子宮腺肌癥常見(jiàn)和不常見(jiàn)的MRI 課件

1、子宮腺肌癥常見(jiàn)和不常見(jiàn)的MRI表現(xiàn)2021/5/71Adenomyosis 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 ge

2、nital bleeding .子宮腺肌癥是一種常見(jiàn)的非腫瘤性婦科疾病，是發(fā)生在子宮肌層的子宮內(nèi)膜異位癥。其主要發(fā)生于超過(guò)30歲，絕經(jīng)前的經(jīng)產(chǎn)婦并且可能引起痛經(jīng)，月經(jīng)過(guò)多和不正常的陰道出血的癥狀。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 al

3、lows differentiation of adenomyosis from leiomyoma or other pathologic conditions owing to its excellent tissue contrast resolution .磁共振（MR）成像是一種非侵入性的檢查方式，其在診斷子宮腺肌癥上具有高的靈敏度和特異度。當(dāng)超聲檢查中發(fā)現(xiàn)子宮增大時(shí)，磁共振由于其出色的組織對(duì)比分辨率可以把子宮腺肌癥與子宮肌瘤或其他疾病鑒別出來(lái)。 Introduction2021/5/72On T2-weighted images, typical adenomyosis appea

4、rs 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，子宮腺肌癥的典型表現(xiàn)為一個(gè)邊界不清的低信號(hào)強(qiáng)度病變伴隨著子宮增大。然而，多種生理和病理改變也許會(huì)影響子宮腺肌癥的MRI表現(xiàn)并且會(huì)導(dǎo)致其出現(xiàn)腫瘤樣

5、的表現(xiàn)Specific topics discussed are MR imaging manifestations of typical adenomyosis, atypical MR imaging manifestations of adenomyosis, pitfalls in diagnosis of adenomyosis, 討論的具體話題包括子宮腺肌癥的典型MRI表現(xiàn)，子宮腺肌癥的不典型MRI表現(xiàn)，子宮腺肌癥的診斷誤區(qū)Introduction2021/5/73MR Imaging Manifestations of Typical Adenomyosis子宮腺肌癥的典型MRI

6、表現(xiàn)2021/5/74 Typical AdenomyosisAt pathologic analysis, adenomyosis is characterized by the presence of ectopic endometrial glands and stroma within the myometrium with hypertrophy and hyperplasia of smooth muscleAdenomyosis may affect the uterine myometrium diffusely and result in a diffusely enlarg

7、ed uterus, or it may be localized as an adenomyoma.病理分析，子宮腺肌癥的特征性表現(xiàn)是子宮肌層內(nèi)異位的子宮內(nèi)膜腺體和間質(zhì)的存在和平滑肌的肥大增生。子宮腺肌癥也許會(huì)彌漫性的影響子宮肌層并導(dǎo)致子宮彌漫性的增大，或者會(huì)作為腺肌瘤局限性的影響肌層2021/5/75A cut section of a diffusely adenomyotic uterus shows thickened myometrium due to the ill-defined adenomyosis; the thickened myometrium is composed

8、 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彌漫型腺肌型子宮的橫斷面顯示由于界限不清的子宮腺肌病導(dǎo)致肌層增厚。肥厚的肌層是由隨意分布的肥

9、大性肌小梁及周圍的異位子宮內(nèi)膜組織所構(gòu)成（圖1）。褐色的舊出血灶也許對(duì)應(yīng)著子宮腺肌癥區(qū)域內(nèi)的出血和含鐵血黃素沉積 Typical Adenomyosis2021/5/76Fig. 1A 1B1A1BFigure 1. Adenomyosis in a 47-year-old woman. 47歲女性，子宮腺肌癥患者，(a) Photograph of the cut surface of the gross specimen shows diffusely thickened myometrium. (b) photomicrograph (hematoxylin-eosin stain) s

10、hows ectopic endometrial glands and stroma (arrow) surrounded by hypertrophied smooth muscle.a.大體標(biāo)本的切面照片顯示彌漫性增厚的子宮肌層 b.顯微鏡下照片（HE染色）顯示異位的子宮內(nèi)膜腺體和間質(zhì)和周圍的肥厚的平滑肌 2021/5/77Typical adenomyosis appears as an ill-demarcated low-signal-intensity area on T2-weighted images owing to abundant smooth muscle prolif

