作者：罗洪1，蔡华崧2，钱辰3，林青雨3，周侦3，邹松孝3，李引3

单位：1.暨南大学附属顺德医院影像科，广东 佛山 528305；2.中山大学附属第一医院放射诊断科，广东 广州 510080；3.中山大学附属第一医院胃肠外科中心，广东 广州 510080

Authors: Luo Hong1, Cai Huasong2, Qian Chen3, Lin Qingyu3, Zhou Zhen3, Zou Songxiao3, Li Yin3

Unit：1.Department of Radiology, Shunde Hospital Affiliated to Jinan University, Foshan 528305, Guangdong, China；2.Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China；3.Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

目的 分析富血供腹膜播散性平滑肌瘤病（leiomyomatosis peritonealis disseminata，LPD）的临床影像特征，提高对富血供LPD的诊断及治疗水平。方法  收集2018年7月至2020年10月在中山大学附属第一医院诊治的4例富血供LPD患者的病历资料，回顾性分析其临床特征、诊治方法、术前影像学表现及术后病理诊断。结果  4例患者均有子宫肌瘤手术史，术前4例患者均行计算机断层扫描（computed tomography, CT）平扫及增强扫描，1例加做磁共振成像（magnetic resonance imaging, MRI）平扫及增强扫描、正电子发射计算机断层显像（positron emission tomography-computed tomography, PET-CT）检查及3D打印。影像学表现呈多发实性结节及肿块，明显不均匀强化，瘤内及瘤周可见迂曲扩张畸形的血管，且瘤体越大越明显。4例术前CT 均误诊。4例患者均接受手术治疗，其中3例行开腹肿瘤切除，1例行腹腔镜下肿瘤切除，肿瘤位于腹盆腔、大网膜、肠系膜或阔韧带、骶韧带等处。结论  术前影像学检查可以准确判断富血供LPD的范围及供血血管，为治疗方案制定提供重要参考信息。

关键词：腹膜播散性平滑肌瘤病；腹膜转移；计算机断层扫描；磁共振成像；3D打印 

Abstract：

Objective To summarize and analyze the imaging characteristics of hyper vascular leiomyomatosis peritonealis disseminata (LPD), aiming to improve the diagnosis and treatment level of hyper vascular LPD. Method  The data of 4 hyper vascular LPD cases diagnosed in the First Affiliated Hospital of Sun Yat-sen University from July 2018 to October 2020 were collected for retrospective analysis, including their clinical characteristics, preoperative imaging findings, diagnoses, treatments, and postoperative pathological diagnoses. Result  All 4 patients had a history of uterine fibroids surgery. 4 patients all underwent preoperative computed tomography (CT) plain and enhanced scans, while 1 case also underwent magnetic resonance imaging (MRI) plain and enhanced scans, positron emission tomography-computed tomography (PET-CT) examination, and 3D printing. Imaging findings showed multiple solid nodules and masses with obvious heterogeneous enhancement, twisted and dilated abnormal vessels were seen inside and around the tumor, which were more prominent as the tumor size increased. 4 patients were misdiagnosed by CT preoperatively. 4 patients all received surgical treatment, with 3 undergoing open abdominal tumor resection, and 1 undergoing laparoscopic tumor resection. Tumors were located in the abdominal pelvic cavity, greater omentum, mesentery, broad ligament and sacroiliac ligament, etc. Conclusion  Preoperative imaging examinations can accurately determine the location of hyper vascular LPD and blood -supplying vessels, providing important information for the surgical plans and other treatments.

Key Words:  Leiomyomatosis peritonealis disseminata; Peritoneal metastasis; Computed tomography; Magnetic resonance imaging; 3D printing

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