女性盆腔解剖與CT診斷

1、女性盆腔解剖與CT診斷女性盆腔解剖與CT診斷女性盆腔解剖與CT診斷子宮的韌帶：子宮闊韌帶子宮圓韌帶子宮主韌帶骶子宮韌帶卵巢的韌帶：卵巢韌帶卵巢懸韌帶女性盆腔的韌帶子宮的韌帶：卵巢的韌帶：女性盆腔的韌帶女性盆腔的韌帶The broad ligament is formed by two layers of peritoneum, which drape over the uterus and extend laterally from the uterus to the pelvic sidewall。The round ligament is a band of fibromuscular t

2、issue that attaches to the anterolateral uterine fundus just below and anterior to the fallopian tube and anterior to the ovarian ligament。The cardinal ligament (transverse cervical ligament, Mackenrodt ligament) forms the base of the broad ligament and provides the primary ligamentous support for t

3、he uterus and upper vagina。The uterosacral ligament extends posteriorly from the lateral cervix and vagina at the level of the internal cervical os and forms a curved arc toward the anterior body of the sacrum at S-2 orS-3女性盆腔的韌帶The broad ligament is f女性盆腔的韌帶The ovarian ligament (round ligament of t

4、he ovary) extends medially from the ovary to the uterus, just inferior and posterior to the fallopian tubes and round ligaments。The suspensory ligament of the ovary (infundibulopelvic ligament) occupies the lateral aspect of the free upper edge of the broad ligament。女性盆腔的韌帶The ovarian ligament (r女性盆

5、腔解剖與CT診斷Axial view of the female pelvic viscera and ligaments.Axial view of the female pelviVisualization of the broad ligament with CT. (a) CT scan shows a large amount of ascites outlining the right cephalic free edge of the broad ligament (BL). The subtle soft-tissue structure(white arrow) extend

6、ing from the posterolateral aspect of the broad ligament toward the right ovary is most consistent with the mesovarium. (b) CT scan obtained just superior to a shows that the suspensory ligament attachment at the anterolateral margin of the right ovary (Ov) is contiguous to the mesovarium.Visualizat

7、ion of the broad ligNormal round ligaments.Normal round ligaments.Axial view of the cardinal and uterosacral ligaments.Axial view of the cardinal andNormal cardinal ligaments.Normal cardinal ligaments.Normal and abnornal uterosacral ligaments.Normal and abnornal uterosacraNormal suspensory ligament

8、of the ovary.Normal suspensory ligament of 女性盆腔解剖與CT診斷女性盆腔的血供髂內動脈 陰道動脈前支 宮頸、陰道子宮動脈 子宮 輸卵管、宮底、卵巢腹主動脈 卵巢動脈女性盆腔的血供髂內動脈 陰道動脈女性盆腔解剖與CT診斷Uterine arteries and their normal anatomic relationship to the pelvic ureters. (a) CT scan through a normal, anteflexed uterus (U) shows bilateral uterine arteries (larg

9、e arrows) arcing anteriorly over the ureters (small arrows).Uterine arteries and their nor正常子宮CT表現三角形或卵圓形軟組織團塊大?。? cm5 cm2.5cm 9 cm 6 cm 4 cm平掃：內膜或少量積液顯示為低密度影，=12mm,高度支持子宮內膜異位；結合帶=1cm，準確率75%88%淋巴結中央壞死，準確率100%淋巴結轉移原發(fā)：宮頸旁，子宮旁，髂內、外及閉孔淋巴結 女性盆腔解剖與CT診斷Lymph node metastases. (a) Obturator node metastasis i

10、n a 32-year-old woman who underwent radical hysterectomy. Contrast-enhanced CT scan shows a peripherally enhancing low-attenuation mass (arrows) attached to the left ilium. (b) Paraaortic node metastases in a 55-year-old woman who underwent radiation therapy. CT scan shows conglomerate enlarged lymp

11、h nodes (arrows) in the portacaval space.Lymph node metastases. 遠處轉移腹部：腹膜種植、肝轉移胸部：肺內結節(jié)，淋巴結轉移骨轉移：常見于繼發(fā)淋巴結轉移的骨侵犯。遠處轉移腹部：腹膜種植、肝轉移女性盆腔解剖與CT診斷卵巢結構和病變卵巢結構和病變正常解剖結構Diameter: about 2.55 cm long, 1.53 cm wide, and 12 cm thick. 體積：11cm3, 最大徑4cm. 卵巢系膜、子宮卵巢韌帶、卵巢懸韌帶.Location: lateral to the uterus, the posterior

