Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
Eur J Radiol. 2012 Aug;81(8):1957-64. doi: 10.1016/j.ejrad.2011.04.064. Epub 2011 May 17.
To evaluate the association between magnetic resonance imaging (MRI) derived uterine and leiomyoma characteristics and symptoms demanding treatment.
Consecutive patients (n=122; mean age, 47.5 years) with symptomatic leiomyomas participated in a prospective study. The leiomyoma/endometrium relationship, sizes of leiomyomas and uteri, and number and enhancement of leiomyomas were determined by MRI. Submucosal leiomyomas were classified as protruding either ≥50% or <50% into the uterine cavity.
Sixty-nine patients (57%) had menorrhagia and pressure symptoms, while 26 (21%) had only menorrhagia and 27 (22%) pressure symptoms alone. Leiomyomas with ≥50% protrusion into the uterine cavity were detected more often in patients with both symptoms or just menorrhagia than in those with pressure symptoms only (18/69 [26%] versus 1/27 [4%], P=0.013; 10/26 [39%] versus 1/27 [4%], P=0.002, respectively). The degree of enhancement of leiomyomas was higher (P=0.005) and leiomyomas were smaller (P=0.002) in patients with menorrhagia than in those with pressure symptoms. Large uterine and leiomyoma measures were associated with increased urinary frequency (P values 0.002-0.032). Urinary stress incontinence, abdominal pain, and pressure on the back were not associated with MRI findings.
In comparison with pressure symptoms, menorrhagia is associated with smaller uterine and leiomyoma size and with more intense enhancement. While a submucosal leiomyoma largely protruding into the cavity contributes to menorrhagia, significance of a minor submucosal component seems to be unclear. The large leiomyoma and uterine volumes contribute to increased urinary frequency, whereas other mechanisms for urinary stress incontinence and pain symptoms should be considered.
评估磁共振成像（MRI）得出的子宫和子宫肌瘤特征与需要治疗的症状之间的关联。
连续入组 122 例（平均年龄 47.5 岁）有症状的子宫肌瘤患者参与前瞻性研究。通过 MRI 确定子宫肌瘤/子宫内膜关系、子宫肌瘤和子宫大小、以及子宫肌瘤数量和增强程度。黏膜下子宫肌瘤按突出子宫腔的程度分为≥50%或<50%。
69 例（57%）患者有月经过多和压迫症状，26 例（21%）仅有月经过多，27 例（22%）仅有压迫症状。有≥50%突入子宫腔的肌瘤在同时有症状或仅月经过多的患者中比仅压迫症状的患者中更常见（18/69[26%]比 1/27[4%]，P=0.013；10/26[39%]比 1/27[4%]，P=0.002）。增强程度较高（P=0.005），肌瘤较小（P=0.002）的患者月经过多。较大的子宫和肌瘤大小与尿频增加有关（P 值 0.002-0.032）。尿失禁、腹痛和腰痛与 MRI 发现无关。
与压迫症状相比，月经过多与子宫和肌瘤体积较小以及增强程度较高相关。虽然黏膜下肌瘤大部分突入子宫腔会导致月经过多，但较小的黏膜下成分的意义似乎不明确。较大的子宫肌瘤和子宫体积会导致尿频增加，而其他导致尿失禁和疼痛症状的机制应加以考虑。
