BonyElementsSacrum/coccyxPubis,Ischium,IliumMuscularComponentsm.levator

Anim.coccygeusm.obturator

internusm.piriformis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女性盆腔的韌帶Thebroadligamentisformedbytwolayersofperitoneum,whichdrapeovertheuterusandextendlaterallyfromtheuterustothepelvicsidewall。Theroundligamentisabandoffibromusculartissuethatattachestotheanterolateraluterinefundusjustbelowandanteriortothefallopiantubeandanteriortotheovarianligament。Thecardinalligament(transversecervicalligament,Mackenrodtligament)formsthebaseofthebroadligamentandprovidestheprimaryligamentoussupportfortheuterusanduppervagina。TheuterosacralligamentextendsposteriorlyfromthelateralcervixandvaginaattheleveloftheinternalcervicalosandformsacurvedarctowardtheanteriorbodyofthesacrumatS-2orS-3女性盆腔的韌帶Theovarianligament(roundligamentoftheovary)extendsmediallyfromtheovarytotheuterus,justinferiorandposteriortothefallopiantubesandroundligaments。Thesuspensoryligamentoftheovary(infundibulopelvicligament)occupiesthelateralaspectofthefreeupperedgeofthebroadligament。Axialviewofthefemalepelvicvisceraandligaments.VisualizationofthebroadligamentwithCT.(a)CTscanshowsalargeamountofascitesoutliningtherightcephalicfreeedgeofthebroadligament(BL).Thesubtlesoft-tissuestructure(whitearrow)extendingfromtheposterolateralaspectofthebroadligamenttowardtherightovaryismostconsistentwiththemesovarium.(b)CTscanobtainedjustsuperiortoashowsthatthesuspensoryligamentattachmentattheanterolateralmarginoftherightovary(Ov)iscontiguoustothemesovarium.Normalroundligaments.Axialviewofthecardinalanduterosacralligaments.Normalcardinalligaments.Normalandabnornal

uterosacralligaments.Normalsuspensoryligamentoftheovary.女性盆腔的血供髂內(nèi)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Uterinearteriesandtheirnormalanatomicrelationshiptothepelvicureters.

(a)CTscanthroughanormal,anteflexeduterus(U)showsbilateraluterinearteries(largearrows)arcinganteriorlyovertheureters(smallarrows).正常子宮CT表現(xiàn)三角形或卵圓形軟組織團(tuán)塊大?。?cm×5cm×2.5cm

9cm×6cm×4cm平掃：內(nèi)膜或少量積液顯示為低密度影，<12mm。增強(qiáng)：肌層強(qiáng)化宮頸粘膜強(qiáng)化陰道粘膜強(qiáng)化Normalandabnormaluterus.

(a)CTscanthroughananteflexeduterusandalargecentralcervicaltumorshowsanormalcontrast-enhanceduterinemyometrium

(m)andcentralendometnalcavity(e).(b)CTscanthroughauterinefluidcollection(f)thatcontainsaCopper-intrauterinedevice(arrow)showscontrastenhancementofthe

myometrium

(m),whichhelpstodelineateaportionofthenonenhancedobstructingcervicaltumor.Cervixandvagina.(a)DynamicCTscanthroughanormalcervixshowspresumednormalcentralenhancementofthecervicalepithelium(arrow).Theperipheralcervicalstromaenhancestoalesserdegree(arrowhead).(b)CTscanthroughthevaginaatthesuprapubiclevelshowscentralintensecontrastenhancementofthevaginalmucosa(blackarrows)andthepoorlyenhancingvagina!wall(whitearrows).子宮腺肌癥

