子宫恶性肿瘤的MRI诊断培训课件.ppt

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level,*,子宫恶性肿瘤的MRI诊断,*,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,2,子宫恶性肿瘤的流行病学现状,Epidemiology,of,Uterine,Malignant,Neoplasm,子宫恶性肿瘤包括子宫颈癌、子宫内膜癌、滋养细,胞恶性肿瘤、子宫肉瘤等,Uterine,malignant,neoplasm,includes,cervical,carcinoma,endometrial,carcinoma,uterine,sarcoma,and,malignant,trophoblastic,tumor,etc.,2,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,3,n,n,n,n,全球妇女恶性肿瘤发病率的第三位,The,No.,3,female,malignant,tumor,in,the,world,我国妇科恶性肿瘤发病率的前两位,The,top,two,common,female,cancer,in,China,女性恶性肿瘤死亡率的第二位,The,second,mortality,in,female,malignant,tumor,in,China,每年约有,3,万名妇女死于宫颈癌,About,30,000,females,died,子宫颈癌,Cervical,Carcinoma,3,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,4,n,n,n,全球妇女恶性肿瘤发病率的第四位,The,fourth,most,common,female,cancer,in,the,world,每年的平均病例数是,30,年前的,40,倍之多,The,yearly,average,number,of,endometrial,carcinoma,is,nearly,fourty,times,as,much,as,those,30,years,ago,随着我国妇女内分泌代谢性疾病的增加，子宫,内膜癌呈对数速度增长,With,endocrinopathy,morbidity,rising,the,number,of,endometrial,carcinoma,is,increasing,according,to,logarithm,fashion,子宫内膜癌,Endometrial,carcinoma,4,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,5,n,n,n,占子宫恶性肿瘤的,2,%,4,%,Accounting,for,2,4,%,of,all,uterine,malignancies,占生殖道恶性肿瘤的,1%,Accounting,for,1%,of,all,malignancies,in,female,reproductive,tract,临床罕见、恶性程度较高,A,very,rare,and,high,malignancy,in,female,reproductive,tract,子宫肉瘤,Uterine,sarcoma,5,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,6,子宫恶性肿瘤的临床检查方法,Clinical,examination,of,uterine,malignant,neoplasm,6,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,7,临床检查,Clinical,examination,p,普通妇科检查：简单，但具有明显的局限性,Gynecological,examination,:,simple,&,limited,p,分期具有主观性：,34,39,的患者分期错误,Subjectivity,on,its,staging:,34%-39%,of,incorrect,staging,p,不能全面评价肿瘤侵犯深度和盆腔淋巴结转移,Difficult,to,identify,invasive,extent,and,lymph,node,metastases,7,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,8,临床检查-细胞学检查,Clinical,examination-Exfoliative,cytologic,examination,n,检测来源于子宫内膜、子宫颈的恶性细胞,Finding,malignant,cells,from,cervix,and,uterine,endometrium,n,为子宫恶性肿瘤的诊断诊断提供直接依据,Providing,direct,diagnosis,for,uterine,malignant,neoplasm,n,为子宫微生物感染提供诊断依据,Finding,foundation,for,uterine,microbial,infection,n,在肿瘤的分期上无明显价值,No,value,on,its,staging,8,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,9,临床检查-阴道宫腔镜,Clinical,examination-,hysteroscopy,n,n,n,对子宫可疑病变进行定位活检,Biopsy,for,suspected,lesion,明显提高子宫体、颈部早期癌的诊断率,Higher,diagnostic,rate,of,uterine,and,cervical,cancer,不能客观评价肿瘤侵犯深度和盆腔淋巴结转移,Unable,to,evaluate,invasive,extent,and,lymphnodes,metastasis,accurately,9,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,10,影像学方法-超声检查,Medical,image,examination-Ultrasonography,p,p,p