子宫腺肌症常见和不常见的MRI表现中英文对照

UsualandUnusualImagingManifestationsonMRIofAdenomyosis 郑州大学第一附属医院磁共振科何杰2013年4月17日 子宫腺肌症常见和不常见的MRI表现 Adenomyosisisacommonnonneoplasticgynecologicdiseasecharacterizedbythepresenceofectopicendometriumwithinthemyometrium Adenomyosistypicallyaffectsmultiparous premenopausalwomenover30yearsofageandmaycausedysmenorrhea menorrhagia andabnormalgenitalbleeding 子宫腺肌症是一种常见的非肿瘤性妇科疾病 是发生在子宫肌层的子宫内膜异位症 其主要发生于超过30岁 绝经前的经产妇并且可能引起痛经 月经过多和不正常的阴道出血的症状 Magneticresonance MR imagingisanoninvasivemodalitywithhighsensitivityandspecificityfordiagnosisofadenomyosis Incasesofanenlargeduterusrevealedwithultrasonography MRimagingallowsdifferentiationofadenomyosisfromleiomyomaorotherpathologicconditionsowingtoitsexcellenttissuecontrastresolution 磁共振 MR 成像是一种非侵入性的检查方式 其在诊断子宫腺肌症上具有高的灵敏度和特异度 当超声检查中发现子宫增大时 磁共振由于其出色的组织对比分辨率可以把子宫腺肌症与子宫肌瘤或其他疾病鉴别出来 Introduction OnT2 weightedimages typicaladenomyosisappearsasanill demarcatedlow signal intensitylesionwithuterineenlargement However variousphysiologicorpathologicstatesmayaffecttheMRimagingappearanceofadenomyosisandmayresultinatumorlikeappearance在T2WI上 子宫腺肌症的典型表现为一个边界不清的低信号强度病变伴随着子宫增大 然而 多种生理和病理改变也许会影响子宫腺肌症的MRI表现并且会导致其出现肿瘤样的表现SpecifictopicsdiscussedareMRimagingmanifestationsoftypicaladenomyosis atypicalMRimagingmanifestationsofadenomyosis pitfallsindiagnosisofadenomyosis 讨论的具体话题包括子宫腺肌症的典型MRI表现 子宫腺肌症的不典型MRI表现 子宫腺肌症的诊断误区 Introduction MRImagingManifestationsofTypicalAdenomyosis 子宫腺肌症的典型MRI表现 TypicalAdenomyosis Atpathologicanalysis adenomyosisischaracterizedbythepresenceofectopicendometrialglandsandstromawithinthemyometriumwithhypertrophyandhyperplasiaofsmoothmuscleAdenomyosismayaffecttheuterinemyometriumdiffuselyandresultinadiffuselyenlargeduterus oritmaybelocalizedasanadenomyoma 病理分析 子宫腺肌症的特征性表现是子宫肌层内异位的子宫内膜腺体和间质的存在和平滑肌的肥大增生 子宫腺肌症也许会弥漫性的影响子宫肌层并导致子宫弥漫性的增大 或者会作为腺肌瘤局限性的影响肌层 Acutsectionofadiffuselyadenomyoticuterusshowsthickenedmyometriumduetotheill definedadenomyosis thethickenedmyometriumiscomposedofhaphazardlydistributedhypertrophiedmusculartrabeculaesurroundingectopicendometrialtissue Fig1 Brownisholdhemorrhagicfocicorrespondingtohemolysedbloodandhemosiderinpigmentdepositsmaybecontainedwithintheareaofadenomyosis弥漫型腺肌型子宫的横断面显示由于界限不清的子宫腺肌病导致肌层增厚 肥厚的肌层是由随意分布的肥大性肌小梁及周围的异位子宫内膜组织所构成 图1 褐色的旧出血灶也许对应着子宫腺肌症区域内的出血和含铁血黄素沉积 TypicalAdenomyosis Fig 1A1B 1A 1B Figure1 Adenomyosisina47 year oldwoman 47岁女性 子宫腺肌症患者 a Photographofthecutsurfaceofthegrossspecimenshowsdiffuselythickenedmyometrium b photomicrograph hematoxylin eosinstain showsectopicendometrialglandsandstroma