三期增强CT联合超声对静脉内平滑肌瘤病的诊断价值
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摘要
目的探讨静脉内平滑肌瘤病的三期增强CT及超声表现和评估各自的临床诊断价值。方法回顾性分析经手术病理证实的11例静脉内平滑肌瘤病患者的增强CT及超声资料,观察病灶的位置、形态、密度、回声强度的特点。结果 11例患者均有子宫肌瘤病史,4例曾行子宫手术。超声检查发现子宫内低回声肿块7例,右心腔内发现中等回声肿块4例,在右心房近三尖瓣处来回移动。增强CT发现子宫内不均匀强化的肿块10例,11例CT发现下腔静脉内连续的不均匀充盈缺损影,病变在横轴位上呈"筛孔"状改变,在多平面重组后冠状位图像上呈"丝瓜瓤"样改变。病变延伸到右心腔7例,在冠状位上表现为"蛇头"状改变。结论三期增强CT和超声在静脉内平滑肌瘤病诊断中具有各自独特的优势。对于疑似静脉内平滑肌瘤病患者,两者联合应用可以帮助提高该病诊断准确率,评估病变累及范围,对临床制定手术方案及预后评估具有重要意义。
Objective To characterize the three-phase contrast-enhanced CT and ultrasonographic imaging findings of patients with intravenous leiomyomatosis( IVL) and evaluate their respective clinical value in the diagnosis of IVL. Methods The contrast-enhanced CT and ultrasonographic imaging findings of 11 patients with pathologically proven IVL were retrospectively analyzed. Imaging features were assessed including location,morphology,attenuation and echogenicity. Results All of the 11 patients had history of uterine leiomyoma,four patients had undergone myomectomy or hysterectomy.Tumors in the uterus appeared as hypoechoic mass under ultrasound examinations in 7 patients. The medium echogenic tumor mass extended into the right atrium,prolapsed through the tricuspid orifice into ther right ventricle in 4 patients. The tumor mass in uterus with heterogeneous enhancement were observed on contrasted CT in 10 patients. The continuous and heterogeneous filling defects could be seen in inferior vena cava in 11 patients. The lesion looked like a sieve pore on axial contrast-enhanced CT images,and a vegetable sponge on post-processing coronal images. The filling defect extends from inferior vena cava to the right atrium in 7 cases and the whole lesion looks serpiginous on coronal images. Conclusion Three-phase contrast-enhanced CT and ultrasonography imaging have respective advantages in the diagnosis of IVL. For patients with suspected IVL,combined application of CT and ultrasonography is helpful in accurate diagnosis of the lesion,evaluation of the extent of involvement of the lesion,guidance of surgery planning and follow-up.
Objective To characterize the three-phase contrast-enhanced CT and ultrasonographic imaging findings of patients with intravenous leiomyomatosis( IVL) and evaluate their respective clinical value in the diagnosis of IVL. Methods The contrast-enhanced CT and ultrasonographic imaging findings of 11 patients with pathologically proven IVL were retrospectively analyzed. Imaging features were assessed including location,morphology,attenuation and echogenicity. Results All of the 11 patients had history of uterine leiomyoma,four patients had undergone myomectomy or hysterectomy.Tumors in the uterus appeared as hypoechoic mass under ultrasound examinations in 7 patients. The medium echogenic tumor mass extended into the right atrium,prolapsed through the tricuspid orifice into ther right ventricle in 4 patients. The tumor mass in uterus with heterogeneous enhancement were observed on contrasted CT in 10 patients. The continuous and heterogeneous filling defects could be seen in inferior vena cava in 11 patients. The lesion looked like a sieve pore on axial contrast-enhanced CT images,and a vegetable sponge on post-processing coronal images. The filling defect extends from inferior vena cava to the right atrium in 7 cases and the whole lesion looks serpiginous on coronal images. Conclusion Three-phase contrast-enhanced CT and ultrasonography imaging have respective advantages in the diagnosis of IVL. For patients with suspected IVL,combined application of CT and ultrasonography is helpful in accurate diagnosis of the lesion,evaluation of the extent of involvement of the lesion,guidance of surgery planning and follow-up.
引文
1支爱华,戴汝平,蒋世良,等.子宫平滑肌瘤病经静脉延伸至右侧心腔的影像学诊断[J].中华放射学杂志,2005,39:275-279.
2赵大春,田庄,梁智勇,等.静脉内平滑肌瘤病的临床病理[J].协和医学杂志,2012,3:51-55.
3 Birch-Hirschfeld FV.Lehrbuch der pathologischen Anatomie[M].5th ed.Germany:Vogel,1896,266.
4 Lam PM,Lo KW,Yu MY,et al.Intravenous leiomyomatosis:two cases with different routes of tumor extension[J].Journal of Vascular Surgery,2004,39:465-469.
5宁燕,周先荣,朱慧庭,等.子宫静脉内平滑肌瘤病临床病理与生物学行为分析[J].临床与实验病理学杂志,2007,23:290-292.
6 Liu B,Liu C,Guan H,et al.Intravenous leiomyomatosis with inferior vena cava and heart extension[J].Journal of Vascular Surgery,2009,50:897-902.
7温兆赢,毕涛,赵映,等.多排CT下腔静脉成像对子宫静脉内平滑肌瘤病的诊断意义[J].心肺血管病杂志,2015,34:631-634.
8 Norris HJ,Parmley T.Mesenchymal tumors of the uterus.V.Intravenous leiomyomatosis.A clinical and pathologic study of 14 cases.[J].Cancer,1976,36:2164-2178.
9 Fukuyama A,Yokoyama Y,Futagami M,et al.A case of uterine leiomyoma with intravenous leiomyomatosis-histological investigation of the pathological condition[J].Pathology&Oncology Research,2011,17:171-174.