,对子宫可疑病变进行定位活检,The,most,common,screen,on,uterine,malignant,tumor,经腹超声在分期上应用价值较小,Trans-abdominal,ultrasound,with,few,value,on,staging,阴式超声可明显提高子宫恶性肿瘤的分期，,其阳性、阴性预测值分别约,62,和,92,Improving,staging,by,trans-vagina,ultrasound,with,62%,for,positive,predictive,value,and,92%,for,negative,predictive,value,10,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,11,影像学方法-,CT检查,Medical,image,examination-CT,n,n,n,平扫,CT,：子宫恶性肿瘤与子宫壁密度相似，难以显,示癌肿的浸润深度和范围,Non-CE,CT:,difficult,to,show,tumor,invasive,depth,and,extent,because,of,similar,intensity,between,uterine,tissues,&,malignant,tissues,CT,增强：子宫恶性肿瘤显示有局限性,Showing,uterine,disease,with,some,limitations,by,CE,CT,CT,评价宫旁浸润假阳性较高，准确度仅,33,58,Accuracy,is,33,58,on,evaluating,parametrical,invasion,by,CT,because,of,a,high,false-positive,error,11,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,12,影像学方法-,MR,Medical,image,examination-MRI,n,n,上世纪,80,年代，,MRI,出现并应用于子宫肿瘤的诊断,MRI,used,in,uterine,diagnosis,in,the,last,80s,当时，成像时间长、图像易受呼吸、血管搏动和肠,蠕动的影响、磁场强度低等缺点使其应用受限,At,that,time,longer,imaging,time,&,imaging,quality,easily,disturbed,by,breath,vessel,pause,bowel,movement,low,magnetic,field,strengt,etc.,These,disadvantages,limited,its,application,12,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,13,n,n,随着,MRI,场强、梯度切换率的提高和多通道高,密相控阵线圈的应用，使应用,MRI,技术对子宫,恶性肿瘤进行准确诊断和客观评价成为可能,With,high-magnetic,MR,scanner,high-gradient,switch,ratio,andmultiple,phased,array,coils,it,is,possible,to,diagnose,uterine,malignacy,accurately,and,evaluate,it,objectively,by,MRI,MRI,因其极高的软组织分辨力，能够清晰显示,子宫的组织结构和信号的细微变化，近而准确,评价子宫恶性肿瘤的大小和范围,Clearly,displaying,uterine,layers,signal,changes,tumor,size,and,extent,on,MRI,image,because,of,it,high,soft,tissue,resolution,13,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,14,n,n,肿瘤分期达到,b,期以上，,MRI,的评价准确性、阳性,和阴性预测值分别可达,81,95%,、,100,、,90%,Above,IB,staging,accuracy,positive,predictive,value,and,negative,predictive,value,of,MRI,evaluation,:,81%-95%,100%,and,90%,在显示子宫恶性肿瘤宫旁浸润和淋巴结转移等方,面，其敏感度、特异度均较高,High,sensitivity,and,specificity,in,showing,parametrical,invasion,and,lympnode,metastasis,from,uterine,malignant,neoplasm,on,MRI,14,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,15,影像学方法-,PETCT检查,Medical,image,examination-PEC/CT,n,n,n,是评价子宫肿瘤良恶性的最佳影像方法之一,One,of,the,best,evaluations,on,uterine,malignancy,对肿瘤及周围淋巴结转移进行客观评价，其特,异性高，阳性预测值约,75%-100%,Objective,view,on,tumor,and,lymph,node,metastasis,with,75%-,100%,positive,predictive,value,昂贵的价格制约了其广泛应用,Application,limited,by,expensive,costing,15,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,16,MRI,在子宫恶性肿瘤诊断上的价值,Diagnostic,Value,of,MRI,in,Uterine,Malignant,Neoplasm,16,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,17,MRI成像的优势,Advantage,of,MRI,n,n,n,n,无损伤和辐射性,No,injury,and,radiation