子宮惡性腫瘤的MRI診斷課件

1、12009-8-7Liaoning Cancer Institute andHospital子宮惡性腫瘤的MRI診斷MRI of Uterine Malignant Neoplasm12009-8-7Liaoning Cancer Insti22009-8-7Liaoning Cancer Institute andHospital2子宮惡性腫瘤的流行病學(xué)現(xiàn)狀Epidemiology of Uterine Malignant Neoplasm子宮惡性腫瘤包括子宮頸癌、子宮內(nèi)膜癌、滋養(yǎng)細(xì)胞惡性腫瘤、子宮肉瘤等Uterine malignant neoplasm includes cervical

2、 carcinoma, endometrialcarcinoma, uterine sarcoma and malignant trophoblastic tumor, etc.22009-8-7Liaoning Cancer Insti32009-8-7Liaoning Cancer Institute andHospital3nnnn全球婦女惡性腫瘤發(fā)病率的第三位The No. 3 female malignant tumor in the world我國(guó)婦科惡性腫瘤發(fā)病率的前兩位The top two common female cancer in China女性惡性腫瘤死亡率的第二位T

3、he second mortality in female malignant tumor in China每年約有3萬(wàn)名婦女死于宮頸癌About 30,000 females died子宮頸癌Cervical Carcinoma32009-8-7Liaoning Cancer Insti42009-8-7Liaoning Cancer Institute andHospital4nnn全球婦女惡性腫瘤發(fā)病率的第四位The fourth most common female cancer in the world每年的平均病例數(shù)是30 年前的40 倍之多The yearly average n

4、umber of endometrial carcinoma is nearlyfourty times as much as those 30 years ago隨著我國(guó)婦女內(nèi)分泌代謝性疾病的增加，子宮內(nèi)膜癌呈對(duì)數(shù)速度增長(zhǎng)With endocrinopathy morbidity rising, the number of endometrialcarcinoma is increasing according to logarithm fashion子宮內(nèi)膜癌Endometrial carcinoma42009-8-7Liaoning Cancer Insti52009-8-7Liaoni

5、ng Cancer Institute andHospital5nnn占子宮惡性腫瘤的2 % 4 %Accounting for 2 4 % of all uterine malignancies占生殖道惡性腫瘤的1%Accounting for 1% of all malignancies in female reproductive tract臨床罕見(jiàn)、惡性程度較高A very rare and high malignancy in female reproductive tract子宮肉瘤Uterine sarcoma52009-8-7Liaoning Cancer Insti62009

6、-8-7Liaoning Cancer Institute andHospital6子宮惡性腫瘤的臨床檢查方法Clinical examination of uterinemalignant neoplasm62009-8-7Liaoning Cancer Insti72009-8-7Liaoning Cancer Institute andHospital7臨床檢查Clinical examinationp普通婦科檢查：簡(jiǎn)單，但具有明顯的局限性Gynecological examination : simple & limitedp分期具有主觀(guān)性：3439的患者分期錯(cuò)誤Subjectivit

7、y on its staging: 34%-39% of incorrect stagingp不能全面評(píng)價(jià)腫瘤侵犯深度和盆腔淋巴結(jié)轉(zhuǎn)移Difficult to identify invasive extent and lymph node metastases72009-8-7Liaoning Cancer Insti82009-8-7Liaoning Cancer Institute andHospital8臨床檢查-細(xì)胞學(xué)檢查Clinical examination-Exfoliative cytologic examinationn檢測(cè)來(lái)源于子宮內(nèi)膜、子宮頸的惡性細(xì)胞Finding ma

8、lignant cells from cervix and uterine endometriumn為子宮惡性腫瘤的診斷診斷提供直接依據(jù)Providing direct diagnosis for uterine malignant neoplasmn為子宮微生物感染提供診斷依據(jù)Finding foundation for uterine microbial infectionn在腫瘤的分期上無(wú)明顯價(jià)值No value on its staging82009-8-7Liaoning Cancer Insti92009-8-7Liaoning Cancer Institute andHospit

9、al9臨床檢查-陰道宮腔鏡Clinical examination- hysteroscopynnn對(duì)子宮可疑病變進(jìn)行定位活檢Biopsy for suspected lesion明顯提高子宮體、頸部早期癌的診斷率Higher diagnostic rate of uterine and cervical cancer不能客觀(guān)評(píng)價(jià)腫瘤侵犯深度和盆腔淋巴結(jié)轉(zhuǎn)移Unable to evaluate invasive extent and lymphnodes metastasisaccurately92009-8-7Liaoning Cancer Insti102009-8-7Liaoning C