(adenomyosis)概念：是一種常見病,由子宮內(nèi)膜腺及基質(zhì)異位至形成,相鄰肌組織增生，源自基底層的異位內(nèi)膜組織對激素刺激不敏感,故周期性出血少見.常見于多產(chǎn)停經(jīng)前婦女,但絕經(jīng)后婦女也不少見。臨床表現(xiàn):盆腔疼痛,月經(jīng)過多,子宮腫大。子宮腺肌癥診斷方法:MRI為首選方法診斷標(biāo)準(zhǔn)鄰近子宮內(nèi)膜低信號病變,結(jié)合帶局灶性／彌漫性增厚；結(jié)合帶>=12mm,高度支持子宮內(nèi)膜異位；結(jié)合帶=<8mm,可排除此病邊界不清楚,邊緣不規(guī)則，T2W高信號區(qū)代表異位的子宮內(nèi)膜島,囊性擴(kuò)張的子宮內(nèi)膜腺和／或血性液體.T1W與周圍肌組織信號相等,局灶性高信號為出血。CT特征：增大的球狀子宮內(nèi)，合并多發(fā)的肌層小囊腫局灶子宮腺肌癥子宮肌瘤無痛，可有疼痛和出血，壓迫癥狀子宮輪廓改變等密度實性腫塊退變、鈣化感染惡變，小于1％CTscanshowsenlargeduterus(U),withalobulatedcontour,secondarytoaleiomyoma(arrow).CTscanofanotherpatientdemonstratesasubmucosal

leiomyoma(arrow)producingdeformityoftheendometrialcavity.CTscandemonstrateshyalmnedegenerationofuterineleiomyomas.Arrowindicatescysticareas.CTscanshowsaleiomyomawithatypicallyhighattenuation.Nomalignantcellswerefoundinpathologicspecimen.子宮內(nèi)膜癌局限型和彌漫型腺癌較多90%~95%絕經(jīng)后子宮出血早期CT不易發(fā)現(xiàn)；內(nèi)膜癌引起子宮增大，表現(xiàn)為對稱性或局限性分葉狀增大，密度不均，其內(nèi)可有液化、壞死。播撒途徑：局部浸潤，淋巴轉(zhuǎn)移，血行轉(zhuǎn)移

子宮內(nèi)膜癌StageI子宮內(nèi)膜癌StageIA子宮內(nèi)膜癌StageIB子宮內(nèi)膜癌StageIBIIb子宮內(nèi)膜癌StageIIB子宮內(nèi)膜癌StageIII宮頸癌鱗狀上皮癌90％，腺癌10％早期無癥狀，晚期可有出血和白帶異常宮頸增大，軟組織腫塊形成，向子宮及周圍蔓延?？捎兄醒雺乃?。播撒途徑：局部浸潤，淋巴轉(zhuǎn)移，血行轉(zhuǎn)移準(zhǔn)確分期對于治療非常重要。CervicalcarcinomaFIGOstageIb.

Sagittal(A)andaxial(B)T2-weightedimages.Thetumor(star)islocatedendocervically.Noextensiontothevaginaisseen(A).Parametrialinvasioncanbeexcludedbecauseofthepreserveddarkrimofnormalcervicalstromasurroundingthetumor(star).CervicalcarcinomaFIGOstageIIb.

Sagittal(A)andaxial(B)T2-weightedimages.Thetumor(star)isprotrudingintothevaginaandextentsintothedorsalvaginalwall(blackarrow).Paravaginalandparametrialinvasionontheleftsideareapparentontheaxialimage(whitearrow).CervicalcarcinomaFIGOstageⅢb.Themassencasesthedistalrightureter(doublearrows),whichisdilatedascomparedwiththeleftureter(arrow).Markedrighthydronephrosis

waspresent.淋巴結(jié)轉(zhuǎn)移原發(fā)：宮頸旁，子宮旁，髂內(nèi)、外及閉孔淋巴結(jié)繼發(fā)：骶旁，髂總，腹股溝及主動脈旁l林巴結(jié)軸位淋巴結(jié)直徑>1cm，準(zhǔn)確率75%–88%淋巴結(jié)中央壞死，準(zhǔn)確率100%Lymphnodemetastases.