11、eration (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 . 子宮腺肌癥的典型表現(xiàn)是在T2WI上有一界限不清的低信號(hào)區(qū)域，這是由于豐富的平滑肌細(xì)胞增殖。因?yàn)橄偌“Y子

12、宮內(nèi)膜跟基底子宮內(nèi)膜一樣，很少對(duì)激素的刺激做出反應(yīng)，所以與其他子宮內(nèi)膜異位癥相比，包括變性，出血，再生這樣的周期性的變化較少出現(xiàn)在子宮腺肌癥中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

13、foci appear as 13mm high-signal-intensity foci on T1-weighted images owing to the T1-shortening effects of methemoglobin (Fig 2)在T2WI圖像上，異位子宮內(nèi)膜表現(xiàn)為跟正常子宮內(nèi)膜一樣的小的片狀高信號(hào)，小的囊腫也可能在T2WI上表現(xiàn)為點(diǎn)狀高信號(hào)。有時(shí)候由于高鐵血紅蛋白T1縮短效應(yīng)的影響，出血灶在T1WI上表現(xiàn)為1-3mm的高信號(hào)病灶 Typical Adenomyosis2021/5/78Susceptibility-weighted imaging is sensit

14、ive 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) 磁敏感加權(quán)成像對(duì)陳舊出血灶很敏感，由于含鐵血黃素T2縮短效

15、應(yīng)的影像，表現(xiàn)點(diǎn)狀低信號(hào)。在彌散加權(quán)像上，子宮腺肌癥表現(xiàn)為低到中等信號(hào)強(qiáng)度，這種表現(xiàn)其實(shí)與它是良性，非腫瘤性病變這種性質(zhì)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 relax

16、ation time and restricted diffusion due to high cellularity.然而，DWI上信號(hào)強(qiáng)度和惡性病變之間并沒(méi)有直接的相關(guān)性；大多數(shù)的惡性腫瘤在DWI上有非常高的信號(hào)強(qiáng)度，這反映了由于長(zhǎng)的T2弛豫時(shí)間和高的細(xì)胞密度導(dǎo)致的擴(kuò)散受限。 Typical Adenomyosis2021/5/79Figure 2. Adenomyosis in a 46-year-old woman. 46歲女性，子宮腺肌癥患者(a) Sagittal T2-weighted fast spin-echo MR image shows an enlarged uteru

17、s with an ill-defined low-signal-intensity lesion (arrow) in the posterior myometrium. The lesion contains multiple small high-signal-intensity areas, which represent ectopic endometrial tissue and small cysts.矢狀位T2加權(quán)快速自旋回波MR圖像顯示子宮增大，伴隨一個(gè)子宮肌層后壁內(nèi)界限不清的低信號(hào)強(qiáng)度的病變（箭頭處），病變包含多個(gè)小的高信號(hào)的區(qū)域，其代表了子宮內(nèi)膜異位組織和小囊腫 (b)

18、Sagittal T1-weighted spin-echo MR image shows high-signal-intensity spots (arrow), which correspond to some of the small high-signal-intensity areas seen on the T2-weighted image.The high-signal-intensity spots represent hemorrhage within the ectopic endometrial tissue.矢狀位T1加權(quán)自旋回波MR圖像顯示了點(diǎn)狀高信號(hào)，它們對(duì)應(yīng)了在

19、T2WI上看到的一些小的高信號(hào)區(qū)域。這些點(diǎn)狀高信號(hào)代表了子宮內(nèi)膜組織內(nèi)的出血2021/5/7109、 人的價(jià)值，在招收誘惑的一瞬間被決定。2022/7/112022/7/11Monday, July 11, 202210、低頭要有勇氣，抬頭要有低氣。2022/7/112022/7/112022/7/117/11/2022 10:55:46 PM11、人總是珍惜為得到。2022/7/112022/7/112022/7/11Jul-2211-Jul-2212、人亂于心，不寬余請(qǐng)。2022/7/112022/7/112022/7/11Monday, July 11, 202213、生氣是拿別人做錯(cuò)的

20、事來(lái)懲罰自己。2022/7/112022/7/112022/7/112022/7/117/11/202214、抱最大的希望，作最大的努力。11 七月 20222022/7/112022/7/112022/7/1115、一個(gè)人炫耀什么，說(shuō)明他內(nèi)心缺少什么。七月 222022/7/112022/7/112022/7/117/11/202216、業(yè)余生活要有意義，不要越軌。2022/7/112022/7/1111 July 202217、一個(gè)人即使已登上頂峰，也仍要自強(qiáng)不息。2022/7/112022/7/112022/7/112022/7/112021/5/711Figure 3. Adenomy

21、osis in a 42-year-old woman. (a) Sagittal diffusion-weighted echo-planar MR image (b = 800 sec/mm2) shows an enlarged uterus with an ill-defined lesion of low to intermediate signal intensity (arrow) in the posterior myometrium. (b) Corresponding apparent diffusion coefficient (ADC) map shows no pro

22、minent decrease of ADC value in the area of adenomyosis (arrow).a.矢狀位擴(kuò)散加權(quán)回波平面MR圖像(b = 800 sec/mm2)顯示增大的子宮伴隨后壁肌層內(nèi)界限不清的病變，呈低到中等信號(hào)強(qiáng)度（箭頭）。b.相應(yīng)的ADC圖上在子宮腺肌癥的區(qū)域內(nèi)沒(méi)有顯示出明顯的ADC值的下降2021/5/712Because adenomyosis may show various degrees of enhancement after administration of contrast medium, contrast-enhanced st

23、udy does not contribute to diagnostic accuracy (Fig 4).Dynamic contrast-enhanced imaging may have greater accuracy than T2-weighted imaging when adenomyosis and endometrial cancer coexist (16). 因?yàn)樵谧⑸湓煊皠┖?，子宮腺肌癥可能顯示為不同程度的強(qiáng)化，所以關(guān)于其對(duì)比增強(qiáng)的研究對(duì)診斷的準(zhǔn)確性沒(méi)有幫助（圖4）。 當(dāng)子宮腺肌癥和子宮內(nèi)膜癌同時(shí)存在時(shí)動(dòng)態(tài)對(duì)比增強(qiáng)圖像也許會(huì)比T2加權(quán)圖像更準(zhǔn)確However, th

24、e heterogeneous enhancement of adenomyosis may cause inaccuracy when evaluating the depth of myometrial invasion by coexisting endometrial cancer; diffusion-weighted imaging may be helpful in accurately determining the depth of myometrial invasion .然而當(dāng)并發(fā)子宮內(nèi)膜癌時(shí)，子宮腺肌癥不均質(zhì)的強(qiáng)化可能會(huì)導(dǎo)致評(píng)估肌層浸潤(rùn)深度的不準(zhǔn)確；擴(kuò)散加權(quán)成像也許會(huì)幫

25、助準(zhǔn)確的確定肌層浸潤(rùn)深度 Typical Adenomyosis2021/5/713Diffusion-weighted ImagingDiffusion-weighted imaging allows visualization of the local microstructural characteristics of water diffusion. The signal intensity seen on diffusion-weighted images is a combination of the degree of water diffusion and the signal

26、 intensity of the underlying T2-weighted images.擴(kuò)散加權(quán)圖像能夠可視化水分子擴(kuò)散的微觀結(jié)構(gòu)特征，在DWI上看的信號(hào)強(qiáng)度是水分子擴(kuò)散程度和基礎(chǔ)T2加權(quán)圖像信號(hào)強(qiáng)度的結(jié)合。In oncologic imaging, various malignant tumors may show high signal intensity at diffusion-weighted imaging due to their high cellularity and long T2 relaxation time 在腫瘤成像上，由于高的細(xì)胞密度和長(zhǎng)的T2弛豫時(shí)間，各

27、種惡性腫瘤在DWI上顯示為高信號(hào)。 ADC measurement yields quantitative information about tissue structure that is based on the molecular motion of water. Malignant lesions with increased cellularity show low ADC values, whereas relatively hypocellular benign lesions and normal structures tend to show relatively high