10、ancer Institute andHospital10影像學(xué)方法-超聲檢查Medical image examination-Ultrasonographyppp對(duì)子宮可疑病變進(jìn)行定位活檢The most common screen on uterine malignant tumor經(jīng)腹超聲在分期上應(yīng)用價(jià)值較小Trans-abdominal ultrasound with few value on staging陰式超聲可明顯提高子宮惡性腫瘤的分期，其陽(yáng)性、陰性預(yù)測(cè)值分別約62和92Improving staging by trans-vagina ultrasound with 62%

11、 forpositive predictive value and 92% for negative predictive value102009-8-7Liaoning Cancer Inst112009-8-7Liaoning Cancer Institute andHospital11影像學(xué)方法- CT檢查Medical image examination-CTnnn平掃CT：子宮惡性腫瘤與子宮壁密度相似，難以顯示癌腫的浸潤(rùn)深度和范圍Non-CE CT: difficult to show tumor invasive depth and extent becauseof similar

12、 intensity between uterine tissues & malignant tissuesCT增強(qiáng)：子宮惡性腫瘤顯示有局限性Showing uterine disease with some limitations by CE CTCT評(píng)價(jià)宮旁浸潤(rùn)假陽(yáng)性較高，準(zhǔn)確度僅3358Accuracy is 3358 on evaluating parametrical invasion by CTbecause of a high false-positive error112009-8-7Liaoning Cancer Inst122009-8-7Liaoning Cancer I

13、nstitute andHospital12影像學(xué)方法- MRMedical image examination-MRInn上世紀(jì)80年代，MRI出現(xiàn)并應(yīng)用于子宮腫瘤的診斷MRI used in uterine diagnosis in the last 80s當(dāng)時(shí)，成像時(shí)間長(zhǎng)、圖像易受呼吸、血管搏動(dòng)和腸蠕動(dòng)的影響、磁場(chǎng)強(qiáng)度低等缺點(diǎn)使其應(yīng)用受限At that time, longer imaging time & imaging quality easily disturbed bybreath, vessel pause, bowel movement, low magnetic field

14、 strengt, etc.These disadvantages limited its application122009-8-7Liaoning Cancer Inst132009-8-7Liaoning Cancer Institute andHospital13nn隨著MRI場(chǎng)強(qiáng)、梯度切換率的提高和多通道高密相控陣線(xiàn)圈的應(yīng)用，使應(yīng)用MRI技術(shù)對(duì)子宮惡性腫瘤進(jìn)行準(zhǔn)確診斷和客觀(guān)評(píng)價(jià)成為可能With high-magnetic MR scanner,high-gradient switch ratio andmultiple phased array coils, it is possib

15、le to diagnose uterinemalignacy accurately and evaluate it objectively by MRIMRI因其極高的軟組織分辨力，能夠清晰顯示子宮的組織結(jié)構(gòu)和信號(hào)的細(xì)微變化，近而準(zhǔn)確評(píng)價(jià)子宮惡性腫瘤的大小和范圍Clearly displaying uterine layers, signal changes, tumor size andextent on MRI image because of it high soft tissue resolution132009-8-7Liaoning Cancer Inst142009-8-7Li

16、aoning Cancer Institute andHospital14nn腫瘤分期達(dá)到b期以上，MRI的評(píng)價(jià)準(zhǔn)確性、陽(yáng)性和陰性預(yù)測(cè)值分別可達(dá)81 95%、100、90%Above IB staging, accuracy, positive predictive value and negativepredictive value of MRI evaluation : 81%-95%,100% and 90%在顯示子宮惡性腫瘤宮旁浸潤(rùn)和淋巴結(jié)轉(zhuǎn)移等方面，其敏感度、特異度均較高High sensitivity and specificity in showing parametrical

17、invasion andlympnode metastasis from uterine malignant neoplasm on MRI142009-8-7Liaoning Cancer Inst152009-8-7Liaoning Cancer Institute andHospital15影像學(xué)方法- PETCT檢查Medical image examination-PEC/CTnnn是評(píng)價(jià)子宮腫瘤良惡性的最佳影像方法之一One of the best evaluations on uterine malignancy對(duì)腫瘤及周?chē)馨徒Y(jié)轉(zhuǎn)移進(jìn)行客觀(guān)評(píng)價(jià)，其特異性高，陽(yáng)性預(yù)測(cè)值約75%-

