Woo G M, Twickler D M, Stettler R W, Erdman W A, Brown C E
Department of Radiology, Queensway General Hospital, Etobicoke, Ontario, Canada.
AJR Am J Roentgenol. 1993 Dec;161(6):1249-52. doi: 10.2214/ajr.161.6.8249736.
In postpartum women, pain and fever can indicate serious complications, such as phlegmon or abscess of the parametrium or bladder flap, ovarian vein thrombosis, or uterine dehiscence. The purpose of this study was to ascertain the MR appearance of the normal pelvis after uncomplicated cesarean section and vaginal delivery.
Twenty-two patients (14 who had cesarean sections and eight who had vaginal deliveries) were imaged with a superconducting 0.35-T MR system 1-5 days after delivery. Sagittal and axial T1-weighted, proton density-weighted, and T2-weighted spin-echo images were acquired. Phase reconstruction of the axial T1-weighted sagittal images was performed to confirm flow in the ovarian veins. The ovarian veins, parametrium, bladder flap, endometrium, and uterine incision were analyzed on all images.
The uterine incision was well seen in all 14 patients who had cesarean section. The signal characteristics of the incision suggested subacute hematoma within the myometrium, and no myometrial defects were seen. In all 13 patients with a low transverse incision, a hematoma of the bladder flap was seen. Patency was confirmed in the majority of ovarian veins (39/44). No evidence of parametrial edema or mass, which can be seen in abscess or phlegmon, was found in any of the 22 patients. The ovarian perivenous fat did not show edema, which can indicate acute ovarian vein thrombosis. Increased signal in the endometrial cavity was seen in all patients; the signal characteristics were similar to those of subacute hematoma, consistent with clinical findings.
Normal findings of the postpartum pelvis on MR imaging are subacute hematoma in the uterine incision, bladder flap, and endometrial cavity. Patent ovarian veins are demonstrated in most (89%) cases.
在产后女性中，疼痛和发热可能提示严重并发症，如子宫旁组织或膀胱腹膜反折处的蜂窝织炎或脓肿、卵巢静脉血栓形成或子宫裂开。本研究的目的是确定无并发症剖宫产和阴道分娩后正常骨盆的磁共振成像（MR）表现。
22例患者（14例行剖宫产，8例行阴道分娩）在产后1 - 5天用超导0.35-T MR系统进行成像。获取矢状位和轴位T1加权、质子密度加权和T2加权自旋回波图像。对轴位T1加权矢状图像进行相位重建以确认卵巢静脉内的血流情况。在所有图像上分析卵巢静脉、子宫旁组织、膀胱腹膜反折、子宫内膜和子宫切口。
在所有14例行剖宫产的患者中均能清晰看到子宫切口。切口的信号特征提示肌层内存在亚急性血肿，未见肌层缺损。在所有13例低位横切口患者中均可见膀胱腹膜反折处血肿。大多数卵巢静脉（39/44）通畅。22例患者中均未发现可在脓肿或蜂窝织炎中见到的子宫旁组织水肿或肿块迹象。卵巢静脉周围脂肪未见水肿，而水肿可提示急性卵巢静脉血栓形成。所有患者子宫内膜腔内信号均增强；信号特征与亚急性血肿相似，与临床 findings相符。
产后骨盆MR成像的正常表现为子宫切口、膀胱腹膜反折和子宫内膜腔内的亚急性血肿。大多数（89%）病例显示卵巢静脉通畅。