10 Wu CK,Luo JL,Yang CY,et al.Intravenous leiomyomatosis with intracardiac extension[J].Internal Medicine,2009,48:997-1001.
11潘莹,孙莉,常才.超声诊断子宫静脉内平滑肌瘤病的结果分析[J].中华超声影像学杂志,2004,13:913-915.
12 Lou YF,Shi XP,Song ZZ.Intravenous leiomyomatosis of the uterus with extension to the right heart[J].Cardiovascular Ultrasound,2011,9:1-5.
13 Kutay V,Tuncer M,Harman M,et al.Intracardiac Extension of Intravenous Leiomyoma[J].Texas Heart Institute Journal,2005,32:232-234.
14 Lai TK,Huang HY,Chan RY,et al.Magnetic resonance venogram of intravenous leiomyomatosis[J].Hong Kong Med J,2005,11:524-526.
15 Gui T,Qian Q,Cao D,et al.Computerized tomography angiography in preoperativeassessment of intravenous leiomyomatosis extending to inferior vena cava and heart[J].BMCCancer,2016,16:1-7.
16 Quade BJ,Dal CP,Neskey DM,et al.Intravenous leiomyomatosis:molecular and cytogenetic analysis of a case[J].Modern Pathology,2002,15:351-356.
17 Buckley O,Madan R,Kwong R,et al.Cardiac Masses,Part 2:Key Imaging Featuresfor Diagnosis and Surgical Planning[J].American Journal of Roentgenology,2011,197:842-851.
18牡丹,麦筱莉,王冬梅,等.下腔静脉平滑肌肉瘤的影像学表现[J].医学影像学杂志,2015,25:274-277.
19 Huang J,Liu Q,Lu JP,et al.Primary intraluminal leiomyosarcoma of the inferior vena cava:value of MRI with contrast-enhanced MRvenography in diagnosis and treatment[J].Abdominal Imaging,2011,36:337.
20郑金龙,韩萍,柳曦,等.下腔静脉病变的螺旋CT诊断[J].临床放射学杂志,2006,25:838-842.
2赵大春,田庄,梁智勇,等.静脉内平滑肌瘤病的临床病理[J].协和医学杂志,2012,3:51-55.
3 Birch-Hirschfeld FV.Lehrbuch der pathologischen Anatomie[M].5th ed.Germany:Vogel,1896,266.
4 Lam PM,Lo KW,Yu MY,et al.Intravenous leiomyomatosis:two cases with different routes of tumor extension[J].Journal of Vascular Surgery,2004,39:465-469.
5宁燕,周先荣,朱慧庭,等.子宫静脉内平滑肌瘤病临床病理与生物学行为分析[J].临床与实验病理学杂志,2007,23:290-292.
6 Liu B,Liu C,Guan H,et al.Intravenous leiomyomatosis with inferior vena cava and heart extension[J].Journal of Vascular Surgery,2009,50:897-902.
7温兆赢,毕涛,赵映,等.多排CT下腔静脉成像对子宫静脉内平滑肌瘤病的诊断意义[J].心肺血管病杂志,2015,34:631-634.
8 Norris HJ,Parmley T.Mesenchymal tumors of the uterus.V.Intravenous leiomyomatosis.A clinical and pathologic study of 14 cases.[J].Cancer,1976,36:2164-2178.
9 Fukuyama A,Yokoyama Y,Futagami M,et al.A case of uterine leiomyoma with intravenous leiomyomatosis-histological investigation of the pathological condition[J].Pathology&Oncology Research,2011,17:171-174.
10 Wu CK,Luo JL,Yang CY,et al.Intravenous leiomyomatosis with intracardiac extension[J].Internal Medicine,2009,48:997-1001.
11潘莹,孙莉,常才.超声诊断子宫静脉内平滑肌瘤病的结果分析[J].中华超声影像学杂志,2004,13:913-915.
12 Lou YF,Shi XP,Song ZZ.Intravenous leiomyomatosis of the uterus with extension to the right heart[J].Cardiovascular Ultrasound,2011,9:1-5.
13 Kutay V,Tuncer M,Harman M,et al.Intracardiac Extension of Intravenous Leiomyoma[J].Texas Heart Institute Journal,2005,32:232-234.
14 Lai TK,Huang HY,Chan RY,et al.Magnetic resonance venogram of intravenous leiomyomatosis[J].Hong Kong Med J,2005,11:524-526.
15 Gui T,Qian Q,Cao D,et al.Computerized tomography angiography in preoperativeassessment of intravenous leiomyomatosis extending to inferior vena cava and heart[J].BMCCancer,2016,16:1-7.
16 Quade BJ,Dal CP,Neskey DM,et al.Intravenous leiomyomatosis:molecular and cytogenetic analysis of a case[J].Modern Pathology,2002,15:351-356.
17 Buckley O,Madan R,Kwong R,et al.Cardiac Masses,Part 2:Key Imaging Featuresfor Diagnosis and Surgical Planning[J].American Journal of Roentgenology,2011,197:842-851.
18牡丹,麦筱莉,王冬梅,等.下腔静脉平滑肌肉瘤的影像学表现[J].医学影像学杂志,2015,25:274-277.
19 Huang J,Liu Q,Lu JP,et al.Primary intraluminal leiomyosarcoma of the inferior vena cava:value of MRI with contrast-enhanced MRvenography in diagnosis and treatment[J].Abdominal Imaging,2011,36:337.
20郑金龙,韩萍,柳曦,等.下腔静脉病变的螺旋CT诊断[J].临床放射学杂志,2006,25:838-842.