18、100%Objective view on tumor and lymph node metastasis with 75%-100% positive predictive value昂貴的價(jià)格制約了其廣泛應(yīng)用Application limited by expensive costing152009-8-7Liaoning Cancer Inst162009-8-7Liaoning Cancer Institute andHospital16MRI在子宮惡性腫瘤診斷上的價(jià)值Diagnostic Value of MRI in UterineMalignant Neoplasm162009-

19、8-7Liaoning Cancer Inst172009-8-7Liaoning Cancer Institute andHospital17MRI成像的優(yōu)勢(shì)Advantage of MRInnnn無(wú)損傷和輻射性No injury and radiation高的軟組織分辨力和極高的敏感度High soft tissue resolution and sensitivityMRI三維成像使病灶定位更準(zhǔn)確3D images with high accuracy in lesions檢出子宮多灶性病變以及評(píng)價(jià)侵犯的范圍、周?chē)馨徒Y(jié)轉(zhuǎn)移區(qū)域有明顯價(jià)值Identifying multiple lesi

20、ons,invasive extending and lymph nodemetastasis172009-8-7Liaoning Cancer Inst182009-8-7Liaoning Cancer Institute andHospital18nn動(dòng)態(tài)增強(qiáng)檢查可了解病變的血流灌注情況,有助于病變性質(zhì)的評(píng)價(jià)Exploring perfusion & evaluation of tumors by DCT為準(zhǔn)確分期和臨床治療方案的制定提供可靠依據(jù)Providing accurate staging and therapy planning182009-8-7Liaoning Cancer

21、Inst192009-8-7Liaoning Cancer Institute andHospital19子宮MRI檢查的適應(yīng)癥Indications of uterine MRI examinationnnnnn檢出子宮隱匿性病灶、囊性病灶及多灶性病變Detecting occult, cystic and multiple lesions評(píng)價(jià)子宮惡性腫瘤的浸潤(rùn)范圍和淋巴結(jié)轉(zhuǎn)移Evaluating invasive extent and lympnode metastasis評(píng)價(jià)子宮惡性腫瘤的新輔助治療療效Evaluateing therapy effect確定手術(shù)適應(yīng)癥Determinin

22、g surgical indications監(jiān)測(cè)子宮惡性腫瘤的術(shù)后復(fù)發(fā)Monitoring post-surgical recurrence192009-8-7Liaoning Cancer Inst202009-8-7Liaoning Cancer Institute andHospital20子宮惡性腫瘤的MRI診斷、分期Diagnosing and Staging of UterineMalignant Neoplasm by MRI202009-8-7Liaoning Cancer Inst212009-8-7Liaoning Cancer Institute andHospital2

23、1（一）子宮內(nèi)膜癌Endometrial Carcinoma212009-8-7Liaoning Cancer Inst222009-8-7Liaoning Cancer Institute andHospital22子宮內(nèi)膜癌的臨床特征Clinical Characters of Endometrial Carcinomann臨床表現(xiàn)：絕經(jīng)后婦女陰道不規(guī)則流血、惡臭液體及爛肉,下腹疼痛、消瘦和貧血Clinical manifestations: postmenopausal women withirregular vaginal bleeding, foul liquid,necrotic

24、tissue,abdominal pain, weight loss and anemia好發(fā)部位：子宮底和體后壁Occurrence sites: the posterior wall of uterus and itsbottom222009-8-7Liaoning Cancer Inst232009-8-7Liaoning Cancer Institute andHospital23擴(kuò)散方式The spreading ways直接播散Direct spreading淋巴轉(zhuǎn)移Lymph node metastasis血行轉(zhuǎn)移Hematogenous metastasis232009-8-7

25、Liaoning Cancer Inst242009-8-7Liaoning Cancer Institute andHospital24子宮內(nèi)膜癌的MRI特征MRI Characters of Endometrial Carcinoma病變局限于內(nèi)膜Lesions confined in endometrialnnnT1WI：癌腫信號(hào)稍低于內(nèi)膜或與肌層信號(hào)一致T1WI: endometrial carcinoma signal is slightly lower than theendometrial signal or same as the myometrial signalT2WI：內(nèi)