arrow surroundedbyhypertrophiedsmoothmuscle a 大体标本的切面照片显示弥漫性增厚的子宫肌层b 显微镜下照片 HE染色 显示异位的子宫内膜腺体和间质和周围的肥厚的平滑肌 Typicaladenomyosisappearsasanill demarcatedlow signal intensityareaonT2 weightedimagesowingtoabundantsmoothmuscleproliferation Fig2 Becauseadenomyoticendometriumlookslikethebasalisendometrium whichseldomrespondstohormonalstimuli cyclicchangesincludingdegeneration bleeding andregenerationarelesscommoninadenomyosisthaninendometriosis 子宫腺肌症的典型表现是在T2WI上有一界限不清的低信号区域 这是由于丰富的平滑肌细胞增殖 因为腺肌症子宫内膜跟基底子宫内膜一样 很少对激素的刺激做出反应 所以与其他子宫内膜异位症相比 包括变性 出血 再生这样的周期性的变化较少出现在子宫腺肌症中OnT2 weightedMRimages ectopicendometriumappearsassmallhigh signal intensityareaslikenormalendometrium Fig2 Smallcystsmayalsoappearashigh signal intensityspotsonT2 weightedimages Sometimes hemorrhagicfociappearas1 3mmhigh signal intensityfocionT1 weightedimagesowingtotheT1 shorteningeffectsofmethemoglobin Fig2 在T2WI图像上 异位子宫内膜表现为跟正常子宫内膜一样的小的片状高信号 小的囊肿也可能在T2WI上表现为点状高信号 有时候由于高铁血红蛋白T1缩短效应的影响 出血灶在T1WI上表现为1 3mm的高信号病灶 TypicalAdenomyosis Susceptibility weightedimagingissensitiveforoldhemorrhagicfoci whichappearasspottysignalvoidsowingtotheT2 shorteningeffectsofhemosiderin Atdiffusion weightedimaging adenomyosishaslowtointermediatesignalintensity afindingconsistentwithitsbenign nonneoplasticnature Fig3 磁敏感加权成像对陈旧出血灶很敏感 由于含铁血黄素T2缩短效应的影像 表现点状低信号 在弥散加权像上 子宫腺肌症表现为低到中等信号强度 这种表现其实与它是良性 非肿瘤性病变这种性质相一致However thereisnodirectcorrelationbetweensignalintensityatdiffusion weightedimagingandmalignancy mostmalignanttumorshaveveryhighsignalintensityatdiffusion weightedimaging afindingthatreflectsthelongT2relaxationtimeandrestricteddiffusionduetohighcellularity 然而 DWI上信号强度和恶性病变之间并没有直接的相关性 大多数的恶性肿瘤在DWI上有非常高的信号强度 这反映了由于长的T2弛豫时间和高的细胞密度导致的扩散受限 TypicalAdenomyosis Figure2 Adenomyosisina46 year oldwoman 46岁女性 子宫腺肌症患者 a SagittalT2 weightedfastspin echoMRimageshowsanenlargeduteruswithanill definedlow signal intensitylesion arrow intheposteriormyometrium Thelesioncontainsmultiplesmallhigh signal intensityareas whichrepresentectopicendometrialtissueandsmallcysts 矢状位T2加权快速自旋回波MR图像显示子宫增大 伴随一个子宫肌层后壁内界限不清的低信号强度的病变 箭头处 病变包含多个小的高信号的区域 其代表了子宫内膜异位组织和小囊肿 b SagittalT1 weightedspin echoMRimageshowshigh signal intensityspots arrow whichcorrespondtosomeofthesmallhigh signal intensityareasseenontheT2 weightedimage Thehigh signal intensityspotsrepresenthemorrhagewithintheectopicendometrialtissue 矢状位T1加权自旋回波MR图像显示了点状高信号 它们对应了在T2WI上看到的一些小的高信号区域 这些点状高信号代表了子宫内膜组织内的出血 Figure3 Adenomyosisina42 year oldwoman a Sagittaldiffusion weightedecho planarMRimage b 800sec mm2 