12、 cul-de-sac, and superior or posterior to the uterine fundus; anterior or anteromedial to the pelvic ureter.正常解剖結構Diameter: about 2.55 cm正常卵巢CT表現Childbearing age：usually contain visible cystic follicles or physiologic cysts。Postmenopausal ovaries：small, and often not identified，featureless soft-tiss

13、ue attenuation。Premenarchal ovaries： less frequently identified, small cysts (9 mm in diameter) , with macrocysts (9 mm) being evident in older girls.正常卵巢CT表現Childbearing age：usualCT features of normal ovaries. (1) CT scan shows that the suspensory ligaments（SL) lead to the ovaries (Ov (2) CT scan s

14、hows that the ovaries (Ov) have a characteristic morphologic appearance, with distinct cystic follicles seen in the right ovary.CT features of normal ovaries.Normal ovaries. (a) CT scan through an anteverted uterine body (U) shows a normal right ovary with multiple large follicles (arrows). (b) Dyna

15、mic CT scan through a central small cervical tumor (7) shows an anatomic variation with a low position of the ovaries (o) bilaterally.Normal ovaries. (a) CT scan t卵巢囊腫濾泡囊腫和黃體囊腫邊界清楚，均勻低密度，直徑通常小于5cm。邊界清楚，低密度，密度均勻。囊內密度增高，邊緣強化 囊內出血卵巢囊腫濾泡囊腫和黃體囊腫濾泡囊腫卵黃囊囊腫濾泡囊腫卵黃囊囊腫女性盆腔解剖與CT診斷輸卵管卵巢膿腫子宮頸炎癥上行感染，引發(fā)內膜炎，最后累及輸卵管和

16、卵巢。CT特征：宮頸增大、強化；輸卵管、卵巢腫大，強化。骶子宮韌帶增厚，骶前脂肪密度增高，腎積水，臨近腸管邊界不清。輸卵管卵巢膿腫子宮頸炎癥上行感染，引發(fā)內膜炎，最后累及輸卵管Bilateral tubo-ovarian abscesses in a 38-year-old woman who presented with fever and pelvic pain.(a) Axial contrast-enhanced CT scan shows bilateral, peripherally enhancing, thick-walled complex cystic structures

17、 with an adjacent serpiginous component (arrow). (b) Coronal oblique reformatted image helps confirm the tubular nature of these structures, which proved to be bilateral tubo-ovarian abscesses at urgery. Bilateral tubo-ovarian abscessTubo-ovarian abscesses in a 42-year-old woman. (a) Axial contrast-

18、enhanced CT scan demonstrates secondary inflammatory involvement of the appendix (arrow). (b) CT scan obtained cephalad to a emonstrates thickening of the cecal wall (black arrows). Note the infiltration of the greater omentum (white arrow).Tubo-ovarian abscesses in a 42Tubo-ovarian abscess in a 60-

19、year-old woman who presented with pelvic discomfort and a palpable pelvic mass. (a) Axial contrast-enhanced CT scan shows a thick-walled, partially cystic enhancing mass posterior to the urinary bladder (b) in the left adnexa and displacing the uterus (U) to the right. A similar-appearing smaller ma

20、ss (not shown) was also seen in the right adnexa. (b) CT scan obtained more inferiorly shows irregular thickening of the adjacent urinary bladder wall (arrow). Tubo-ovarian abscess in a 60-y附件扭轉50%81%并發(fā)卵巢囊腫或腫瘤輸卵管水腫附件囊性病灶，壁光滑增厚。子宮向對側移位腹水出血性壞死：病灶壁厚度大于10mm，病變實性成分無強化；輸卵管出血，腫瘤內出血；血性腹水附件扭轉50%81%并發(fā)卵巢囊腫或腫瘤T

21、orsion of a benign left ovarian cyst in a 43-year-old woman with a 9-day history of gradually increasing lower abdominal pain. (a) Contrast-enhanced CT scan shows a unilocular cystic mass with a mildly enhancing wall (arrows). (b) Contrast-enhanced CT scan obtained caudad to a shows a poorly enhance

22、d masslike structure (arrows) connecting the ovarian cystic mass (M) and the uterus (U). This finding represents a twisted, thickened fallopian tube.Torsion of a benign left ovariTorsion of a left ovarian cyst with hemorrhagic infarction in an 85-year-old woman. Contrastenhanced CT scan shows a high