26、膜局限/彌漫增厚，呈稍高信號(hào)T2WI: hyper-signal in limitations / diffuse thickening endometrial病變不強(qiáng)化或輕度強(qiáng)化，低于肌層Slightly or no enhanced contrast with a signal lower than myometrial242009-8-7Liaoning Cancer Inst252009-8-7Liaoning Cancer Institute andHospital25病變侵入肌層Invading myometrialnnn癌腫呈菜花狀、息肉狀突入宮腔lesions with cau

27、liflower-like mass in the uterine cavityT2WI:低信號(hào)的結(jié)合帶內(nèi)出現(xiàn)高信號(hào)T2WI: hyper-signal in lower junctional zone增強(qiáng)時(shí):肌層病變與內(nèi)膜病變均呈低信號(hào)，強(qiáng)化的結(jié)合帶不完整CE: lesion with low signals in both myometrial and endometriallayers, showing incompletely enhanced changes in the junctionalzone252009-8-7Liaoning Cancer Inst262009-8-7Li

28、aoning Cancer Institute andHospital26深肌層受侵Deep myometrial invasionnn子宮各層結(jié)構(gòu)消失, 局部肌層出現(xiàn)不規(guī)則低信號(hào)病灶，肌層變薄Disappearance uterine layers with focused, irregular low-signallesions in myometrium & thinning myometrium子宮增大, 盆腔內(nèi)組織器官?gòu)V泛受侵Enlarged uterus, diffusion involvement in pelvic tissues & organs262009-8-7Liaon

29、ing Cancer Inst272009-8-7Liaoning Cancer Institute andHospital27nnnna:腫瘤僅局限于子宮內(nèi)膜a :Tumor confined in endometriumb:子宮肌層受侵小于1/2b: invaded myometrial less than 1/2c:子宮肌層受侵大于1/2c: invased myometrial more than1/2a:宮頸內(nèi)膜受侵a: invasion into cervical endometrial子宮內(nèi)膜癌的臨床分期Staging of Endometrial Carcinoma采用國(guó)際婦產(chǎn)

30、科聯(lián)盟分期標(biāo)準(zhǔn)From International Federation of Gynecology and Obstetrics, FIGO272009-8-7Liaoning Cancer Inst282009-8-7Liaoning Cancer Institute andHospital28nnnnnnb:腫瘤侵犯到宮頸基質(zhì)外b: invasion into cervical stromal outsidea:附件受侵或穿出漿膜/腹腔積液細(xì)胞學(xué)()a: out of the annex or serosal invasion/peritoneal fluid cytology (+)b

31、:陰道擴(kuò)散b: the spread of the vaginac:盆腔或主動(dòng)脈周?chē)馨徒Y(jié)轉(zhuǎn)移c: pelvic lymph node metastasis around the aortaa期:膀胱或直腸受侵a: involvement of bladder or rectumb期:遠(yuǎn)處轉(zhuǎn)移或腹部、腹股溝淋巴結(jié)轉(zhuǎn)移b: distant metastasis or the abdomen, groin lymphnode metastasis282009-8-7Liaoning Cancer Inst292009-8-7Liaoning Cancer Institute andHospital

32、29292009-8-7Liaoning Cancer Inst302009-8-7Liaoning Cancer Institute andHospital30302009-8-7Liaoning Cancer Inst31肌層受侵小于 Cancer Institute and2009-8-7Hospital31子宮內(nèi)膜癌Ib 期 55歲-Stageb endometrial carcinoma in a 55-year-old womanT2WIT1WIT2WI1/2LiaoningInvaded myometrial less than 1/231肌層受侵小于 Cancer Instit

33、ute and232Invased myometrial more than1/2T2WI2009-8-7T1WI32子宮內(nèi)膜癌Ic期 40歲-Stage Ic endometrial carcinoma in a 40-year-old womanCE: T1WICE: T1WI肌層受侵大于1/2Liaoning Cancer Institute andHospital32Invased myometrial more than33Liaoning Cancer Institute andHospital332009-8-7Copyright 2007 by the American Roe

