下腔静脉CT血管成像在Ⅱ、Ⅲ期子宫静脉内平滑肌瘤病中的临床应用

Clinical Application of Inferior Vena Cava CT Angiography in the Diagnosis of Stage II and III Uterine Intravenous Leiomyomatosis

摘要: 本研究旨在评估下腔静脉CT血管成像技术对Ⅱ、Ⅲ期子宫静脉内平滑肌瘤病的诊断效能。通过对13例经病理确诊的IVL病例进行回顾性分析，系统研究了患者的临床资料及影像学特征，特别关注下腔静脉血管成像的典型表现。影像学检查显示，所有病例均存在子宫及宫旁不均匀强化肿块，下腔静脉成像清晰呈现病变沿髂静脉或卵巢静脉向心性延伸的条索状、蠕虫样改变，其中2例累及右心房，4例呈现特征性的“血管内血管征”。病例分期显示Ⅱ期占69.2%，Ⅲ期占30.8%，病变延伸路径以右卵巢静脉和右髂静脉为主。值得注意的是，84.6%的患者有妇科手术史，其中69.2%曾接受子宫肌瘤手术，76.9%有子宫肌瘤病史。研究证实，下腔静脉CT血管成像可准确显示Ⅱ、Ⅲ期IVL的病变范围及延伸路径，为临床诊断、分期及治疗决策提供重要影像学依据。

Abstract: The study explored the clinical application value of inferior vena cava CT angiography in the diagnosis of stage II and III uterine intravenous leiomyomatosis (IVL). The data of 13 patients with uterine IVL confirmed by surgery and pathology were collected, and their clinical and imaging findings were retrospectively analyzed, with emphasis on summarizing the imaging features after inferior vena cava angiography. All 13 patients underwent inferior vena cava CT angiography. In all patients, uneven and significantly enhanced masses were observed in the uterus and parametrial regions. Inferior vena cava CT angiography clearly demonstrated that the lesions extended along the iliac veins or ovarian veins to the inferior vena cava, presenting cord-like or worm-like patterns. Lesions in 2 patients extended to the right atrium area. Enhanced vascular shadows were detected within the venous lesions in 4 patients, showing the “intravascular vessel sign”. Case staging showed that stage II accounted for 69.2% and stage III for 30.8%, with the lesion extending primarily along the right ovarian vein and right iliac vein. Notably, 84.6% of patients had a history of gynecological surgery, of which 69.2% had undergone uterine fibroid surgery, and 76.9% had a history of uterine fibroids. The study confirmed that inferior vena cava CT angiography can accurately display the extent and extension pathway of stage II and III IVL lesions, providing important imaging evidence for clinical diagnosis, staging, and treatment decisions.