23、-attenuation fluid collection in the Douglas pouch (arrows), a finding that suggests hemoperitoneum.Torsion of a benign left ovarian cyst in a 55-year-old woman with a 3-day history of lower abdominal pain.Contrast-enhanced CT scan shows a unilocular cystic mass (C) with eccentric smooth wall thicke

24、ning along the anterior aspect (arrows). Torsion of a left ovarian cystTorsion of a left ovarian dermoid cyst with hemorrhagic infarction in a 57-year-old woman. (a) Unenhanced CT scan shows a large mass (M) with a fat-fluid level and focal wall calcification. Note also the ill-defined tubular struc

25、ture adhering to the cyst wall (arrowheads). This structure had an attenuation of about 64.3 HU, a finding that suggested a tubal hemorrhage. (b) Enhanced CT scan shows the uterus deviated to the twisted side. Torsion of a left ovarian dermTorsion of a serous cystadenoma of the right ovary with hemo

26、rrhagic necrosis in a 37-yearoldwoman with a 2-month history of recurrent lower abdominal pain. (a) Sagittal T2-weighted MR image shows a large, multiseptated cystic tumor with a beaklike protrusion inferiorly (arrows). (b) Sagittal contrast-enhanced fat-suppressed T1-weighted MR image shows linear

27、peripheral tumor enhancement but lack of enhancement of the internal septa (arrowheads) and vascular pedicle (arrows). (c) Axial T1-weighted MR image shows a masslike tubular structure abutting the inferior margin of the mass (arrowheads), a finding that suggests a thickened fallopian tube. f fluid,

28、 U uterus. (d) Photograph of the gross specimen shows a large, multiseptated cystic tumor with extensive hemorrhagic necrosis. At surgery, the pedicle (arrowheads) was found to have a torsion of 900 in a counterclockwise direction.Torsion of a serous cystadenom卵巢腫瘤卵巢腫瘤卵巢上皮腫瘤卵巢上皮腫瘤卵巢上皮腫瘤占卵巢腫瘤的60，卵巢惡性

29、腫瘤的85青春期前較少見，高峰在6070歲。亞型：漿液性，黏液性，子宮內膜樣，透明細胞及卵巢纖維上皮瘤（Brenner tumors ）良性60，惡性35，臨界5卵巢上皮腫瘤占卵巢腫瘤的60，卵巢惡性腫瘤的85囊腺瘤漿液性和黏液性單房和多房囊腫，囊壁及囊內間隔薄而規(guī)則。囊腺瘤漿液性和黏液性女性盆腔解剖與CT診斷Benign serous cystadenoma in a 49-year-old woman. Benign mucinous cystadenoma in a 26-year-old woman. Benign serous cystadenoma in aBorderline m

30、ucinous tumor in a 20-year-old woman. Contrast-enhanced CT scan shows a large, multilocular cystic mass with variable attenuation in the locules and enhancing solid-tissue elements (arrows).Borderline mucinous tumor in 囊腺癌厚壁，間隔厚而部規(guī)則，囊內結節(jié)狀突出，軟組織成分，其內可有壞死，向盆腔器官侵犯，種植轉移，腹水，淋巴結轉移。多房，厚壁及間隔改變，診斷惡性不可靠，可見于纖維

31、囊腺瘤，黏液性囊腺瘤和子宮內膜瘤。良性的黏液和漿液瘤較多見，良性的子宮內膜瘤極少見，透明細胞瘤均為惡性。囊腺癌厚壁，間隔厚而部規(guī)則，囊內結節(jié)狀突出，軟組織成分，其內Bilateral serous cystadenocarcinomas in a 50-year-old woman. Contrast-enhanced CT scan shows bilateral ovoid tumors (T) with some septa and mural nodules. Bilateral serous cystadenocarc囊腺癌囊腺癌Serous cystadenocarcinoma o

32、f the ovary with peritoneal carcinomatosis in a 60-year-old woman. Contrast-enhanced CT scans obtained at the level of the liver (a) and upper pole of the kidney (b) show a subcapsular hepatic implant with a scalloped margin (arrows in a). Diffuse multilocular cystic implants are seen along the grea

33、ter omentum, parietal peritoneum, gastrosplenic ligament, and lesser sac (arrowheads), and calcified peritoneal implants are noted in the gastrosplenic ligaments (arrows in b). Serous cystadenocarcinoma of t子宮內膜癌子宮內膜癌占卵巢惡性腫瘤的10%15% ，15%30% 合并子宮內膜的癌和增生。影像學物特異性，表現為大的囊實性腫瘤，可有子宮內膜的改變。子宮內膜癌子宮內膜癌占卵巢惡性腫瘤的1

34、0%15% ，15%Endodermal sinus tumor in a 29-year-old woman. Contrast-enhanced CT scan shows a large, complex pelvic mass with solid and cystic components (arrows). Associated ascites is also seen (*). The patient had an elevated serum -fetoprotein level of 58,000 IU/mL (normal range, 0-15 IU/mL). Endod

35、ermal sinus tumor in a 29卵巢的生殖細胞腫瘤卵巢的生殖細胞腫瘤卵巢的生殖細胞腫瘤起源于生殖細胞，占卵巢腫瘤的第二，g 15%20% 。包括成熟的畸胎瘤，未成熟畸胎瘤，無性細胞瘤，內胚竇腫瘤，胚胎癌，絨毛膜癌。惡性生殖細胞腫瘤無特異性，通常體積較大，實性成分為主。HOG和AFP升高有助于診斷。 卵巢的生殖細胞腫瘤起源于生殖細胞，占卵巢腫瘤的第二，g 15畸胎瘤常見于小于45歲女性含有脂肪密度厚壁囊性腫塊，囊壁可有鈣化脂肪平面，脂肪液體平面Rokitansky nodule，CT典型特征未成熟畸胎瘤，發(fā)病年齡小，包含較大實性成分，表現為大的囊實性占位，可見少量脂肪成分，可有

36、散在的鈣化，腫瘤壁顯示不清?；チ龀Ｒ娪谛∮?5歲女性女性盆腔解剖與CT診斷Mature teratoma in a 21-year-old woman.(a) Conventional radiograph shows a large mass with fat opacity and multiple toothlike calcifications, findings that indicate a typical mature teratoma. (b) Axial turbo spin-echo T1-weighted MR image (800/12) shows a well-d

37、efined round, hyperintense mass with hypointense calcifications and a mural nodule (arrows). (c) On a sagittal turbo spin-echo T2-weighted MR image (3,800/99), the tumor is isointense relative to subcutaneous fat. The calcifications have low signal intensity (arrows), whereas the Rokitansky protuber

38、ance has high signal intensity (arrowheads). (d) Gadolinium-enhanced fat-suppressed FLASH T1-weighted MR image (147/4.8) demonstrates the mass with markedly decreased signal intensity compared with the non-fat-suppressed T1-weighted image (cf b). Mature teratoma in a 21-year-o女性盆腔解剖與CT診斷Immature ter

39、atoma in a 23-year-old woman. (a) Contrast-enhanced pelvic CT scan shows a large mass with a large soft-tissue component, a cystic portion, small foci of fat, and scattered calcifications. (b) CT scan obtained at the level of the renal hilum demonstrates extensive retroperitoneal adenopathy. Immatur

40、e teratoma in a 23-year無性細胞瘤Dysgerminomas 常見于年輕女性。 5%無性細胞瘤可引起HCG升高?？捎邪唿c狀鈣化。典型表現為分葉狀實性腫物， 其內可見纖維血管分隔，有出血和壞死。無性細胞瘤Dysgerminomas 常見于年輕女性。Dysgerminoma in an 18-year-old woman. Contrast-enhanced CT scan shows a large, multilobulated solid mass with highly enhancing fibrovascular septa (arrows) and cystic

41、 change (arrowheads).Dysgerminoma in an 18-year-oldDysgerminoma in a 17-year-old girl. (a) Axial turbo spin-echo T2-weighted MR image (3,800/99) shows a large, multilobulated mass with intermediate signal intensity and persistent low signal intensity of the septa (arrows). The irregular high-signal-

42、intensity areas (arrowheads) indicate necrosis. (b) Axial gadolinium-enhanced turbo spin-echo T1-weighted MR image (782/14) demonstrates relatively homogeneous enhancement with persistent low signal intensity of the septa (arrows) and unenhanced necrotic areas (arrowheads).Dysgerminoma in a 17-year-

43、old Endometrioid carcinoma of the ovary and endometrial carcinoma of the uterus in a 38-year-old woman. (a) Contrast-enhanced lower abdominal CT scan shows a complex cystic and solid tumor with enhancement of the solid-tissue elements and a thick, irregular wall. (b) Contrast-enhanced pelvic CT scan shows a widened endometrial cavity with a nodular enhancing solid mass (arrowheads). Endometrioid carcinoma of the性索間質腫瘤Sex CordStromal Tumors性索間質腫瘤Sex CordStromal Tumors性索間質腫瘤Sex CordStromal Tumors 占卵