MRI Diagnosis and Differential Diagnosis of Benign and Malignant Gestational Trophoblastic Disease
-
摘要: 目的：探讨MRI对良恶性滋养细胞疾病（GTD）的诊断价值。方法：回顾性分析55例（良性15例，恶性40例）经临床手术病理证实GTD的MRI表现。结果：15例良性病灶均位于宫腔，子宫肌层无受累；40例恶性病灶位于宫腔26例，宫颈管2例，均伴有子宫肌层浸润；位于子宫肌层12例，位于肌层的病灶，子宫结合带连续。MRI表现为病灶呈混杂信号影，T1WI于低信号中夹杂高信号者良性3例、恶性20例；增强扫描后40例恶性病变中10例呈动脉期强化，15例病灶分隔及实性部分中度以上强化，15例囊性病灶中央可见“暴风雪”样强化。良性均呈分隔状、渐进性持续性强化。31例恶性病变周围及肌层、宫旁可见增多增粗迂曲的流空血管影，5例良性病变宫旁见增多血管影，MR增强扫描显示清晰。结论：良恶性GTD的MRI表现具有一定特征性，可以很好的显示肿瘤侵及范围，早期有助于提示良恶性，为临床诊断及治疗提供依据。Abstract: Objective: To explore the diagnostic value of MRI for benign and malignant gestational trophoblastic disease. Methods: retrospective analysis of 55 cases (15 benign, 40 malignant) confirmed the MRI manifestations of GTD by clinical operation and pathology.Results: 15 cases of benign lesions were all located in the uterine cavity, and the myometrium was not affected; 40 cases of malignant lesions were located in the uterine cavity in 26 cases, and in 2 cases of the cervical canal, all with myometrial infiltration; 12 cases were located in the myometrium, and the uterine junction zone was continuous. MRI showed that the lesion showed mixed signal shadow, 3 cases of benign and 20 malignant cases were mixed with high signal on T1WI; After the enhanced scan, 10 of the 40 malignant lesions showed arterial enhancement, 15 cases of lesion separation and solid part were moderately enhanced, 15 cases of cystic lesions showed "blizzard"-like enhancement in the center. The benign ones are separated and gradually strengthened continuously. In 31 cases of malignant lesions, there were more thick and tortuous vascular shadows around the muscle layer and uterus. 5 cases of benign lesions with increased vascular shadows around the palace. Conclusion: The MRI manifestations of benign and malignant GTD have certain characteristics, which can well show the extent of tumor invasion, and help prompt benign and malignant early, and provide basis for clinical diagnosis and treatment.
-
-
[1] SECKL M J, SEBIRE N J, BERKOWITZ R S. Gestational trophoblastic disease[J]. Lancet, 2010, 376(9742):717-729.
[2] 秦佳乐, 王双燕, 吕卫国. 超声在葡萄胎病变中的应用价值分析[J]. 临床超声医学杂志, 2018, 20(1):41-43. QIN J L, WANG S Y, LV W G. Application value of ultrasonography in molar pregnancy[J]. Journal of Ultrasound in Clinical Medicine, 2018, 20(1):41-43. (in Chinese).
[3] LURAIN J R. Gestational trophoblastic disease I:Epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole[J]. American Journal of Obstetrics & Gynecology, 2010, 203(6):531-539.
[4] 杨昂, 张雪林, 张玉忠. MRI对恶性妊娠性滋养层细胞肿瘤的诊断价值[J]. 中华放射学杂志, 2007, 41(10):1090-1092. YANG A, ZHANG X L, ZHANG Y Z. The value of MRI in diagnosis of malignant gestational trophoblastic neoplasia[J]. Chinese Journal of Radiology, 2007, 41(10):1090-1092. (in Chinese).
[5] 李芳. 恶性滋养细胞肿瘤临床治疗体会[J]. 青海医药杂志, 2015, 45(10):11-12. [6] BROWN D L, DUDIAK K M, LAING F C. Adnexal masses:US characterization and reporting[J]. Radiology, 2010, 254(2):342-354.
[7] 刘艳, 赵峰, 张越, 等. 磁共振成像诊断恶性滋养细胞肿瘤[J]. 中国医学影像技术, 2009, 35(4):665-667. LIU Y, ZHAO F, ZHANG Y, et al. MRI diagnosis of malignant trophoblastic tumor[J]. Chinese Journal of Medical Imaging Technology, 2009, 35(4):665-667. (in Chinese).
[8] SITA-LUMSDEN A, SHORT D, LINDSAY I, et al. Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000-2009[J]. British Journal of Cancer, 2012, 107(11):1810-1814.
[9] EYSBOUTS Y K, OTTEVANGER P B, MASSUGER L F A G, et al. Can the FIGO 2000 scoring system for gestational trophoblastic neoplasia be simplified? A new retrospective analysis from a nationwide dataset[J]. Annals of Oncology:Official Journal of the European Society for Medical Oncology, 2017, 28(8):1856-1861.
[10] SUN S Y, MELAMED A, JOSEPH N T, et al. Clinical presentation of complete hydatidiform mole and partial hydatidiform mole at a regional trophoblastic disease center in the United States over the past 2 decades[J]. International Journal of Gynecological Cancer, 2016, 26(2):367-370.
[11] 周宙, 杨敏洁, 易芹芹, 等. 恶性滋养细胞肿瘤MRI表现[J]. 医学影像学杂志, 2016, 26(3):496-499. ZHOU Z, YANG M J, YI Q Q, et al. MRI features of malignant trophoblastic tumors[J]. Journal of Medical Imaging, 2016, 26(3):496-499. (in Chinese).
[12] 何俊燊, 陈春林, 李朋飞, 等. 基于CTA三维重建技术的滋养细胞疾病动脉血供特点分析及其临床意义[J]. 妇产与遗传, 2017, 7(4):7-10. HE J S, CHEN C L, LI P F, et al. The arterial blood supply feature analysis and its clinical significances of gestational trophoblastic disease by three-dimensional reconstruction models based on computed tomography angiography[J]. Obstetrics-Gynecology and Genetics, 2017, 7(4):7-10. (in Chinese).
[13] DARBY S, JOLLEY I, PENNINGTON S, et al. Does chest CT matter in the staging of GTN?[J]. Gynecologic Oncology:An International Journal, 2009, 112(1):155-160.
[14] SHAABAN AKRAM M, REZVANI Maryam, HAROUN REHAM R, et al. Gestational Trophoblastic Disease:Clinical and Imaging Features[J]. Radiographics, 2017, 37:681-700.
[15] LIBSHITZ H I, BABER C E, HAMMOND C B. The pulmonary metastases of choriocarcinoma[J]. Obstet Gynecol, 1977, 49(4):412-416.
[16] COCKSHOTT W P, HENDRICKSE J P. Pulmonary calcification at the site of trophoblastic metastases[J]. The British Journal of Radiology, 1996, 42(493):17-20.
[17] 江雪峰, 徐晨歌, 周雨, 等. 绒毛膜癌骨骼肌转移一例[J]. 放射学实践, 2016, 31(5):470-471. JIANG X F, XU C G, ZHOU Y, et al. A case of choriocarcinoma with skeletal muscle metastasis[J]. Radiologic Practice, 2016, 31(5):470-471. (in Chinese).
[18] BRAGA A, MORAES V, MAESTÁ I, et al. Changing trends in the clinical presentation and management of complete hydatidform mole among Brazilian women[J]. International Journal of Gynecological Cancer, 2016, 26(5):984-990.
计量
- 文章访问数: 204
- HTML全文浏览量: 6
- PDF下载量: 11
下载:
