1. VAI TR CA MRI TRONG CHN ON BNH L LC NI MC T CUNG V Tn c Hunh Phng Hi B mn chn on hnh nh i hc Y dc TP. H Ch Minh

2. Gii thiu Trong ph khoa: Siu m chn la u tin CT & MRI quan trng trong (+) & Nguyn l to hnh khc nhau Ch nh v ng dng khc nhau 3. MRI: tng phn m mm ni ti cao la chn u tin /vng chu, cht lng hnh tt nht T trng an ton Lu nh gi do c.ng Ghi hnh tng mt phng khc nhau: axial, sag, cor Khong thu hnh nh: bng hoc chu k/s ti ch, ti vng CT: nhiu xng bao quanh nh gi chm tia cng, gim cht lng hnh nh chi tit m mm Tia X nhim x Nhanh sc nt Ch axial dng hnh Khong thu hnh rng: ngc-bng / bng-chu / ngc-bng-chu xm ln, di cn 4. GPH CT T CUNG Khng cn quang khng phn bit cc lp C cn quang phn bit km C TC (myometrium) bt thuc m cao ng nht Ni mc (endometrium) & vng ni (junctional zone) km bt thuc m thp Khng phn bit ni mc v vng ni 5. GPH MRI T CUNG T1Ws: tn hiu thp ng nht # c vn. T2Ws: tng phn r rt 3 lp C (myometrium): t/h trung gian Vng ni (junctional zone) / lp c trong (inner myometrium): t/h thp t.i theo ck kinh, dy nht N 24 5mm Focal > 12mm adenomyosis? ( co c cc b, eo) Ni mc 6. GPH MRI T CUNG T1Ws: t/h thp ng nht # c vn. T2Ws: tng phn r rt 3 lp C Vng ni Ni mc (endometrium): t/h cao trn T2Ws, dy : 1-3mm / tng sinh sm 5-10mm / gia chu k Dy nht / tk non (N8N16) Gim dn / tk hong th Hnh kinh: cc mu tn hiu thp ( polyp, d vt, uxtc di nim) 7. G tng sinh 8. G hnh kinh 9. G mn kinh 10. GPH C T CUNG 11. LC NI MC T CUNG Lc ni mc t cung (LNMTC): hin din ca m ni mc c chc nng nm ngoi t cung Adenomyosis: lc ni mc trong c t cung Endometriosis: lc ni mc ngoi t cung Lm sng: khng c hiu Chn on: chn on hnh nh MRI c gi tr cao 12. MRI L k thut khng xm ln Kho st a mt ct tng phn m mm cao nhn din r cc cu trc vng chu D dng nhn din cc tn thng xut huyt 13. Nhn din r gii phu ca t cung 16 14. T1W FS: xut huyt hay m 15. Protocol CHT i vi lc ni mc t cung Axial, Coronal, Sagittal T2W Axial T1W Axial, Sagittal T1W FS Hng chp: ty mc ch Thuc tng phn Hng chp: ty mc ch Thuc tng phn 16. LC NI MC T CUNG VNG CHU V tr: thng gp bung trng v phc mc chu Tn thng hnh trn mu en ch nang lc ni mc bung trng (P); cc tn thng c ng b bt thng ch lc ni mc thm nhim su. 17. Tn hiu ni mc lc ch Thay i ty thuc tui ca thnh phn cha ng: Ch yu l m tuyn: t/h cao / T2Ws; cha sp mu t/h cao / T1Ws; bt gadolinium. Ch yu l m x: khi b hnh gai, t/h thp hay ng t/h / T1Ws v T2Ws, bt gadolinium. Hn hp: thng gp +++: khi x cha cc nt lm tm bn trong t/h cao trn T2Ws v T1Ws. Mi Mn C 18. Xut huyt tn hiu cao trn T1W v T1 FS Ni mc dn thnh nang tn hiu cao T2W M x tn hiu thp T1W, T2W Cc dng tn thng c th cng hin din/bn 19. LC NI MC T CUNG PHN LOI: ch yu c 3 dng: 1. lc ni mc nng (superficial endometrial implants), 2. lc ni mc bung trng (ovarian endometrioma), v 3. lc ni mc su dng thm nhim (deep infiltrating endometriosis- DIE). 20. 1. Lc ni mc nng (superficial endometriosis) Nm ri rc trn b mt phc mc, bung trng, dy chng t cung cng t gy xo trn cu trc vng chu MRI: ch thy khi d>5mm hoc c xut huyt ( nhy 5%, c hiu 94%) 21. 