,高的软组织分辨力和极高的敏感度,High,soft,tissue,resolution,and,sensitivity,MRI,三维成像使病灶定位更准确,3D,images,with,high,accuracy,in,lesions,检出子宫多灶性病变以及评价侵犯的范围、,周围淋巴结转移区域有明显价值,Identifying,multiple,lesions,invasive,extending,and,lymph,node,metastasis,17,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,18,n,n,动态增强检查可了解病变的血流灌注情况,有助于,病变性质的评价,Exploring,perfusion,&,evaluation,of,tumors,by,DCT,为准确分期和临床治疗方案的制定提供可靠依据,Providing,accurate,staging,and,therapy,planning,18,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,19,子宫MRI检查的适应症,Indications,of,uterine,MRI,examination,n,n,n,n,n,检出子宫隐匿性病灶、囊性病灶及多灶性病变,Detecting,occult,cystic,and,multiple,lesions,评价子宫恶性肿瘤的浸润范围和淋巴结转移,Evaluating,invasive,extent,and,lympnode,metastasis,评价子宫恶性肿瘤的新辅助治疗疗效,Evaluateing,therapy,effect,确定手术适应症,Determining,surgical,indications,监测子宫恶性肿瘤的术后复发,Monitoring,post-surgical,recurrence,19,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,20,子宫恶性肿瘤的,MRI,诊断、分期,Diagnosing,and,Staging,of,Uterine,Malignant,Neoplasm,by,MRI,20,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,21,（一）子宫内膜癌,Endometrial,Carcinoma,21,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,22,子宫内膜癌的临床特征,Clinical,Characters,of,Endometrial,Carcinoma,n,n,临床表现：绝经后妇女阴道不规则流血、,恶臭液体及烂肉,下腹疼痛、消瘦和贫血,Clinical,manifestations:,postmenopausal,women,with,irregular,vaginal,bleeding,foul,liquid,necrotic,tissue,abdominal,pain,weight,loss,and,anemia,好发部位：子宫底和体后壁,Occurrence,sites:,the,posterior,wall,of,uterus,and,its,bottom,22,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,23,扩散方式,The,spreading,ways,直接播散,Direct,spreading,淋巴转移,Lymph,node,metastasis,血行转移,Hematogenous,metastasis,23,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,24,子宫内膜癌的MRI特征,MRI,Characters,of,Endometrial,Carcinoma,病变局限于内膜,Lesions,confined,in,endometrial,n,n,n,T1WI,：癌肿信号稍低于内膜或与肌层信号一致,T1WI:,endometrial,carcinoma,signal,is,slightly,lower,than,the,endometrial,signal,or,same,as,themyometrial,signal,T2WI,：内膜局限,/,弥漫增厚，呈稍高信号,T2WI:,hyper-signal,in,limitations,/,diffuse,thickening,endometrial,病变不强化或轻度强化，低于肌层,Slightly,or,no,enhanced,contrast,with,a,signal,lower,than,myometrial,24,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,25,病变侵入肌层,Invading,myometrial,n,n,n,癌肿呈菜花状、息肉状突入宫腔,lesions,with,cauliflower-like,mass,in,the,uterine,cavity,T2WI:,低信号的结合带内出现高信号,T2WI:,hyper-signal,in,lower,junctional,zone,增强时,:,肌层病变与内膜病变均呈低信号，强化的,结合带不完整,CE:,lesion,with,low,signals,in,both,myometrial,and,endometrial,layers,showing,incompletely,enhanced,changes,in,the,junctional,zone,25,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,26,深肌层受侵,Deep,myometrial,invasion,n,n,子宫各层结构消失,局部肌层出现不规则低信号,病灶，肌层变薄,Disappearance,uterine,layers,with,focused,irregular,low-signal,lesions,in,myometrium,&,thinning,myometrium,子宫增大,盆腔内