Ahmed Taha M, Coco Abigail, Vaught Arthur J, Gomez Erin N
Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA.
The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA.
Abdom Radiol (NY). 2025 Feb;50(2):966-978. doi: 10.1007/s00261-024-04527-x. Epub 2024 Aug 23.
Pelvic adhesions are nonanatomic connections between organs and normal peritoneal surfaces that develop secondary to a maladaptive inflammatory response to tissue insults. Comprised of fibrous tissue, adhesions can result in the distortion of operative dissection planes, which can complicate the establishment of abdominal access in patients undergoing surgery, prolong the length of surgery, and increase the risk of injury to bowel and other structures if involved by extensive adhesive disease. This can adversely impact patient outcomes by increasing the risk of surgical complications including bleeding, infection, and prolonging postoperative length of stay. Literature on the characterization of adhesions with imaging is limited and a systematic framework for evaluating adhesive disease on cross-sectional imaging of the pelvis does not currently exist. In this review, we discuss the MR imaging features of pelvic adhesions, highlighting unique teaching cases in which surgical exploration was significantly complicated by the presence of adhesive disease. We will also review the correlation between MR imaging and intraoperative findings in these cases. A proposed standardized framework for the detection and characterization of adhesions on pelvic MRI will be reviewed with multiple imaging examples. Identification and characterization of pelvic adhesive disease on preoperative imaging provides radiologists with an opportunity to inform the referring clinician of their presence, potentially improving outcomes and the quality of patient care.
盆腔粘连是器官与正常腹膜表面之间的非解剖学连接，其继发于对组织损伤的适应性炎症反应。粘连由纤维组织构成，可导致手术解剖平面变形，这会使接受手术的患者建立腹部入路变得复杂，延长手术时间，并且如果广泛的粘连性疾病累及肠道和其他结构，会增加损伤风险。这会增加包括出血、感染在内的手术并发症风险，并延长术后住院时间，从而对患者的预后产生不利影响。关于通过影像学对粘连进行特征描述的文献有限，目前尚不存在用于评估盆腔横断面影像学上粘连性疾病的系统框架。在本综述中，我们讨论盆腔粘连的磁共振成像（MR）特征，重点介绍因粘连性疾病导致手术探查显著复杂化的独特教学病例。我们还将回顾这些病例中MR成像与术中发现之间的相关性。将通过多个成像实例对提出的用于盆腔MRI上粘连检测和特征描述的标准化框架进行综述。术前影像学上对盆腔粘连性疾病的识别和特征描述为放射科医生提供了一个向转诊临床医生告知其存在的机会，这有可能改善预后和患者护理质量。