28、er ADC values.ADC圖以水分子的運(yùn)動(dòng)為基礎(chǔ)來(lái)測(cè)量組織結(jié)構(gòu)的定量信息。高的細(xì)胞密度大的病變表現(xiàn)出低的ADC值，而相對(duì)低度增生的良性病變和正常組織顯示相對(duì)高的ADC值 Typical Adenomyosis2021/5/714Figure 4. Adenomyosis in a 47-year-old woman. 47歲女性，子宮腺肌癥患者(a) Sagittal T2-weighted fast spin-echo MR image shows an enlarged uterus with an ill-defined low-signal-intensity lesion (

29、arrow) in the posterior myometrium. The lesion contains multiple small high-signal-intensity areas.(b) Unenhanced (upper left), early arterial phase (upper right), late arterial phase (lower left), and venous phase (lower right) images, obtained with a dynamic gadolinium-enhanced three-dimensional f

30、ast spoiled gradient-echo sequence with fat suppression, show heterogeneous and gradual enhancement of the lesion.a.矢狀位T2加權(quán)快速自旋回波MR圖像顯示子宮增大伴隨子宮肌層后壁內(nèi)界限不清的低信號(hào)強(qiáng)度病變。病變內(nèi)包含多個(gè)小的高信號(hào)強(qiáng)度區(qū)域b.由一個(gè)壓脂動(dòng)態(tài)釓增強(qiáng)型三維快速小角度梯度回波序列獲得平掃（左上圖），動(dòng)脈早期相（右上圖），動(dòng)脈晚期相（左上圖），以及靜脈相（右下圖），病變表現(xiàn)為不均勻和漸進(jìn)性的強(qiáng)化。2021/5/715Atypical MR Imaging Manifest

31、ations of Adenomyosis子宮腺肌癥的非典型MRI表現(xiàn)2021/5/716Atypical Adenomyosis Various physiologic or pathologic states may affect the MR imaging appearance of adenomyosis: amount of functional endometrial tissue, phase of the menstrual cycle, endogenous hormonal abnormality, and exogenous hormonal stimulation.

32、Secretory transformation of adenomyotic endometrium including stromal decidualizationmay cause a heterogeneous increase in signal intensity on T2-weighted images.多種生理或病理狀態(tài)可能會(huì)影響子宮腺肌癥的MRI表現(xiàn)：功能性子宮內(nèi)膜組織的量，月經(jīng)周期的階段，內(nèi)源激素的異常，外源激素的刺激。腺肌癥子宮內(nèi)膜的分泌轉(zhuǎn)化包括間質(zhì)蛻膜化會(huì)導(dǎo)致T2WI上信號(hào)強(qiáng)度不均質(zhì)的提高This phenomenon may be encountered duri

33、ng gestation and exogenous progestational therapy or even in patients without specific hormonal stimulation. Congestion or edematous change may also increase the signal intensity of adenomyosis diffusely or focally on T2-weighted images (Fig 5). 這種現(xiàn)象可能發(fā)生于懷孕期間，外源性孕激素治療期間，或者甚至在沒(méi)有特定激素刺激的患者身上。充血或水腫的變化也可

34、能會(huì)在T2WI上彌漫性增加子宮腺肌癥的信號(hào)強(qiáng)度或者局部信號(hào)強(qiáng)度（圖5）。2021/5/717In such conditions, MR imaging manifestations may fluctuate, and follow-up MR imaging may be helpful for diagnosis. Gonadotropin-releasing hormone analog is used in the treatment of adenomyosis. After hormonal therapy or menopause, an area of adenomyosis

35、 may shrink with decreased signal intensity on T2-weighted images(Fig 6)在這種情況下，MRI表現(xiàn)會(huì)變化較大，再一次的復(fù)查對(duì)診斷有幫助。促性腺激素釋放激素類似物被用于治療子宮腺肌癥。激素治療后或在絕經(jīng)期時(shí)，子宮腺肌癥的面積可能會(huì)萎縮，并伴隨著T2WI上信號(hào)強(qiáng)度的降低(圖6)。Atypical Adenomyosis 2021/5/718Figure 5. Adenomyosis with focal edema in a 54-year-old woman. (a) Sagittal T2-weighted fast spi