(a)Obturatornodemetastasisina32-year-oldwomanwhounderwentradicalhysterectomy.Contrast-enhancedCTscanshowsaperipherallyenhancinglow-attenuationmass(arrows)attachedtotheleftilium.(b)Paraaorticnodemetastasesina55-year-oldwomanwhounderwentradiationtherapy.CTscanshowsconglomerateenlargedlymphnodes(arrows)intheportacavalspace.遠(yuǎn)處轉(zhuǎn)移腹部：腹膜種植、肝轉(zhuǎn)移胸部：肺內(nèi)結(jié)節(jié)，淋巴結(jié)轉(zhuǎn)移骨轉(zhuǎn)移：常見于繼發(fā)淋巴結(jié)轉(zhuǎn)移的骨侵犯。卵巢結(jié)構(gòu)和病變正常解剖結(jié)構(gòu)Diameter:about2.5–5cmlong,1.5–3cmwide,and1–2cmthick.

體積：11cm3,最大徑4cm.卵巢系膜、子宮－卵巢韌帶、卵巢懸韌帶.Location:lateraltotheuterus,theposteriorcul-de-sac,andsuperiororposteriortotheuterinefundus;anteriororanteromedialtothepelvicureter.正常卵巢CT表現(xiàn)Childbearingage：usuallycontainvisiblecysticfolliclesorphysiologiccysts。Postmenopausalovaries：small,andoftennotidentified，featurelesssoft-tissueattenuation。Premenarchalovaries：lessfrequentlyidentified,smallcysts(9mmindiameter),withmacrocysts(9mm)beingevidentinoldergirls.CTfeaturesofnormalovaries.(1)CTscanshowsthatthesuspensoryligaments（SL)leadtotheovaries(Ov

(2)CTscanshowsthattheovaries(Ov)haveacharacteristicmorphologicappearance,withdistinctcysticfolliclesseenintherightovary.Normalovaries.(a)CTscanthroughananteverteduterinebody(U)showsanormalrightovarywithmultiplelargefollicles(arrows).(b)DynamicCTscanthroughacentralsmallcervicaltumor(7)showsananatomicvariationwithalowpositionoftheovaries(o)bilaterally.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(nèi)密度增高，邊緣強(qiáng)化囊內(nèi)出血濾泡囊腫卵黃囊囊腫輸卵管卵巢膿腫子宮頸炎癥上行感染，引發(fā)內(nèi)膜炎，最后累及輸卵管和卵巢。CT特征：宮頸增大、強(qiáng)化；輸卵管、卵巢腫大，強(qiáng)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。Bilateraltubo-ovarianabscessesina38-year-oldwomanwhopresentedwithfeverandpelvicpain.(a)Axialcontrast-enhancedCTscanshowsbilateral,peripherallyenhancing,thick-walledcomplexcysticstructureswithanadjacentserpiginouscomponent(arrow).(b)Coronalobliquereformattedimagehelpsconfirmthetubularnatureofthesestructures,whichprovedtobebilateraltubo-ovarianabscessesaturgery.Tubo-ovarianabscessesina42-year-oldwoman.(a)Axialcontrast-enhancedCTscandemonstratessecondaryinflammatoryinvolvementoftheappendix(arrow).(b)CTscanobtainedcephaladtoaemonstratesthickeningofthececalwall(blackarrows).Notetheinfiltrationofthegreateromentum(whitearrow).Tubo-ovarianabscessina60-year-oldwomanwhopresentedwithpelvicdiscomfortandapalpablepelvicmass.(a)Axialcontrast-enhancedCTscanshowsathick-walled,partiallycysticenhancingmassposteriortotheurinarybladder(b)intheleftadnexaanddisplacingtheuterus(U)totheright.Asimilar-appearingsmallermass(notshown)wasalsoseenintherightadnexa.(b)CTscanobtainedmoreinferiorlyshowsirregularthickeningoftheadjacenturinarybladderwall(arrow).附件扭轉(zhuǎn)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?qū)?cè)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(qiáng)化；輸卵管出血，腫瘤內(nèi)出血；血性腹水Torsionofabenignleftovariancystina43-year-oldwomanwitha9-dayhistoryofgraduallyincreasinglowerabdominalpain.(a)Contrast-enhancedCTscanshowsaunilocularcysticmasswithamildlyenhancingwall(arrows).(b)Contrast-enhancedCTscanobtainedcaudadtoashowsapoorlyenhancedmasslikestructure(arrows)connectingtheovariancysticmass(M)andtheuterus(U).Thisfindingrepresentsatwisted,thickenedfallopiantube.Torsionofaleftovariancystwithhemorrhagicinfarctioninan85-year-oldwoman.