showsanenlargeduteruswithanill definedlesionoflowtointermediatesignalintensity arrow intheposteriormyometrium b Correspondingapparentdiffusioncoefficient ADC mapshowsnoprominentdecreaseofADCvalueintheareaofadenomyosis arrow a 矢状位扩散加权回波平面MR图像 b 800sec mm2 显示增大的子宫伴随后壁肌层内界限不清的病变 呈低到中等信号强度 箭头 b 相应的ADC图上在子宫腺肌症的区域内没有显示出明显的ADC值的下降 Becauseadenomyosismayshowvariousdegreesofenhancementafteradministrationofcontrastmedium contrast enhancedstudydoesnotcontributetodiagnosticaccuracy Fig4 Dynamiccontrast enhancedimagingmayhavegreateraccuracythanT2 weightedimagingwhenadenomyosisandendometrialcancercoexist 16 因为在注射造影剂后 子宫腺肌症可能显示为不同程度的强化 所以关于其对比增强的研究对诊断的准确性没有帮助 图4 当子宫腺肌症和子宫内膜癌同时存在时动态对比增强图像也许会比T2加权图像更准确However theheterogeneousenhancementofadenomyosismaycauseinaccuracywhenevaluatingthedepthofmyometrialinvasionbycoexistingendometrialcancer diffusion weightedimagingmaybehelpfulinaccuratelydeterminingthedepthofmyometrialinvasion 然而当并发子宫内膜癌时 子宫腺肌症不均质的强化可能会导致评估肌层浸润深度的不准确 扩散加权成像也许会帮助准确的确定肌层浸润深度 TypicalAdenomyosis Diffusion weightedImagingDiffusion weightedimagingallowsvisualizationofthelocalmicrostructuralcharacteristicsofwaterdiffusion Thesignalintensityseenondiffusion weightedimagesisacombinationofthedegreeofwaterdiffusionandthesignalintensityoftheunderlyingT2 weightedimages 扩散加权图像能够可视化水分子扩散的微观结构特征 在DWI上看的信号强度是水分子扩散程度和基础T2加权图像信号强度的结合 Inoncologicimaging variousmalignanttumorsmayshowhighsignalintensityatdiffusion weightedimagingduetotheirhighcellularityandlongT2relaxationtime在肿瘤成像上 由于高的细胞密度和长的T2弛豫时间 各种恶性肿瘤在DWI上显示为高信号 ADCmeasurementyieldsquantitativeinformationabouttissuestructurethatisbasedonthemolecularmotionofwater MalignantlesionswithincreasedcellularityshowlowADCvalues whereasrelativelyhypocellularbenignlesionsandnormalstructurestendtoshowrelativelyhigherADCvalues ADC图以水分子的运动为基础来测量组织结构的定量信息 高的细胞密度大的病变表现出低的ADC值 而相对低度增生的良性病变和正常组织显示相对高的ADC值 TypicalAdenomyosis Figure4 Adenomyosisina47 year oldwoman 47岁女性 子宫腺肌症患者 a SagittalT2 weightedfastspin echoMRimageshowsanenlargeduteruswithanill definedlow signal intensitylesion arrow intheposteriormyometrium Thelesioncontainsmultiplesmallhigh signal intensityareas b Unenhanced upperleft earlyarterialphase upperright latearterialphase lowerleft andvenousphase lowerright images obtainedwithadynamicgadolinium enhancedthree dimensionalfastspoiledgradient echosequencewithfatsuppression showheterogeneousandgradualenhancementofthelesion a 矢状位T2加权快速自旋回波MR图像显示子宫增大伴随子宫肌层后壁内界限不清的低信号强度病变 病变内包含多个小的高信号强度区域b 由一个压脂动态钆增强型三维快速小角度梯度回波序列获得平扫 左上图 动脉早期相 右上图 动脉晚期相 左上图 以及静脉相 右下图 病变表现为不均匀和渐进性的强化 