2. Lc ni bung trng (Endometrioma) M ni mc cn hot ng lc ch bung trng (nhy vi cc loi hormone) 50% c LNMTC n khm v sinh 40% c 2 bn BT. Gy RL phng non: do ph hy c/t & chc nng BT, ngn cn non trng thnh, dnh. t khi tn thng ring l : nn tm thm cc v tr khc phc mc, ng tiu ha, dy dnh. 22. MRI: ty thuc vo giai on xut huyt in hnh: tn hiu cao trn T1W, T1W FS, thp trn T2W (dh shading: nng st v protein cao t cc ln xut huyt. V bao tn hiu thp trn T2W : do macrophages cha y Hemosiderin kt hp vi m x trng thnh ca thnh nang) Nu c xut huyt mi: tn hiu thay i theo giai on xut huyt Endometrioma thng c v bao dy, tn hiu thp trn T2W 23. V bao tn hiu thp trn T2W 24. C th c dng a thy vi cc vch bn trong 25. Cc mu ng (c th nhm l chi trn thnh nang/SA: tn hiu thp trn T2W, T1W, khng bt thuc tng phn 26. 3. Lc ni mc su (Deep pelvic endometriosis ) + Gieo rc NMTC / b mt phc mc: bung trng, t cung, rut, t.c Douglas (sao vng). + v tr thng gp ca LNMTC su: dc theo vch trc trng-m o, vch bng quang-t cung lan vo np PM ln cn (ng chm ). 27. Tn thng x trong t/c Douglas 28. LNMTC xm ln thnh trc trc trng (mi tn ) v bng quang (mi tn xanh) 29. Lc ni mc t cung dy chng trn hai bn, gn ch cm vo t cung. 30. Lc ni mc sau c t cung, lin quan dy chng t cung cng (T) 31. Mng dnh: hnh gai ni lin cc tng b xm ln. Bin dng cc cu trc 32. ADENOMYOSIS Endometriosis interna # adenomyosis: Xm ln lnh tnh ca ni mc vo c t cung km ph i c trn ln cn Phn loi: Khu tr Lan ta Tng on c bit: U lc tuyn (adenomyoma) Nang lc tuyn 33. MRI Vng chuyn tip dy khu tr hoc lan ta >12 mm +/- cc nh tn hiu cao trn T2W Khng gy hiu ng khi 34. Cc dng him gp Adenomyoma (u c tuyn): dng LTTCTC khu tr, gii hn r: + thng c dng khi polyp lng vo lng t cung + t gp hn: dng mt khi trong c hay mt khi di thanh mc. 35. Nang c tuyn: bin th cc k him gp ca LTTCTC, do xut huyt nghim trng ca m ni mc lc ch. Tn thng l mt nang xut huyt ln, c th ton b nm trong c, di thanh mc hay di nim mc. 36. Leiomyoma Adenomyosis Thn, y, c, d/c rng, di thanh mc, trong thnh, di ni mc, c cung Bu dc, a din, bin i ng b, v bao gi 0,5 20cm, tua c quanh u T1W: ng t/h vi c TC (vin t/h thp: vi ha; vng t/h cao: xut huyt; vin t/h cao hay u t/h cao ng nht: nhi mu) T2W: thng t/h thp so vi c TC (t/h cao ng nht: cellular F.; vin t/h cao: dn bch huyt quanh u) Gado: , , t/h vi c (tng sinh m/m mnh: cellular F.), v bao gi, khng bt gado: nhi mu : Flow void m/m; cung mch c cung JZ dy khu tr / lan ta > 12mm, thng thnh sau, khng CTC, him khi khng t/x JZ Mt ranh gii vi ni mc, hnh dng v nh, hiu ng khi u (-), t bin i b ni mc, c dng nang T1W: ng t/h vi c TC, c nh t/h cao do xut huyt T2W: t/h thp bn trong c nhiu nh t/h cao lm tm / ng vn t/h cao t ni mc: gi lan rng n/m. t/h cao bn trong thng < 5mm, dng nang bn trong: him Gado: , , ; bt thng ti mu : Khng c v bao gi; adenomyosis thng kt hp endometriosis 37. KT LUN CHT l k thut khng xm ln chn on LNMTC v LTTCTC Cho bit v tr v mc lan rng ca tn thng, gip nh gi ton din trc khi phu thut