ContrastenhancedCTscanshowsahigh-attenuationfluidcollectionintheDouglaspouch(arrows),afindingthatsuggestshemoperitoneum.Torsionofabenignleftovariancystina55-year-oldwomanwitha3-dayhistoryoflowerabdominalpain.Contrast-enhancedCTscanshowsaunilocularcysticmass(C)witheccentricsmoothwallthickeningalongtheanterioraspect(arrows).

Torsionofaleftovariandermoidcystwithhemorrhagicinfarctionina57-year-oldwoman.

(a)UnenhancedCTscanshowsalargemass(M)withafat-fluidlevelandfocalwallcalcification.Notealsotheill-definedtubularstructureadheringtothecystwall(arrowheads).Thisstructurehadanattenuationofabout64.3HU,afindingthatsuggestedatubalhemorrhage.(b)EnhancedCTscanshowstheuterusdeviatedtothetwistedside.

Torsionofaserouscystadenomaoftherightovarywithhemorrhagicnecrosisina37-yearoldwomanwitha2-monthhistoryofrecurrentlowerabdominalpain.

(a)SagittalT2-weightedMRimageshowsalarge,multiseptatedcystictumorwithabeaklikeprotrusioninferiorly(arrows).(b)Sagittalcontrast-enhancedfat-suppressedT1-weightedMRimageshowslinearperipheraltumorenhancementbutlackofenhancementoftheinternalsepta(arrowheads)andvascularpedicle(arrows).(c)AxialT1-weightedMRimageshowsamassliketubularstructureabuttingtheinferiormarginofthemass(arrowheads),afindingthatsuggestsathickenedfallopiantube.ffluid,Uuterus.(d)Photographofthegrossspecimenshowsalarge,multiseptatedcystictumorwithextensivehemorrhagicnecrosis.Atsurgery,thepedicle(arrowheads)wasfoundtohaveatorsionof900°inacounterclockwisedirection.卵巢腫瘤卵巢上皮腫瘤卵巢上皮腫瘤占卵巢腫瘤的60％，卵巢惡性腫瘤的85％青春期前較少見，高峰在60～70歲。亞型：漿液性，黏液性，子宮內(nèi)膜樣，透明細(xì)胞及卵巢纖維上皮瘤（Brennertumors））良性60％，惡性35％，臨界5％囊腺瘤漿液性和黏液性單房和多房囊腫，囊壁及囊內(nèi)間隔薄而規(guī)則。Benignserouscystadenomaina49-year-oldwoman.Benignmucinous

cystadenomaina26-year-oldwoman.

Borderlinemucinoustumorina20-year-oldwoman.Contrast-enhancedCTscanshowsalarge,multilocularcysticmasswithvariableattenuationintheloculesandenhancingsolid-tissueelements(arrows).囊腺癌厚壁，間隔厚而部規(guī)則，囊內(nèi)結(jié)節(jié)狀突出，軟組織成分，其內(nèi)可有壞死，向盆腔器官侵犯，種植轉(zhuǎn)移，腹水，淋巴結(jié)轉(zhuǎn)移。多房，厚壁及間隔改變，診斷惡性不可靠，可見于纖維囊腺瘤，黏液性囊腺瘤和子宮內(nèi)膜瘤。良性的黏液和漿液瘤較多見，良性的子宮內(nèi)膜瘤極少見，透明細(xì)胞瘤均為惡性。Bilateralserouscystadenocarcinomasina50-year-oldwoman.Contrast-enhancedCTscanshowsbilateralovoidtumors(T)withsomeseptaandmuralnodules.