AtypicalMRImagingManifestationsofAdenomyosis 子宫腺肌症的非典型MRI表现 AtypicalAdenomyosis VariousphysiologicorpathologicstatesmayaffecttheMRimagingappearanceofadenomyosis amountoffunctionalendometrialtissue phaseofthemenstrualcycle endogenoushormonalabnormality andexogenoushormonalstimulation SecretorytransformationofadenomyoticendometriumincludingstromaldecidualizationmaycauseaheterogeneousincreaseinsignalintensityonT2 weightedimages 多种生理或病理状态可能会影响子宫腺肌症的MRI表现 功能性子宫内膜组织的量 月经周期的阶段 内源激素的异常 外源激素的刺激 腺肌症子宫内膜的分泌转化包括间质蜕膜化会导致T2WI上信号强度不均质的提高Thisphenomenonmaybeencounteredduringgestationandexogenousprogestationaltherapyoreveninpatientswithoutspecifichormonalstimulation CongestionoredematouschangemayalsoincreasethesignalintensityofadenomyosisdiffuselyorfocallyonT2 weightedimages Fig5 这种现象可能发生于怀孕期间 外源性孕激素治疗期间 或者甚至在没有特定激素刺激的患者身上 充血或水肿的变化也可能会在T2WI上弥漫性增加子宫腺肌症的信号强度或者局部信号强度 图5 Insuchconditions MRimagingmanifestationsmayfluctuate andfollow upMRimagingmaybehelpfulfordiagnosis Gonadotropin releasinghormoneanalogisusedinthetreatmentofadenomyosis Afterhormonaltherapyormenopause anareaofadenomyosismayshrinkwithdecreasedsignalintensityonT2 weightedimages Fig6 在这种情况下 MRI表现会变化较大 再一次的复查对诊断有帮助 促性腺激素释放激素类似物被用于治疗子宫腺肌症 激素治疗后或在绝经期时 子宫腺肌症的面积可能会萎缩 并伴随着T2WI上信号强度的降低 图6 AtypicalAdenomyosis Figure5 Adenomyosiswithfocaledemaina54 year oldwoman a SagittalT2 weightedfastspin echoMRimageshowsanenlargeduteruswithanill definedlow signal intensitylesionintheposteriormyometrium Thelow signal intensitylesioncontainsafocalhigh signal intensitymasslikearea arrow b Ondiffusionweightedecho planarMRimage b 800sec mm2 thehigh signal intensitymasslikeareainasagittalshowsnoincreaseinsignalintensity arrow a 矢状位T2加权快速自旋回波MR图像显示增大的子宫伴随子宫后壁内界限不清的低信号强度病变 这个低信号病变内包含一个肿块样高信号强度区域 箭头 b 在矢状位扩散加权平面回波MR图像上 b 800sec mm2 这个高信号强度肿瘤样区域没有显示信号强度的增高 箭头 Figure5 c OnanimagefromMRspectroscopy thehigh signal intensitymasslikeareashowsalowcholinepeak Cho at3 2ppm Biopsyrevealedbenignadenomyotictissuewithstromaledema Thesignalintensityofthemasslikeareaisdecreasedonfollow upT2 weightedimagesobtained3monthslater c 在磁共振波谱上 这个高信号强度的肿块样区域在3 2ppm处显示为低的胆碱峰 Cho 活检发现良性子宫腺肌组织间质水肿 这个肿块样区域的信号强度在3个月后的T2WI图像上降低 MRspectroscopy Figure6 Adenomyosisina50 year oldwomanbeforeandafterhormonaltherapywithgonadotropinreleasinghormoneanalog 一个50岁女性 子宫腺肌症患者 促性腺激素释放激素类似物治疗前后 a AxialT2 weightedfastspin echoMRimageshowsadenomyosisasanill definedheterogeneouslow signal intensitylesionwithlinearorreticularhigh signal intensityareasintheanteriormyometrium arrow b AxialT2 weightedfastspin