36、n-echo MR image shows an enlarged uterus with an ill-defined low-signal-intensity lesion in the posterior myometrium. The low-signal-intensity lesion contains a focal high-signal-intensity masslike area (arrow).(b) On diffusion weighted echo-planar MR image (b = 800 sec/ mm2), the high-signal-intens

37、ity masslike area in a sagittal shows no increase in signal intensity (arrow). a.矢狀位T2加權(quán)快速自旋回波MR圖像顯示增大的子宮伴隨子宮后壁內(nèi)界限不清的低信號(hào)強(qiáng)度病變。這個(gè)低信號(hào)病變內(nèi)包含一個(gè)腫塊樣高信號(hào)強(qiáng)度區(qū)域（箭頭）b.在矢狀位擴(kuò)散加權(quán)平面回波MR圖像上 (b = 800 sec/ mm2) ，這個(gè)高信號(hào)強(qiáng)度腫瘤樣區(qū)域沒(méi)有顯示信號(hào)強(qiáng)度的增高（箭頭）2021/5/719Figure 5.（c ） On an image from MR spectroscopy, the high-signal-intensit

38、y masslike area shows a low choline peak (Cho) at 3.2 ppm. Biopsy revealed benign adenomyotic tissue with stromal edema. The signal intensity of the masslike area is decreased on follow-up T2-weighted images obtained 3 months later. c.在磁共振波譜上，這個(gè)高信號(hào)強(qiáng)度的腫塊樣區(qū)域在3.2ppm處顯示為低的膽堿峰（Cho）。活檢發(fā)現(xiàn)良性子宮腺肌組織間質(zhì)水腫，這個(gè)腫塊樣

39、區(qū)域的信號(hào)強(qiáng)度在3個(gè)月后的T2WI圖像上降低。MR spectroscopy2021/5/720Figure 6. Adenomyosis in a 50-year-old woman before and after hormonal therapy with gonadotropinre leasing hormone analog.一個(gè)50歲女性，子宮腺肌癥患者，促性腺激素釋放激素類似物治療前后(a)Axial T2-weighted fast spin-echo MR image shows adenomyosis as an ill-defined heterogeneous low

40、-signal-intensity lesion with linear or reticular high-signal-intensity areas in the anterior myometrium (arrow). (b) Axial T2-weighted fast spin-echo MR image obtained after hormonal therapy shows decreased volume and signal intensity of the area of adenomyosis (arrow). a.在軸位T2加權(quán)快速自旋回波MR圖像上，子宮腺肌癥顯示

41、為邊界不清的不均勻的低信號(hào)強(qiáng)度病變伴隨肌層前壁線狀或網(wǎng)狀高信號(hào)強(qiáng)度區(qū)域（箭頭） b.激素治療后，獲取的軸位T2加權(quán)快速自旋回波MR圖像顯示子宮腺肌癥區(qū)域的面積和信號(hào)強(qiáng)度都下降了2021/5/721In such conditions, MR imaging manifestations may fluctuate, and follow-up MR imaging may be helpful for diagnosis. Gonadotropin-releasing hormone analog is used in the treatment of adenomyosis. After h

42、ormonal therapy or menopause, an area of adenomyosis may shrink with decreased signal intensity on T2-weighted images(Fig 6) 在這種情況下，MRI表現(xiàn)會(huì)變化較大，再一次的復(fù)查對(duì)診斷有幫助。促性腺激素釋放激素類似物被用于治療子宮腺肌癥。激素治療后或絕經(jīng)期子宮腺肌癥的面積可能會(huì)萎縮，并伴隨著T2WI上信號(hào)強(qiáng)度的降低。Diffusion-weighted imaging with ADC measurement may provide another clue for the

43、diagnosis, because these conditions (secretory transformation, decidualization, congestion or edema) usually increase the ADC in tissues. A relatively high ADC in adenomyotic lesions with high signal intensity on T2-weighted images may allow differentiation from malignant lesions, which have a low A