组织器官广泛受侵,Enlarged,uterus,diffusion,involvement,in,pelvic,tissues,&,organs,26,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,27,n,n,n,n,a:,肿瘤仅局限于子宫内膜,a,:Tumor,confined,in,endometrium,b:,子宫肌层受侵小于,1/2,b:,invaded,myometrial,less,than,1/2,c:,子宫肌层受侵大于,1/2,c:,invased,myometrial,more,than1/2,a:,宫颈内膜受侵,a:,invasion,into,cervical,endometrial,子宫内膜癌的临床分期,Staging,of,Endometrial,Carcinoma,采用国际妇产科联盟分期标准,From,International,Federation,of,Gynecology,and,Obstetrics,FIGO,27,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,28,n,n,n,n,n,n,b:,肿瘤侵犯到宫颈基质外,b:,invasion,into,cervical,stromal,outside,a:,附件受侵或穿出浆膜,/,腹腔积液细胞学,(,),a:,out,of,the,annex,or,serosal,invasion/peritoneal,fluid,cytology,(+),b:,阴道扩散,b:,the,spread,of,the,vagina,c:,盆腔或主动脉周围淋巴结转移,c:,pelvic,lymph,node,metastasis,around,the,aorta,a,期,:,膀胱或直肠受侵,a:,involvement,of,bladder,or,rectum,b,期,:,远处转移或腹部、腹股沟淋巴结转移,b:,distant,metastasis,or,the,abdomen,groin,lymphnode,metastasis,28,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,29,29,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,30,30,子宫恶性肿瘤的MRI诊断,肌层受侵小于,Cancer,Institute,and,2009-8-7,Hospital,31,子宫内膜癌Ib,期,55岁,-Stage,b,endometrial,carcinoma,in,a,55-year-old,woman,T2WI,T1WI,T2WI,1/2,Liaoning,Invaded,myometrial,less,than,1/2,31,子宫恶性肿瘤的MRI诊断,Invased,myometrial,more,than1/2,T2WI,2009-8-7,T1WI,32,子宫内膜癌Ic期,40岁,-Stage,Ic,endometrial,carcinoma,in,a,40-year-old,woman,CE:,T1WI,CE:,T1WI,肌层受侵大于1/2,Liaoning,Cancer,Institute,and,Hospital,32,子宫恶性肿瘤的MRI诊断,Liaoning,Cancer,Institute,and,Hospital,33,2009-8-7,Copyright,2007,by,the,American,Roentgen,Ray,Society,子宫内膜癌IIa期,78岁,-Stage,IIa,endometrial,carcinoma,in,a,78-year-old,woman,宫颈内膜受侵,Invasion,into,cervical,endometrial,Sala,E.,et,al.,Am.,J.,Roentgenol.,2007;188:1577-1587,T2WI,T2WI,33,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,34,子宫内膜癌a期,-Stage,a,endometrial,carcinoma,双侧卵巢受侵,tumor,invading,the,ovaries,T2WI,T2WI,34,子宫恶性肿瘤的MRI诊断,Liaoning,Cancer,Institute,and,Hospital,35,子宫内膜癌b期,-Stage,b,endometrial,carcinoma,肌层受侵大于1/2伴阴道扩散,Deep,invasion,50%,of,the,myometrial,thickness,of,endometrial,carcinoma,(arrow).The,spread,of,the,vagina,2009-8-7,T2WI,35,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,36,Riccardo,et.al,子宫内膜癌c期,-Stage,c,endometrial,carcinoma,肌层受侵大于1/2伴闭孔内淋巴结转移,Deep,invasion,50%,of,the,myometrial,thickness,of,endometrial,carcinoma,(arrow),and,internal,obturator,lymph,node,metastasis,T2WI,Radiology,2004,18,(,10).1148,36,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,37,T2WI,直肠受侵,Involvement,of,rectum,T2WI,子宫内膜癌a期,-Stage,a,endometrial,carcinoma,T2WI,T1WI,37,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,38,Jpn,Clinica,lRadol,50（11）1514-1515,Involvement,of,bladder,子宫内膜癌a期,-Stage,a,endometrial,carcinoma,T2WI,T2WI,膀胱受侵,38,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,39,子宫内膜癌b期,-Stage,b,endometrial,carcinoma,宫颈受侵、腹部多发转移,Invasion,into,cervical,and,abdomen,metastasis,39,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,40,（二）子宫颈癌,Cervical,carcinoma,40,子宫恶性肿瘤的MRI诊断,2009-8-7Liaoning,Cancer,Institute,and,Hospital,41,n,n,n,病因,:,尚不清，可能与妇女性生活、生育史、生殖道病,毒或细菌感染、性病、种族、地理和营养状况等相关,Etiology:,not,clearly,maybe,related,with,sexual,life,reproductive,history,reproductive,tract,virus,or,bacterial,infection,sexually,transmitted,diseases,race,geography,and,nutrition,肿瘤来源,:95%,为宫颈鳞状上皮；,5%,为宫颈管腺上皮,Oncology,resource,:,95%,from,cervical,squamous,cell;,5%,from,the,cervical,epithelium,好发部位：鳞状上皮和柱状上皮间的移行区,Ocurrence,site:,transitional,zone,between,squamous,epithelium,and,columnar,epithelium,子宫颈癌的临床特征,Clinical,Characters,of,Cervical,Carcinoma,41,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,42,n,n,临床表现：阴道出血是主要征象，可以是自然出,血或接触性出血，合并感染时白带增多,Clinical,:,the,main,symptom,:,vaginal,bleeding,with,natural,or,contact,bleeding,white,discharge,infection,扩散方式：深部浸润、直接蔓延、淋巴转移，血,行转移少,The,spreading:,deep,infiltration,direct,spreading,lymph,node,metastasis,hematogenous,metastasis,42,子宫恶性肿瘤的MRI诊断,43,n,期：限于宫颈,Stage,confined,to,the,cervix,a:,早期镜下浸润,a,-,Diagnosed,only,by,microscopy;,no,visible,lesions,a1,期,:,微灶浸润深度小于,3mm,宽度小于,7mm,a1,-,stromal,invasion,less,than,3,mm,in,depth,and,7,mm,or,less,in,horizontal,spread,a2,期,:,融合性浸润，深度在,3-5mm,，宽度,7mm,a2,-,stromal,invasion,between,3,and,5,mm,with,horizontal,spread,of,7,mm,or,less,Liaoning,Cancer,Institute,and,2009-8-7,Hospital,子宫颈癌的临床分期,Staging,of,Cervical,Carcinoma,采用国际妇产科联盟分期标准,From,International,Federation,of,Gynecology,and,Obstetrics,FIGO,43,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,44,b,期：浸润深度,5mm,，宽度,7mm,b,-,visible,lesion,or,a,microscopic,lesion,with,more,than,5,mm,of,depth,or,horizontal,spread,of,more,than,7,mm,b1,期：病灶可视最大径,40mm,b2,-,visible,lesion,more,than,4,cm,n,期：癌灶超越宫颈,Stage,involved,in,cervix,a:,癌肿未达到骨盆壁，累及阴道上部,2/3,a,no,parametrial,invasion,but,involved,in,upper,2/3,of,vagina,b:,宫颈旁组织浸润,b,-,parametrial,invasion,44,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,45,n,期：癌肿累及阴道下,1/3,和,/,或达到骨盆壁,Stage,III,-,extends,to,pelvic,wall,or,lower,third,of,the,vagina,a,期：癌肿累及阴道下,1/3,a,-,involves,lower,1/3,of,vagina,b,期：骨盆壁累和,/,或肾盂积水或无功能肾,B,-,extends,to,pelvic,wall,and/or,causes,hydronephrosis,or,non-,functioning,kidney,n,期：癌肿累及真骨盆以外部分或累及膀胱或直肠,(,a),，到达远处器官,(,b),a,-,invades,mucosa,of,bladder,or,rectum,and/or,extends,beyond,true,pelvis,b,-,distant,metastasis,45,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,46,46,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,47,47,子宫恶性肿瘤的MRI诊断,2009-8-7,Liaoning,Cancer,Institute,and,Hospital,48,