子宫内膜异位症MR表现

子宫内膜异位症 多中心：双侧卵巢（箭），子宫后壁（c中E）。卵巢病灶T1高信号（a），T1抑 脂高信号（b），T2低信号（c）。子宫后壁病灶T2低信号，内见斑点状高信号 （c弯箭）代表异位内膜腺体。包涵囊肿（*）。
The presence of restricted diffusion and low ADC values within an adnexal lesion does not have a high positive predictive value or specificity for the diagnosis of malignancy. Benign hemorrhagic ovarian cysts, endometriomas, and solid endometrial implants , as well as benign mature cystic teratomas, also demonstrate restricted diffusion. 弥散受限（ADC低信号）的附件肿块：子宫内膜异位症，良性出 血性卵巢囊肿，良性成熟畸胎瘤，恶性病变。 The most common cause of a dilated fallopian tube encountered at pelvic imaging is pelvic inflammatory disease. In acute pelvic inflammatory disease, a dilated fallopian tube is usually a pyosalpinx. In the chronic form of the disease, a hydrosalpinx develops secondary to adhesions and scarring. Dilated fallopian tubes secondary to pelvic inflammatory disease do not exhibit T1 shortening at MR imaging. Endometriosis is another frequent cause of dilated fallopian tubes, with 30% of women with the disease demonstrating tubal involvement at laparoscopy. The presence of T1-weighted hyperintensity within a dilated fallopian tube is suggestive of endometriosis and may be the only finding at MR imaging in some women. Low T2 signal intensity (T2 shading) is not often present within a hematosalpinx that occurs in association with endometriosis. 输卵管扩张最常见的原因是盆腔炎性病变，扩张的输卵管代表输卵 管积脓（急性炎症）和瘢痕粘连（慢性炎症），炎性病变中扩张输尿管T1低信号。子宫内膜异位 症也常导致输卵管扩张，但表现为T1高信号。继发输尿管扩张的子宫内膜异位症T2常不是低信号 （与常规子宫内膜异位症不符）。 Although most women have reflux menstruation, only 5%–10% of them develop endometriosis. However, a subset of women with mü llerian duct anomalies that cause obstruction of antegrade menstruation are considered to have an increased risk for endometriosis. This subset includes women who have a unicornuate uterus with a noncommunicating rudimentary horn or uterus didelphys with a transverse vaginal septum. 部分苗勒管发育异常（单角子宫合并宫角与宫腔不通，双子宫合并阴道 横隔）导致生殖道阻塞，月经逆流增多，进而增加患子宫内膜异位症的几率。
Three forms of pelvic endometriosis盆腔子宫内膜异位症分类 1. superficial peritoneal lesions, or noninvasive implants 腹膜浅表子宫内膜异位症（非浸润性） They are well recognized at laparoscopy; these have been described as black, white, or red, depending on the degree of fibrosis, scarring, and hemorrhage within the lesion.Small nonhemorrhagic foci of superficial endometriosis are often not detectable with magnetic resonance (MR) imaging. 腹膜浅表病变在腹腔镜下易见，根据成分不同有不同表现（纤维化-黑，瘢痕-白，出血红）。小的非出血性浅表病变MR显示不清。
盆腔及卵巢子宫内膜异位症，侵犯子宫后壁 多中心，左侧卵巢（a-c箭），盆腔（ac箭头）， 子宫后壁（cd中F）。T1高信号（a），T1抑脂 高信号（b），并发现一小的异位病灶，T2信号 减低（c）。输卵管扩张（de箭）。
子宫内膜异位症：STIR序列低信 号不能说明含脂肪 右卵巢子宫内膜异位症（箭）， T1高信号（a）。STIR序列（b） 病变与盆腔脂肪均为低信号。但 T1抑脂（c）病变为高信号，证 明不是脂肪。
子宫内膜异位症MR表现
Endometriosis manifests in as many as 10% of women of reproductive age. 10%生育期妇 女有子宫内膜异位症。 The reference standard for the diagnosis of pelvic endometriosis is laparoscopic biopsy of lesions with a suspicious appearance, followed by histologic confirmation. 诊断盆腔子宫内膜异位症主要依据腹腔镜活检。
2. ovarian endometrioma卵巢子宫内膜异位症
3.deep (or solid infiltrating) pelvic endometriosis 盆腔深部（实性浸润性）子宫内膜异位症 It is defined by the invasion of endometrial glands and stroma at least 5 mm beneath the peritoneal surface. It is thought to contribute most often to female pelvic pain and infertility, the two major manifestations. of endometriosis. Infertility is treated surgically (ie, remoБайду номын сангаасal of ovarian endometriomas and deep pelvic endometriosis and lysis of adhesions), with medical therapy, and with assisted reproduction techniques. Pain associated with endometriosis is initially treated with antiinflammatory agents and hormonal therapy. Depending on a woman’s symptoms and desire to preserve fertility, surgical procedures may also be performed. 病变浸润致腹膜下方5mm以下。此型最容易引起盆腔痛 及不孕。治疗不孕可进行手术和药物治疗，辅以生殖技术。疼痛可先用抗炎药物或激素治疗，必 要时手术治疗。
The findings of an adnexal mass with high signal intensity on T1-weighted MR images and signal intensity lower than that of simple fluid on T2-weighted images helped establish a diagnosis of endometrioma with specificity greater than 90%. In addition to endometrioma, the main differential diagnoses of an adnexal lesion with high signal intensity on T1-weighted images include hemorrhagic functional ovarian cyst and mature cystic teratoma. Endometriomas tended to have higher T1 and lower T2 signal intensities than hemorrhagic cysts. The greater degree of T1 and T2 shortening in endometriomas is attributable to their higher protein concentration and viscosity. 子宫内膜异位症表现为附件肿块，T1高信号，T2低信号， 可双侧，多中心。需与同样T1高信号的出血性功能性卵巢囊肿和成熟囊性畸胎瘤鉴别。与出血性囊 肿相比，子宫内膜异位症T1信号更高，T2信号更低（因为子宫内膜异位症蛋白含量及粘度更高）。 we recommend that all MR imaging examinations of the female pelvis include a T1-weighted fatsuppressed sequence for two reasons: First, the loss of signal intensity within a T1-hyperintense adnexal mass at fat-suppressed imaging facilitates characterization of the mass as a mature cystic teratoma. Second, saturation of the high signal intensity of fat improves the dynamic range of T1-weighted images by enhancing the differences among non fat-containing T1-hyperintense structures, thereby enabling more sensitive detection of smaller endometriomas. 畸胎瘤T1抑脂低信号，子宫内膜异位症T1抑脂高信号。 T1抑脂可发现一些T1不能发现的小的子宫内膜异位症病灶。 The loss of T1 signal hyperintensity on STIR images is not a finding specific to fat; hemorrhagic ovarian cysts and endometriomas can have T1 relaxation times similar to that of fat (ie, they can show “suppressed” signal intensity) and thus may mimic mature cystic teratomas at STIR imaging. Use of an MR imaging system capable of chemically selective T1-weighted fat-suppressed imaging will prevent the occurrence of this pitfall. STIR序列低信号不一定代表脂肪，T1抑脂上低信号才代表脂肪。子宫内 膜异位症、出血性功能性卵巢囊肿和成熟囊性畸胎瘤在STIR上均为低信号。