44、DC due to their high cellularity (Fig 5) (15). 彌散加權(quán)成像圖像上ADC值的測(cè)量可能提供診斷的另一條線索，因?yàn)樵谶@些情況下（分泌轉(zhuǎn)化，蛻膜變，充血或水腫）通常會(huì)增加組織的ADC值。子宮腺肌癥病灶的一個(gè)相對(duì)高的ADC值和高的T2信號(hào)強(qiáng)度可以將其從惡性病變中鑒別出來(lái)，因?yàn)閻盒圆∽冇捎谄涓叩募?xì)胞密度導(dǎo)致低的ADC值MR spectroscopy may also provide a clue for the diagnosis, because these benign adenomyotic conditions do not show high me

45、tabolic activity. A relatively low choline peak in adenomyotic lesions may allow differentiation from malignant tumors, which show a high choline peak due to their high metabolic activity (Fig5)磁共振質(zhì)子波譜也可以提供診斷線索，因?yàn)檫@些良性的腺肌并沒(méi)有表現(xiàn)為高的代謝活動(dòng)。子宮腺肌癥病變的一個(gè)相對(duì)低的膽堿峰有助于將其與惡性腫瘤鑒別開(kāi)，因?yàn)閻盒阅[瘤由于其高的代謝活動(dòng)顯示為高的膽堿峰。Atypical Ade

46、nomyosis 2021/5/722Pitfalls in Diagnosis of Adenomyosis子宮腺肌癥診斷中的陷阱2021/5/723The uterine body may show physiologic changes during the menstrual cycle. The low-signal-intensity junctional zone and adenomyosis are well visualized due to increased signal intensity of the myometrium in the secretory phas

47、e (luteal phase). 子宮體在月經(jīng)周期中表現(xiàn)了生理性的變化。由于在分泌期（黃體期）時(shí)子宮肌層信號(hào)變高，導(dǎo)致能清楚的看到低信號(hào)的結(jié)合帶和子宮腺肌癥Decreased signal intensity of the myometrium in the menstrualearly proliferative phase (follicular phase) may cause widening of the junctional zone, which mimics diffuse adenomyosis. Therefore, MR imaging for the evaluati

48、on of a uterine myometrial lesion should be performed in the late proliferativesecretory phase (Fig 7)肌層在月經(jīng)早期增殖期（卵泡期）信號(hào)強(qiáng)度的下降會(huì)引起結(jié)合帶的增寬，使其像彌漫性子宮腺肌癥。因此MRI對(duì)子宮肌層的評(píng)價(jià)應(yīng)該在增生晚期-分泌期進(jìn)行（圖7）Physiologic Changes in the Uterine Body during the Menstrual Cycle 在月經(jīng)周期中子宮體的生理變化2021/5/724Figure 7. Subserosal adenomyosis-

49、like lesion (invasive solid endometriosis) in a 33-year-old woman during different phases of the menstrual cycle. (a) Sagittal T2-weighted fast spin-echo MR image obtained in the early proliferative phase shows decreased signal intensity of the myometrium. The boundary between the myometrium and a s

50、ubserosal adenomyosis-like lesion (arrow) is obscure.(b) Sagittal T2-weighted fast spin-echo MR image obtained in the late secretory phase shows increased signal intensity of the myometrium. The low-signal-intensity junctional zone and the subserosal adenomyosis-likelesion (arrow) are clearly visual

51、ized.33歲女性，漿膜下的子宮腺肌樣病變，在月經(jīng)周期的不同階段a.在增殖早期時(shí)相獲取的矢狀位T2加權(quán)快速自旋回波MR圖像顯示肌層信號(hào)強(qiáng)度的下降。肌層和漿膜下子宮腺肌樣病變之間的界限是模糊的b.在分泌晚期階段獲得的矢狀位T2加權(quán)快速自旋回波MR圖像顯示肌層信號(hào)強(qiáng)度增高。低信號(hào)強(qiáng)度的結(jié)合帶和漿膜下腺肌樣病變清晰可見(jiàn)2021/5/725Various benign conditions and malignant tumors may mimic adenomyosis: physiologic myometrial contraction, myometrial involvement by

52、pelvic endometriosis, low-grade endometrial stroma sarcoma (LG-ESS), and myometrial metastases 多種良性改變和惡性腫瘤類似于子宮腺肌癥：生理肌層收縮，肌層受累的盆腔子宮內(nèi)膜異位癥，低度惡性子宮內(nèi)膜間質(zhì)肉瘤（LG-ESS），和肌層轉(zhuǎn)移 Transient myometrial contraction as a physiologic phenomenon may mimic adenomyosis; this appearance may disappear on subsequent images o

53、r at cine MR imaging, whereas focal adenomyosis persists on subsequent images or at cine MR imaging (Fig 8) In the pregnant uterus, myometrium adjacent to the implant site may show low signal intensity, which reflects blood supplying a contraction; this finding mimics physiologic contraction or foca

54、l adenomyosis (Fig 9) . 作為一種生理現(xiàn)象的瞬態(tài)肌層收縮類似于子宮腺肌癥，這種外觀可能會(huì)消失在隨后的圖像或電影MRI圖像，而局灶性子宮腺肌病持續(xù)的存在于隨后的圖像或電影MR成像。在懷孕的子宮，子宮肌層植入的地方表現(xiàn)為低信號(hào)，這反映了血液供給的收縮；這個(gè)表現(xiàn)類似于生理性收縮或局灶性腺肌病。Contractions in the pregnant uterus are commonly seen and usually do not present a diagnostic dilemma; however, radiologists who are not familiar

55、 with MR imaging of pregnant women may misdiagnose the contraction 孕婦子宮的收縮很常見(jiàn)，通常不存在診斷的難題，然而，不熟悉懷孕女性MR成像的放射學(xué)醫(yī)生可能會(huì)將子宮收縮誤診Benign and Malignant Mimics of Adenomyosis 類似于子宮腺肌癥的良性和惡性病變2021/5/726Figure 8. Physiologic transient myometrial contraction in a 32-year-old woman. 發(fā)生在一個(gè)32歲女性的生理性瞬間肌層收縮Sagittal T2-w

56、eighted fast spin-echo MR image shows focal low-signal-intensity bulging of the myometrium (arrow), a finding that mimics adenomyosis. This finding disappeared on subsequent T2-weighted images.矢狀位T2加權(quán)快速自旋回波MR圖像顯示為子宮肌層局灶性低信號(hào)強(qiáng)度的膨脹（箭頭），這個(gè)表現(xiàn)類似于子宮腺肌癥。其在接下來(lái)的T2WI上消失了。Pitfalls in Diagnosis 2021/5/727Figure

57、9. Transient myometrial contraction during pregnancy in a 31-year-old woman. 一個(gè)31歲女性懷孕期間的瞬間肌層收縮(a) Axial T2-weighted fast spin-echo MR image shows a localized area of low signal intensity (arrow) in the uterus, a finding that mimics adenomyosis. Because a rapid T2-weighted sequence (eg, half-Fourier

58、 acquisition single-shot turbo spin-echo or single-shot fast spin-echo) was not used, depiction of the embryo-fetus is poor. (b) Axial susceptibility-weighted gradient-echo MR image shows absence of signal voids (arrow) within the low-signal-intensity area . However, absence of signal voids at susce

59、ptibility-weighted imaging should not be considered to exclude adenomyosis. To establish the diagnosis of a contraction, it would be critical to show the low-signal-intensity area on subsequent T2-weighted images.a.軸位T2加權(quán)快速自旋回波MR圖像顯示子宮內(nèi)一個(gè)局部低信號(hào)，類似于子宮腺肌癥，因?yàn)榭焖賂2加權(quán)序列沒(méi)有使用，導(dǎo)致顯示胎兒顯示較差b.軸位SWI圖顯示低信號(hào)區(qū)域內(nèi)沒(méi)有點(diǎn)狀低信

60、號(hào)，然而在SWI圖上缺乏點(diǎn)狀低信號(hào)并不能排除子宮腺肌癥。為了確定生理收縮的診斷，在隨后的T2加權(quán)圖像上顯示低信號(hào)強(qiáng)度的區(qū)域至關(guān)重要2021/5/728Susceptibility-weighted imaging can show small hemorrhagic foci in adenomyosis as spotty signal voids and may be helpful in differentiating adenomyosis from focal contraction (Fig 10) . On the other hand, absence of signal vo