34、ntgen Ray Society子宮內(nèi)膜癌IIa期 78歲-Stage IIa endometrial carcinoma in a 78-year-old woman宮頸內(nèi)膜受侵Invasion into cervical endometrialSala, E. et al. Am. J. Roentgenol. 2007;188:1577-1587T2WIT2WI33Liaoning Cancer Institute an342009-8-7Liaoning Cancer Institute andHospital34子宮內(nèi)膜癌a期-Stage a endometrial carcino

35、ma雙側(cè)卵巢受侵tumor invading the ovariesT2WIT2WI342009-8-7Liaoning Cancer Inst35Liaoning Cancer Institute andHospital35子宮內(nèi)膜癌b期-Stage b endometrial carcinoma肌層受侵大于1/2伴陰道擴(kuò)散Deep invasion 50% of the myometrialthickness of endometrial carcinoma(arrow).The spread of the vagina2009-8-7T2WI35Liaoning Cancer Insti

36、tute an362009-8-7Liaoning Cancer Institute andHospital36Riccardo et.al子宮內(nèi)膜癌c期-Stage c endometrial carcinoma肌層受侵大于1/2伴閉孔內(nèi)淋巴結(jié)轉(zhuǎn)移Deep invasion 50% of the myometrialthickness of endometrial carcinoma (arrow)and internal obturator lymph node metastasisT2WIRadiology 2004 18 ( 10).1148362009-8-7Liaoning Can

37、cer Inst372009-8-7Liaoning Cancer Institute andHospital37T2WI直腸受侵Involvement of rectumT2WI子宮內(nèi)膜癌a期-Stage a endometrial carcinomaT2WIT1WI372009-8-7Liaoning Cancer Inst382009-8-7Liaoning Cancer Institute andHospital38Jpn Clinica lRadol 50（11）1514-1515Involvement of bladder子宮內(nèi)膜癌a期-Stage a endometrial ca

38、rcinomaT2WIT2WI膀胱受侵382009-8-7Liaoning Cancer Inst392009-8-7Liaoning Cancer Institute andHospital39子宮內(nèi)膜癌b期-Stage b endometrial carcinoma宮頸受侵、腹部多發(fā)轉(zhuǎn)移Invasion into cervical and abdomenmetastasis392009-8-7Liaoning Cancer Inst402009-8-7Liaoning Cancer Institute andHospital40（二）子宮頸癌Cervical carcinoma402009

39、-8-7Liaoning Cancer Inst412009-8-7Liaoning Cancer Institute andHospital41nnn病因:尚不清，可能與婦女性生活、生育史、生殖道病毒或細(xì)菌感染、性病、種族、地理和營(yíng)養(yǎng)狀況等相關(guān)Etiology: not clearly, maybe related with sexual life, reproductive history,reproductive tract virus or bacterial infection, sexually transmitteddiseases, race, geography and nu

40、trition腫瘤來(lái)源:95%為宮頸鱗狀上皮；5%為宮頸管腺上皮Oncology resource : 95% from cervical squamous cell; 5% from thecervical epithelium好發(fā)部位：鱗狀上皮和柱狀上皮間的移行區(qū)Ocurrence site: transitional zone between squamous epithelium andcolumnar epithelium子宮頸癌的臨床特征Clinical Characters of Cervical Carcinoma412009-8-7Liaoning Cancer Inst42

41、2009-8-7Liaoning Cancer Institute andHospital42nn臨床表現(xiàn)：陰道出血是主要征象，可以是自然出血或接觸性出血，合并感染時(shí)白帶增多Clinical : the main symptom : vaginal bleeding with natural or contactbleeding, white discharge infection擴(kuò)散方式：深部浸潤(rùn)、直接蔓延、淋巴轉(zhuǎn)移，血行轉(zhuǎn)移少The spreading: deep infiltration, direct spreading, lymph nodemetastasis, hematogen

42、ous metastasis422009-8-7Liaoning Cancer Inst4343n期：限于宮頸Stage confined to the cervixa:早期鏡下浸潤(rùn)a - Diagnosed only by microscopy; no visible lesionsa1期:微灶浸潤(rùn)深度小于3mm,寬度小于7mma1 - stromal invasion less than 3 mm in depth and7 mm or less in horizontal spreada2期:融合性浸潤(rùn)，深度在3-5mm，寬度7mma2 - stromal invasion betwee