echoMRimageobtainedafterhormonaltherapyshowsdecreasedvolumeandsignalintensityoftheareaofadenomyosis arrow a 在轴位T2加权快速自旋回波MR图像上 子宫腺肌症显示为边界不清的不均匀的低信号强度病变伴随肌层前壁线状或网状高信号强度区域 箭头 b 激素治疗后 获取的轴位T2加权快速自旋回波MR图像显示子宫腺肌症区域的面积和信号强度都下降了 Insuchconditions MRimagingmanifestationsmayfluctuate andfollow upMRimagingmaybehelpfulfordiagnosis Gonadotropin releasinghormoneanalogisusedinthetreatmentofadenomyosis Afterhormonaltherapyormenopause anareaofadenomyosismayshrinkwithdecreasedsignalintensityonT2 weightedimages Fig6 在这种情况下 MRI表现会变化较大 再一次的复查对诊断有帮助 促性腺激素释放激素类似物被用于治疗子宫腺肌症 激素治疗后或绝经期子宫腺肌症的面积可能会萎缩 并伴随着T2WI上信号强度的降低 Diffusion weightedimagingwithADCmeasurementmayprovideanotherclueforthediagnosis becausetheseconditions secretorytransformation decidualization congestionoredema usuallyincreasetheADCintissues ArelativelyhighADCinadenomyoticlesionswithhighsignalintensityonT2 weightedimagesmayallowdifferentiationfrommalignantlesions whichhavealowADCduetotheirhighcellularity Fig5 15 弥散加权成像图像上ADC值的测量可能提供诊断的另一条线索 因为在这些情况下 分泌转化 蜕膜变 充血或水肿 通常会增加组织的ADC值 子宫腺肌症病灶的一个相对高的ADC值和高的T2信号强度可以将其从恶性病变中鉴别出来 因为恶性病变由于其高的细胞密度导致低的ADC值MRspectroscopymayalsoprovideaclueforthediagnosis becausethesebenignadenomyoticconditionsdonotshowhighmetabolicactivity Arelativelylowcholinepeakinadenomyoticlesionsmayallowdifferentiationfrommalignanttumors whichshowahighcholinepeakduetotheirhighmetabolicactivity Fig5 磁共振质子波谱也可以提供诊断线索 因为这些良性的腺肌并没有表现为高的代谢活动 子宫腺肌症病变的一个相对低的胆碱峰有助于将其与恶性肿瘤鉴别开 因为恶性肿瘤由于其高的代谢活动显示为高的胆碱峰 AtypicalAdenomyosis PitfallsinDiagnosisofAdenomyosis 子宫腺肌症诊断中的陷阱 Theuterinebodymayshowphysiologicchangesduringthemenstrualcycle Thelow signal intensityjunctionalzoneandadenomyosisarewellvisualizedduetoincreasedsignalintensityofthemyometriuminthesecretoryphase lutealphase 子宫体在月经周期中表现了生理性的变化 由于在分泌期 黄体期 时子宫肌层信号变高 导致能清楚的看到低信号的结合带和子宫腺肌症Decreasedsignalintensityofthemyometriuminthemenstrual earlyproliferativephase follicularphase maycausewideningofthejunctionalzone whichmimicsdiffuseadenomyosis Therefore MRimagingfortheevaluationofauterinemyometriallesionshouldbeperformedinthelateproliferative secretoryphase Fig7 肌层在月经早期增殖期 卵泡期 信号强度的下降会引起结合带的增宽 使其像弥漫性子宫腺肌症 因此MRI对子宫肌层的评价应该在增生晚期 分泌期进行 图7 PhysiologicChangesintheUterineBodyduringtheMenstrualCycle在月经周期中子宫体的生理变化 Figure7 Subserosaladenomyosis likelesion invasivesolidendometriosis ina33 year oldwomanduringdifferentphasesofthemenstrualcycle a SagittalT2 weightedfastspin echoMRimageobtainedintheearlyproliferativephaseshowsdecreasedsignalintensityofthemyometrium Theboundarybetweenthemyometriumandasubserosaladenomyosis likelesion arrow isobscure b SagittalT2 weightedfastspin echoMRimageobtainedinthelatesecretoryphaseshowsincreasedsignalintensityofthemyometrium Thelow signal intensityjunctionalzoneandthesubserosaladenomyosis likelesion arrow areclearlyvisualized 33岁女性 浆膜下的子宫腺肌样病变 在月经周期的不同阶段a 在增殖早期时相获取的矢状位T2加权快速自旋回波MR图像显示肌层信号强度的下降 肌层和浆膜下子宫腺肌样病变之间的界限是模糊的b 在分泌晚期阶段获得的矢状位T2加权快速自旋回波MR图像显示肌层信号强度增高 低信号强度的结合带和浆膜下腺肌样病变清晰可见 Variousbenignconditionsandmalignanttumorsmaymimicadenomyosis physiologicmyometrialcontraction myometrialinvolvementbypelvicendometriosis low gradeendometrialstromasarcoma LG ESS andmyometrialmetastases多种良性改变和恶性肿瘤类似于子宫腺肌症 生理肌层收缩 肌层受累的盆腔子宫内膜异位症 低度恶性子宫内膜间质肉瘤 LG ESS 和肌层转移Transientmyometrialcontractionasaphysiologicphenomenonmaymimicadenomyosis thisappearancemaydisappearonsubsequentimagesoratcineMRimaging whereasfocaladenomyosispersistsonsubsequentimagesoratcineMRimaging Fig8 Inthepregnantuterus myometriumadjacenttotheimplantsitemayshowlowsignalintensity whichreflectsbloodsupplyingacontraction thisfindingmimicsphysiologiccontractionorfocaladenomyosis Fig9 作为一种生理现象的瞬态肌层收缩类似于子宫腺肌症 这种外观可能会消失在随后的图像或电影MRI图像 而局灶性子宫腺肌病持续的存在于随后的图像或电影MR成像 在怀孕的子宫 子宫肌层植入的地方表现为低信号 这反映了血液供给的收缩 这个表现类似于生理性收缩或局灶性腺肌病 Contractionsinthepregnantuterusarecommonlyseenandusuallydonotpresentadiagnosticdilemma however radiologistswhoarenotfamiliarwithMRimagingofpregnantwomenmaymisdiagnosethecontraction孕妇子宫的收缩很常见 通常不存在诊断的难题 然而 不熟悉怀孕女性MR成像的放射学医生可能会将子宫收缩误诊 BenignandMalignantMimicsofAdenomyosis类似于子宫腺肌症的良性和恶性病变 Figure8 Physiologictransientmyometrialcontractionina32 year oldwoman 发生在一个32岁女性的生理性瞬间肌层收缩SagittalT2 weightedfastspin echoMRimageshowsfocallow signal intensitybulgingofthemyometrium arrow afindingthatmimicsadenomyosis ThisfindingdisappearedonsubsequentT2 weightedimages 矢状位T2加权快速自旋回波MR图像显示为子宫肌层局灶性低信号强度的膨胀 箭头 这个表现类似于子宫腺肌症 其在接下来的T2WI上消失了 PitfallsinDiagnosis Figure9 Transientmyometrialcontractionduringpregnancyina31 year oldwoman 一个31岁女性怀孕期间的瞬间肌层收缩 a AxialT2 weightedfastspin echoMRimageshowsalocalizedareaoflowsignalintensity arrow intheuterus afindingthatmimicsadenomyosis BecausearapidT2 weightedsequence eg half Fourieracquisitionsingle shotturbospin echoorsingle shotfastspin echo wasnotused depictionoftheembryo fetusispoor b Axialsusceptibility weightedgradient echoMRimageshowsabsenceofsignalvoids arrow withinthelow signal intensityarea However absenceofsignalvoidsatsusceptibility weightedimagingshouldnotbeconsideredtoexcludeadenomyosis Toestablishthediagnosisofacontraction itwouldbecriticaltoshowthelow signal intensityareaonsubsequentT2 