Polat Pýnar, Suma Selami, Kantarcý Mecit, Alper Fatih, Levent Akýn
Department of Radiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Radiographics. 2002 Jan-Feb;22(1):47-53. doi: 10.1148/radiographics.22.1.g02ja0947.
Uterine vascular lesions are rare but potentially life-threatening lesions that should be suspected in women of reproductive age with unexplained vaginal bleeding and in postmenopausal women in whom anechoic structures are detected at ultrasonography (US). This is especially true in patients with a history of infection, curettage, therapeutic abortion, pelvic surgery, endometrial carcinoma, or gestational trophoblastic disease. Color Doppler US is valuable in the detection and characterization of many uterine vascular lesions, including arteriovenous malformations (AVMs) (especially arteriovenous fistulas), true aneurysms, pseudoaneurysms, and chorioangioma of the placenta. Arteriovenous fistulas demonstrate a mosaic pattern representing turbulent flow. Spectral analysis of intralesional arterial flow demonstrates high-velocity flow with a low resistive index, and spectral analysis of intralesional venous flow shows high peak systolic velocities consistent with an arterial flow pattern. Spectral analysis of a true aneurysm demonstrates arterial signals, whereas a to-and-fro or swirling pattern of flow is seen at the neck of a pseudoaneurysm. Chorioangioma is a benign hypervascular lesion with arterial and venous flow that, like AVMs, contains numerous cystic spaces that produce color signals. Color Doppler US is useful in the early diagnosis and treatment of these potentially clinically significant disorders of the uterus and placenta. Response to treatment can also be assessed with this technique.
子宫血管病变罕见，但可能危及生命，对于有不明原因阴道出血的育龄妇女以及超声检查发现无回声结构的绝经后妇女，应怀疑有此类病变。有感染、刮宫、治疗性流产、盆腔手术、子宫内膜癌或妊娠滋养细胞疾病史的患者尤其如此。彩色多普勒超声在许多子宫血管病变的检测和特征描述中具有重要价值，包括动静脉畸形（AVM）（尤其是动静脉瘘）、真性动脉瘤、假性动脉瘤和胎盘绒毛膜血管瘤。动静脉瘘表现为代表湍流的马赛克样血流模式。病灶内动脉血流的频谱分析显示高速血流且阻力指数低，病灶内静脉血流的频谱分析显示与动脉血流模式一致的高收缩期峰值速度。真性动脉瘤的频谱分析显示动脉信号，而假性动脉瘤颈部可见来回或漩涡状血流模式。绒毛膜血管瘤是一种良性高血管病变，有动脉和静脉血流，与动静脉畸形一样，含有许多产生彩色信号的囊性间隙。彩色多普勒超声在这些可能具有临床意义的子宫和胎盘疾病的早期诊断和治疗中很有用。也可用该技术评估治疗反应。
