良、恶性妊娠滋养细胞肿瘤的MRI特征分析

良、恶性妊娠滋养细胞肿瘤的MRI特征分析作者：陈伟，严志汉，方必东，虞志康，陈裕，张弦，白光辉，曾庆娟

【摘要】目的：分析良、恶性妊娠滋养细胞肿瘤(GTN)的MRI平扫及动态增强特征。方法：回顾性分析21例(10例良性、11例恶性)经病理证实的GTN临床和MRI资料，所有病例均行MR常规扫描，其中16例行MR动态增强扫描。结果：病灶位于子宫腔或子宫肌层内，其共同MRI表现包括：①子宫增大，子宫腔内见“蜂窝状”或团块状异常信号影，在T1WI呈等或混杂信号，在T2WI呈混杂高信号；②9例子宫旁和肌层内可见扭曲、扩张的血管影，在MR动态增强扫描上显示更清晰。其不同MRI表现为：良性GTN的子宫肌层无受累，恶性者子宫肌层常受侵，表现为肌层的连续性中断，动态增强扫描有助于清晰显示病灶。结论：MRI平扫及其增强扫描对于良恶性妊娠滋养细胞肿瘤的定位、定性诊断具有较高的参考价值，可以为临床诊断及治疗随访提供重要信息。

【关键词】妊娠滋养细胞肿瘤磁共振成像诊断技术和方法Abstract: Objective: To analyze the conventional MR scan and dynamic contrast-enhanced scan features of benign and malignant gestational trophoblastic neoplasia (GTN). Methods: The clinical and MRI findins of 21 cases (benign 10 case and malignant 11 cases) of GTN which proved by pathology were retros pectively reviewed， all the patients underwent MR scaning，

16 of 21 cases underwent dynamic contrast-enhanced MR scaning. Results: The lesions mainly located in the cavity of uterus or myometrium，the general MR imaging characteristics of benign and malignant GTN including: ①Hysterauxesis or characteristic honeycomb-like or crumb mass in the uterine cavity， which showed hypo-intensity or iso-intensity on T1WI and mixed hyper-intensity on T2WI；②Tortuous dilation of myometrial and para-uterine vessels were detected in 9 cases of 21， which displayed more clearly on MR dynamic-enhanced scaning. The different characteristics of benign and malignant GTN including: The myometrium was not invaded in benign GTN， in contrast， it was usually invaed in malignant GTN，and the dynamic contrast-enhanced scan was helpful to display the lesions clearly. Conclusion: Conventional MR scan and dynamic contrast-enhanced scan have considerable value in level of diagnosis and qualitative diagnosis of benign and malignant GTN. It also can provide valuable information for clinical diagnosis and follow-up therapy.

Key words: gestational trophoblastic neoplasia；magnetic resonance imaging；diagnostic techniques and procedures

妊娠滋养细胞肿瘤（gestational tropho-blastic

neoplasia，GTN）是一组源于胚胎滋养层细胞的肿瘤，包括良性葡萄胎、恶性侵袭性葡萄胎、绒毛膜癌及罕见的胎盘部位滋养细胞肿瘤[1]，后三者统称为恶性妊娠滋养细胞肿瘤。影像学诊断报道中以B超对其诊断报道较多，而MR对于本病的诊断价值近年来逐渐被大家所接受。我们对21例GTN患者作回顾性分析，以探讨良、恶性GTN的MRI平扫及动态增强扫描特征。

1 资料和方法

1.1 一般资料

本组21例，是本院从2005年10月至2008年10月间的门诊及住院患者，年龄19～52岁，平均(30.9±7.22)岁。多因近期停经伴阴道不规则流血或难免流产清宫术后阴道持续出血来院就诊，其中8例刮宫术后血β-hCG持续升高，2例为确诊葡萄胎行刮宫手术并一直用化疗药物治疗随访，11例尚未刮宫患者因阴道不规则流血来院就诊。首诊10例刮宫术后患者血β-hCG值最低14.9 U/L，最高29 378 U/L；首诊11例未刮宫患者血β-hCG值最低5 263 U/L，最高大于196 000 U/L。所有病例事先均行B超检查，1例提示早孕（胚胎停止发育），1例提示难免流产，1例提示胎盘植入（系难免流产清宫术后），其他均提示良性或恶性妊娠性滋养细胞肿瘤，建议结合实验室检查。本组病例中21例均行MR平扫，16例行MR动态增强扫描，其中3例行肺部CT扫描提示肺部转移瘤。结合临床、实验室检查、手术病理结果及随访最后诊断恶性GTN11例（其中绒癌3例，侵袭性葡萄胎8例），良性GTN10例。