weightedimages a 轴位T2加权快速自旋回波MR图像显示子宫内一个局部低信号 类似于子宫腺肌症 因为快速T2加权序列没有使用 导致显示胎儿显示较差b 轴位SWI图显示低信号区域内没有点状低信号 然而在SWI图上缺乏点状低信号并不能排除子宫腺肌症 为了确定生理收缩的诊断 在随后的T2加权图像上显示低信号强度的区域至关重要 Susceptibility weightedimagingcanshowsmallhemorrhagicfociinadenomyosisasspottysignalvoidsandmaybehelpfulindifferentiatingadenomyosisfromfocalcontraction Fig10 Ontheotherhand absenceofsignalvoidsatsusceptibility weightedimagingshouldnotbeconsideredtoexcludeadenomyosis 磁敏感图能显示子宫腺肌症中的小的出血灶 表现为点状低信号 可以帮助鉴别子宫腺肌症和局灶性收缩 另一方面 磁敏感图上点状低信号的不存在不应该认为可以排除子宫腺肌症Adenomyosisisduetobenigninvasionofthemyometriumbyectopicendometriumandisadifferententityfromendometriosis However someadenomyosis likelesionsmaybesituatedinthesubserosalregionapartfromthejunctionalzone Figs7 11 Theselesionsmaybeduetomyometrialinvolvementbypelvicendometriosis patientstendtoexperienceseveremenstrualpainduetoadhesions子宫腺肌症是子宫内膜异位症中子宫肌层的良性浸润 是一种不同于子宫内膜异位症的实体肿瘤 然而 一些腺肌样病变有的除了位于结合带也会位于浆膜区这些病变可能是由于盆腔子宫内膜异位症侵入到肌层 由于粘连的原因 患者会感到严重的经期疼痛 PitfallsinDiagnosis Figure10 Adenomyosisina46 year oldwoman a AxialT2 weightedfastspin echoMRimageshowsadiffuselyenlargeduteruswithlowsignalintensity b Axialfat saturatedT1 weightedspin echoMRimageshowsabsenceofhigh signal intensityhemorrhagicfociwithintheuterus 46岁的女性 子宫腺肌症患者a 轴位T2加权快速自旋回波MR图像显示一个弥漫扩大的子宫伴随信号强度减低b 轴位脂肪抑制T1加权自旋回波MR图像显示子宫内没有高信号的出血灶 Figure10 c Axialsusceptibility weightedgradientechoMRimageshowsmultiplespottysignalvoids arrows whichareduetohemosiderindepositsandreflectoldhemorrhagicfocic 轴位SWI图像显示多个大小不等的低信号 这是由于含铁血黄素沉积和反应了陈旧出血灶 PitfallsinDiagnosis Figure11 Subserosaladenomyosis likelesionina41 year oldwoman 一个41岁的女性 浆膜下子宫腺肌样病变的患者SagittalT2 weightedfastspin echoMRimageshowsalow signal intensityadenomyosislikelesion arrow situatedinthesubserosalregionapartfromthejunctionalzone Thelesionmaybeduetomyometrialinvolvementbypelvicendometriosis Theuterusisdeformedduetoadhesions EM endometrioma 矢状位T2加权快速自选回波MR像显示除了结合带还有位于浆膜下的低信号强度腺肌样病变 这个病变可能是由于盆腔子宫内膜异位症侵入到肌层 子宫由于粘连而变形 PitfallsinDiagnosis Someprimaryorsecondarymalignanttumorsmayappearasill demarcatedmyometrialmasseswithuterineenlargement findingsthatmimicadenomyosis LG ESSisararemalignantmesenchymaltumoraffectingyoungwomenandusuallyoccursintheendometriumwithextensivemyometrialinvasion LG ESSmayoccasionallybesituatedalmostwithinthemyometrium 有些原发性或继发性的恶性肿瘤可能会出现边界不清的肌层内肿块伴随子宫增大 表现类似于子宫腺肌症 LG ESSS是一种罕见的发生于年轻女性的恶性间质瘤 通常发生于子宫内膜并伴随着广泛的肌层浸润MyometrialinvasionbyLG ESSisveryinfiltrative andpreservedlow signal intensitymusclebundleswithinthehigh signal intensitytumoronT2 weightedimagesareacharacte