43、n 3 and 5 mm withhorizontal spread of 7 mm or lessLiaoning Cancer Institute and2009-8-7Hospital子宮頸癌的臨床分期Staging of Cervical Carcinoma采用國(guó)際婦產(chǎn)科聯(lián)盟分期標(biāo)準(zhǔn)From International Federation of Gynecology and Obstetrics, FIGO4343n期：限于宮頸a1期:微灶浸潤(rùn)深度小于3mm,442009-8-7Liaoning Cancer Institute andHospital44b期：浸潤(rùn)深度5mm，寬度7

44、mmb - visible lesion or a microscopic lesion with more than 5 mm ofdepth or horizontal spread of more than 7 mmb1期：病灶可視最大徑40mmb2 - visible lesion more than 4 cmn期：癌灶超越宮頸Stage involved in cervixa:癌腫未達(dá)到骨盆壁，累及陰道上部2/3a no parametrial invasion, but involved in upper 2/3 of vaginab:宮頸旁組織浸潤(rùn)b - parametrial

45、invasion442009-8-7Liaoning Cancer Inst452009-8-7Liaoning Cancer Institute andHospital45n期：癌腫累及陰道下1/3和/或達(dá)到骨盆壁Stage III - extends to pelvic wall or lower third of the vaginaa期：癌腫累及陰道下1/3a - involves lower 1/3 of vaginab期：骨盆壁累和/或腎盂積水或無(wú)功能腎B - extends to pelvic wall and/or causes hydronephrosis or non-fu

46、nctioning kidneyn期：癌腫累及真骨盆以外部分或累及膀胱或直腸(a)，到達(dá)遠(yuǎn)處器官(b)a - invades mucosa of bladder or rectum and/or extends beyond truepelvisb - distant metastasis452009-8-7Liaoning Cancer Inst462009-8-7Liaoning Cancer Institute andHospital46462009-8-7Liaoning Cancer Inst472009-8-7Liaoning Cancer Institute andHospita

47、l47472009-8-7Liaoning Cancer Inst482009-8-7Liaoning Cancer Institute andHospital48/best-practi.482009-8-7Liaoning Cancer Inst492009-8-7Liaoning Cancer Institute andHospital49http:/www.scielo.br/scielo.php?script=sci_arttext&pid=S0100 -39842007000300014&tlng=en&lng=en&nrm=iso492009-8-7Liaoning Cancer

48、 Inst502009-8-7Liaoning Cancer Institute andHospital50nnnMRI軸位上顯示為類(lèi)圓形和不規(guī)則形分葉腫塊MRI: a round, irregular-shaped and lobulated mass on axial MRI矢狀位顯示宮頸增大為桶狀，宮頸管腔消失Enlarged cervix with barrel shape on sgaiggtal imagingT1WI呈等信號(hào)，T2WI呈高信號(hào)the disappearance of cervical cannel iso-signal on T1WI; hyper-signal

49、on T2WI子宮頸癌的MRI特征MRI Characters of Cervical Carcinoma癌腫的MRI表現(xiàn)MRI Characters of lesion502009-8-7Liaoning Cancer Inst512009-8-7Liaoning Cancer Institute andHospital51nnT2WI:癌腫與正常宮頸基質(zhì)低信號(hào)及宮旁脂肪間隙有良好對(duì)比T2WI: good contrast between the tumor and normal cervicalstroma with low signal & parametrial space增強(qiáng)動(dòng)態(tài)掃描

50、，T1WI癌腫早期強(qiáng)化，可清晰顯示病灶的形態(tài)、邊界和宮頸基質(zhì)受侵犯的深度CE: obviously showing enhanced tumor with shape and rimand the depth of cervical stromal invasion512009-8-7Liaoning Cancer Inst522009-8-7Liaoning Cancer Institute andHospital52癌腫侵犯深度的MRI評(píng)價(jià)Tumor invasion depth: evaluation by MRInn局限于粘膜內(nèi)：浸潤(rùn)深度5mm，T1WI與T2WI呈中等信號(hào)，與正常粘膜

51、接近;增強(qiáng)掃描可依據(jù)早期強(qiáng)化的癌腫清晰顯示病灶的邊緣及其浸潤(rùn)的深度Confined in mucosa: the invasion depth 5mm，寬度7mmStromal invasion more than5 mm in depth and morethan7 mm in horizontal spreadT1WIT2WI542009-8-7Liaoning Cancer Inst552009-8-7Liaoning Cancer Institute andHospital55浸潤(rùn)深度5mm，寬度7mmStromal invasion more than5 mm in depth an

