肉瘤Pathologicalclassification:uterineleiomyosarcoma,endometrialstromalsarcoma,homologousmixedmulleriansarcoma,mixedmullerianheterologoussarcoma,子宫肉瘤的临床特征ClinicalCharactersofUterineSarcoma,2009-8-7,Hospital,65,临床表现Clinicalmanifestations,nnnn,最常见症状不规则阴道出血Commonsymptoms-irregularvaginalbleeding肿瘤生长过快、过度膨胀或瘤内出血坏死Excessivetumorgrowth,excessiveswellingorbleedingandnecrosis腹痛及肿瘤的压迫症状Symptomsofoppressionandpain触及腹部包块Palpableabdominalmass,2009-8-7,Hospital,66,nn,生长方式：多数为弥漫性生长，与肌层分界不清，无包膜Growth:themajorityofthemhavingdiffusegrowthwithunclearboundariesbetweenmuscularandtumorandwithoutenvelope扩散方式：直接侵犯、淋巴转移、血行转移Spreading:directinvasion,lymphaticmetastasis,hematogenousmetastasis,2009-8-7,Hospital,67,nnnn,子宫肉瘤的MRI表现无特异性NospecificfindingsonMRIofuterinesarcoma子宫肉瘤较之其它肿瘤，体积一般较大Comparedwithothertumors,generallyhavinglargervolume子宫肉瘤常出血、囊变，导致癌肿信号混杂Frequenthemorrhageandcysticdegenerationwithmixed-signal子宫肉瘤发生深部肌内膜浸润和腹腔种植转移的几率较高Uterinesarcomawithhigherprobabilityofendometrialdeepmuscleinvasionandperitonealmetastasis,子宫肉瘤的MRI特征MRICharactersofUterineSarcoma,2009-8-7,Hospital,68,子宫肉瘤42岁-Low-gradeendometrialstromalsarcomaina42-year-oldwoman,T2WI,T1WIRha,S.E.etal.Am.J.Roentgenol.2003;181:1369-1374,2009-8-7,Hospital,69,子宫肉瘤58岁-High-gradeendometrialstromalsarcomaina58-year-oldwomanT1WI,T2WI,Rha,S.E.etal.Am.J.Roentgenol.2003;181:1369-1374,2009-8-7,Hospital,70,子宫肉瘤20岁-High-gradeendometrialstromalsarcomaina20-year-oldwomanRha,S.E.etal.Am.J.Roentgenol.2003;181:1369-1374,2009-8-7,Hospital,71,结语Summary,nn,随着技术的进步，MRI在子宫恶性肿瘤的诊治领域得到了飞速的发展。目前，MRI已成为子宫恶性肿瘤分期和疗效评价的最佳手段，但在a期早期病变的