子宫腺肌症常见和不常见的MRI表现中英文对照

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Usual and Unusual Imaging Manifestations on MRI of Adenomyosis,郑州大学第一附属医院磁共振科,何杰 2013年,4,月1,7,日,子宫腺肌症常见和不常见的,MRI,表现,Adenomyosis is a common nonneoplastic gynecologic disease characterized by the presence of ectopic endometrium within the myometrium.,Adenomyosis typically affects multiparous,premenopausal women over 30 years of age and may cause dysmenorrhea,menorrhagia,and abnormal genital bleeding.,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,。,Magnetic resonance(MR)imaging is a noninvasive modality with high sensitivity and specificity for diagnosis of adenomyosis.In cases of an enlarged uterus revealed with ultrasonography,MR imaging allows differentiation of adenomyosis from leiomyoma or other pathologic conditions owing to its excellent tissue contrast resolution.,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,On T2-weighted images,typical adenomyosis appears as an ill-demarcated low-signal-intensity lesion with uterine enlargement.However,various physiologic or pathologic states may affect the MR imaging appearance of adenomyosis and may result in a tumorlike appearance,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,Specific topics discussed are MR imaging manifestations of typical adenomyosis,atypical MR imaging manifestations of adenomyosis,pitfalls in diagnosis of adenomyosis,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,MR Imaging Manifestations of Typical Adenomyosis,子宫腺肌症的典型,MRI,表现,Typical Adenomyosis,At pathologic analysis,adenomyosis is characterized by the presence of ectopic endometrial glands and stroma within the myometrium with hypertrophy and hyperplasia of smooth muscle,Adenomyosis may affect the uterine myometrium diffusely and result in a diffusely enlarged uterus,or it may be localized as an adenomyoma.,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,A cut section of a diffusely adenomyotic uterus shows thickened myometrium due to the ill-defined adenomyosis;,the thickened myometrium is composed of haphazardly distributed hypertrophied muscular trabeculae surrounding ectopic endometrial tissue,(Fig 1),.,Brownish old hemorrhagic foci corresponding to hemolysed blood and hemosiderin pigment deposits may be contained within the area of adenomyosis,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,Typical Adenomyosis,Fig.1A 1B,1A,1B,Figure 1,.,Adenomyosis in a 47-year-old woman.47,岁女性，子宫腺肌症患者，,(a),Photograph of the cut surface of the gross specimen shows diffusely thickened myometrium.,(b),photomicrograph(hematoxylin-eosin stain)shows ectopic endometrial glands and stroma(arrow)surrounded by hypertrophied smooth muscle.,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,Typical adenomyosis appears as an ill-demarcated low-signal-intensity area on T2-weighted images owing to abundant smooth muscle proliferation,(Fig 2),.,Because adenomyotic endometrium looks like the basalis endometrium,which seldom responds to hormonal stimuli,cyclic changes including degeneration,bleeding,and regeneration are less common in adenomyosis than in endometriosis.,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,On T2-weighted MR images,ectopic endometrium appears as small high-signal-intensity areas like normal endometrium,(Fig 2).,Small cysts may also appear as high-signal-intensity spots on T2-weighted images.,Sometimes,hemorrhagic foci appear as 13mm high-signal-intensity foci on T1-weighted images owing to the T1-shortening effects of methemoglobin,(Fig 2),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,Typical Adenomyosis,Susceptibility-weighted imaging is sensitive for old hemorrhagic foci,which appear as spotty signal voids owing to the T2*-shortening effects of hemosiderin.,At diffusion-weighted imaging,adenomyosis has low to intermediate signal intensity,a finding consistent with its benign,nonneoplastic nature,(Fig 3),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,there is no direct correlation between signal intensity at diffusion-weighted imaging and malignancy;most malignant tumors have very high signal intensity at diffusion-weighted imaging,a finding that reflects the long T2 relaxation time and restricted diffusion due to high cellularity.,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。,Typical Adenomyosis,Figure 2,.Adenomyosis in a 46-year-old woman.46,岁女性，子宫腺肌症患者,(a),Sagittal T2-weighted fast spin-echo MR image shows an enlarged uterus with an ill-defined low-signal-intensity lesion(arrow)in the posterior myome