Lorenzen M
Abteilung für Röntgendiagnostik, Universitätsklinik Hamburg-Eppendorf.
Aktuelle Radiol. 1996 Mar;6(2):63-8.
Traditionally gynecologic malignancies are staged by examination under anaesthesia which provides high accuracy as far as small tumors are concerned. In advanced tumors clinical staging is often inaccurate because of the difficulty to evaluate parametrial or myometrial tumor infiltration or lymphatic tumor spread. Therefore imaging modalities, such as sonography, computed tomography (CT), and magnetic resonance imaging (MRI), are required in most cases. The range of applications for MRI imaging includes staging, therapy planning, and follow-up examinations of uterine tumors and recurrent carcinoma. Based on its excellent soft tissue contrast, which allows a precise differentiation between several tissues and its direct multiplanar imaging capability, MRI is superior to sonography and CT. Only in the staging of ovarian carcinoma has the value of MRT not yet been defined, nevertheless it seems to offer diagnostic advantages over CT and sonography on account of its higher specificity. CT lose some of its value after the introduction of MRI into clinical practice. Indications for the use of CT are advanced space-occupying tumors with lymphatic spread or peritoneal implants as well as monitoring the tumor response to therapy for ovarian cancer. Sonography, as the technically simplest imaging modality, has consistently demonstrated its value as a screening method in the evaluation of benign gynecologic disease and is traditionally used for the detection of ovarian masses.
传统上,妇科恶性肿瘤通过麻醉下检查进行分期,就小肿瘤而言,这种方法具有很高的准确性。对于晚期肿瘤,由于难以评估宫旁或肌层肿瘤浸润或肿瘤淋巴扩散,临床分期往往不准确。因此,在大多数情况下需要超声、计算机断层扫描(CT)和磁共振成像(MRI)等成像方式。MRI成像的应用范围包括子宫肿瘤和复发性癌的分期、治疗计划制定以及随访检查。基于其出色的软组织对比度(能够精确区分多种组织)及其直接多平面成像能力,MRI优于超声和CT。仅在卵巢癌分期方面,MRI的价值尚未明确,不过由于其更高的特异性,它似乎比CT和超声具有诊断优势。在MRI引入临床实践后,CT的一些价值有所降低。CT的应用指征是伴有淋巴扩散或腹膜种植的晚期占位性肿瘤,以及监测卵巢癌的肿瘤治疗反应。超声作为技术上最简单的成像方式,在评估良性妇科疾病时一直证明其作为筛查方法的价值,并且传统上用于检测卵巢肿块。