52、d morethan7 mm in horizontal spread子宮頸癌Ib期-Stage b cervical carcinomaT2WIT2WI552009-8-7Liaoning Cancer Inst562009-8-7Liaoning Cancer Institute andHospital56子宮頸癌a期 34歲-Stage a cervical carcinoma in a 34-year-old womanT2WIT2WIT2WIT1WI癌腫累及陰道上部2/3involved in upper 2/3 ofvagina562009-8-7Liaoning Cancer I

53、nst572009-8-7Liaoning Cancer Institute andHospital57子宮頸癌b期 47歲-Stage b cervical carcinoma in a 47-year-old woman宮頸旁組織浸潤(rùn)parametrial invasionT2WIT2WISala, E. et al. Am. J. Roentgenol. 2007;188:1577-1587572009-8-7Liaoning Cancer Inst5858子宮頸癌b期-Stage b cervical carcinoma宮頸旁組織浸潤(rùn)parametrial invasion2009-8

54、-7T2WIT2WIT2WILiaoning Cancer Institute andHospitalT2WI5858子宮頸癌b期宮頸旁組織浸潤(rùn)parametrial59Liaoning Cancer Institute andHospital592009-8-7Copyright 2007 by the American Roentgen Ray Society子宮頸癌IIb期 42歲-Stage IIb cervical cancer in 42-year-old womanT2WI宮頸旁組織浸潤(rùn)parametrial invasionT2WISala, E. et al. Am. J.

55、Roentgenol. 2007;188:1577-158759Liaoning Cancer Institute an602009-8-7Liaoning Cancer Institute andHospital60子宮頸癌IIIa期 45歲-Stage a cervical cancer in 45-year-old womanT2WI累及陰道下1/3extends to the lower 1/3 of vaginaT2WI602009-8-7Liaoning Cancer Inst612009-8-7Liaoning Cancer Institute andHospital61子宮頸癌

56、IVa期 39歲-Stage a cervical cancer in 39-year-old womanT2WI累及直腸extends to rectumT2WISala, E. et al. Am. J. Roentgenol. 2007;188:1577-1587612009-8-7Liaoning Cancer Inst62Liaoning Cancer Institute andHospital622009-8-7Copyright 2007 by the American Roentgen Ray Society子宮頸癌IVa期-Stage a cervical cancer累及膀

57、胱extends to rectum and bladderT2WISala, E. et al. Am. J. Roentgenol. 2007;188:1577-158762Liaoning Cancer Institute an632009-8-7Liaoning Cancer Institute andHospital63（三）子宮肉瘤Uterine Sarcoma632009-8-7Liaoning Cancer Inst642009-8-7Liaoning Cancer Institute andHospital64nnn病因：尚不清Etiology: unclear腫瘤來(lái)源:子宮

58、平滑肌、子宮內(nèi)膜間質(zhì)、血管、纖維組織Oncology Source: uterine smooth muscle, endometrial stromal, vascular,fibrous tissues病理分類(lèi)：子宮平滑肌肉瘤、子宮內(nèi)膜間質(zhì)肉瘤、混合型同源mullerian肉瘤、混合型異源mullerian肉瘤Pathological classification: uterine leiomyosarcoma, endometrial stromalsarcoma, homologous mixed mullerian sarcoma, mixed mullerianheterologo

59、us sarcoma子宮肉瘤的臨床特征Clinical Characters of Uterine Sarcoma642009-8-7Liaoning Cancer Inst652009-8-7Liaoning Cancer Institute andHospital65臨床表現(xiàn)Clinical manifestationsnnnn最常見(jiàn)癥狀不規(guī)則陰道出血Common symptoms- irregular vaginal bleeding腫瘤生長(zhǎng)過(guò)快、過(guò)度膨脹或瘤內(nèi)出血壞死Excessive tumor growth, excessive swelling or bleeding andne

60、crosis腹痛及腫瘤的壓迫癥狀Symptoms of oppression and pain觸及腹部包塊Palpable abdominal mass652009-8-7Liaoning Cancer Inst662009-8-7Liaoning Cancer Institute andHospital66nn生長(zhǎng)方式：多數(shù)為彌漫性生長(zhǎng)，與肌層分界不清，無(wú)包膜Growth : the majority of them having diffuse growth with unclearboundaries between muscular and tumor and without enve