Oguchi O, Mori A, Kobayashi Y, Horiuchi A, Nikaido T, Fujii S
Department of Obstetrics and Gynecology, School of Medicine, Shinshu University, Matsumoto, Japan.
J Obstet Gynaecol (Tokyo 1995). 1995 Apr;21(2):107-17. doi: 10.1111/j.1447-0756.1995.tb01083.x.
To predict the histological features and proliferative activity of leiomyomas and to evaluate the effect of GnRH analogues (GnRHa) by MR images, the correlation between MR images and histopathologic findings was studied on 137 leiomyomatous nodules from 79 patients. The correlation among cellularity, proliferative activity and MR images was studied on sections of 42 leiomyomatous, nodules stained with hematoxylin-eosin and immunohistochemistry for proliferating cell nuclear antigen. The utility of MR imaging in assessing response to therapy with a GnRHa (buserelin 900 micrograms/day, intranasal for 16 weeks) was studied on 62 leiomyomatous nodules from 29 patients. On T2-weighted MR images, we encountered five major images. According to the increase of signal intensity relative to that of the myometrium and/or the endometrium, the images were classified as Type 1, Type 2, Type 3, Type 4, and Type 5. Histopathologically, the majority of Type 1, Type 2 and Type 3 images had features of typical leiomyoma. Almost all cellular leiomyomas and bizarre leiomyomas had Type 4 images. Variable degenerative features were observed in the nodules with Type 5 images. According to the increase of signal intensity, leiomyomas had a tendency to show a high degree of both cellularity and proliferative activity. Moreover, the reduction rate of leiomyomatous nodules after GnRHa therapy correlated with the tumor signal intensity on T2-weighted images before therapy. The reduction rate was the lowest in Type 1 images (20.9%) and the highest in Type 4 images (50.7%). These results suggest that increased the signal intensity on T2-weighted MR images correlates with the cellularity and proliferative activity of leiomyomas, and with tumor response to GnRHa treatment. MR imaging enables quantitative monitoring of GnRHa therapy in patients with leiomyomatous nodules, and allows us to predict the histopathology, cellularity, proliferative activity, and shrinkage rate of nodules before GnRHa treatment.
为了通过磁共振成像（MR）预测平滑肌瘤的组织学特征和增殖活性，并评估促性腺激素释放激素类似物（GnRHa）的疗效，我们对79例患者的137个平滑肌瘤结节进行了MR图像与组织病理学结果之间的相关性研究。对42个用苏木精-伊红染色及增殖细胞核抗原免疫组化染色的平滑肌瘤结节切片，研究了细胞密度、增殖活性与MR图像之间的相关性。对29例患者的62个平滑肌瘤结节，研究了MR成像在评估GnRHa（布舍瑞林900微克/天，经鼻给药16周）治疗反应中的作用。在T2加权MR图像上，我们发现了五种主要图像类型。根据相对于子宫肌层和/或子宫内膜信号强度的增加，这些图像被分为1型、2型、3型、4型和5型。组织病理学上，大多数1型、2型和3型图像具有典型平滑肌瘤的特征。几乎所有的细胞性平滑肌瘤和奇异型平滑肌瘤都表现为4型图像。在5型图像的结节中观察到各种变性特征。随着信号强度的增加，平滑肌瘤倾向于表现出较高的细胞密度和增殖活性。此外，GnRHa治疗后平滑肌瘤结节的缩小率与治疗前T2加权图像上的肿瘤信号强度相关。缩小率在1型图像中最低（20.9%），在4型图像中最高（50.7%）。这些结果表明，T2加权MR图像上信号强度的增加与平滑肌瘤的细胞密度、增殖活性以及肿瘤对GnRHa治疗的反应相关。MR成像能够对平滑肌瘤结节患者的GnRHa治疗进行定量监测，并使我们能够在GnRHa治疗前预测结节的组织病理学、细胞密度、增殖活性和缩小率。