囊腺癌Serouscystadenocarcinomaoftheovarywithperitonealcarcinomatosisina60-year-oldwoman.Contrast-enhancedCTscansobtainedattheleveloftheliver(a)andupperpoleofthekidney(b)showasubcapsularhepaticimplantwithascallopedmargin(arrowsina).Diffusemultilocularcysticimplantsareseenalongthegreateromentum,parietalperitoneum,gastrosplenicligament,andlessersac(arrowheads),andcalcifiedperitonealimplantsarenotedinthegastrosplenicligaments(arrowsinb).子宮內(nèi)膜癌子宮內(nèi)膜癌占卵巢惡性腫瘤的10%–15%，15%–30%合并子宮內(nèi)膜的癌和增生。影像學(xué)物特異性，表現(xiàn)為大的囊實性腫瘤，可有子宮內(nèi)膜的改變。Endodermalsinustumorina29-year-oldwoman.Contrast-enhancedCTscanshowsalarge,complexpelvicmasswithsolidandcysticcomponents(arrows).Associatedascitesisalsoseen(*).Thepatienthadanelevatedserum-fetoproteinlevelof58,000IU/mL(normalrange,0-15IU/mL).卵巢的生殖細(xì)胞腫瘤卵巢的生殖細(xì)胞腫瘤起源于生殖細(xì)胞，占卵巢腫瘤的第二，g15%–20%。包括成熟的畸胎瘤，未成熟畸胎瘤，無性細(xì)胞瘤，內(nèi)胚竇腫瘤，胚胎癌，絨毛膜癌。惡性生殖細(xì)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?；チ龀Ｒ娪谛∮?5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Rokitanskynodule，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(xiàn)為大的囊實性占位，可見少量脂肪成分，可有散在的鈣化，腫瘤壁顯示不清。Matureteratomaina21-year-oldwoman.(a)Conventionalradiographshowsalargemasswithfatopacityandmultipletoothlikecalcifications,findingsthatindicateatypicalmatureteratoma.(b)Axialturbospin-echoT1-weightedMRimage(800/12)showsawell-definedround,hyperintense

masswithhypointensecalcificationsandamuralnodule(arrows).(c)Onasagittalturbospin-echoT2-weightedMRimage(3,800/99),thetumorisisointenserelativetosubcutaneousfat.Thecalcificationshavelowsignalintensity(arrows),whereastheRokitanskyprotuberancehashighsignalintensity(arrowheads).(d)Gadolinium-enhancedfat-suppressedFLASHT1-weightedMRimage(147/4.8)demonstratesthemasswithmarkedlydecreasedsignalintensitycomparedwiththenon-fat-suppressedT1-weightedimage(cf

b).Immatureteratomaina23-year-oldwoman.

(a)Contrast-enhancedpelvicCTscanshowsalargemasswithalargesoft-tissuecomponent,acysticportion,smallfocioffat,andscatteredcalcifications.(b)

CTscanobtainedattheleveloftherenalhilumdemonstratesextensiveretroperitonealadenopathy.無性細(xì)胞瘤Dysgerminomas

常見于年輕女性。5%無性細(xì)胞瘤可引起HCG升高?？捎邪唿c狀鈣化。典型表現(xiàn)為分葉狀實性腫物，其內(nèi)可見纖維血管分隔，有出血和壞死。Dysgerminomainan18-year-oldwoman.Contrast-enhancedCTscanshowsalarge,multilobulatedsolidmasswithhighlyenhancingfibrovascularsepta(arrows)andcysticchange(arrowheads).Dysgerminomaina17-year-oldgirl.(a)Axialturbospin-echoT2-weightedMRimage(3,800/99)showsalarge,multilobulated

masswithintermediatesignalintensityandpersistentlowsignalintensityofthesepta(arrows).Theirregularhigh-signal-intensityareas(arrowheads)indicatenecrosis.(b)Axialgadolinium-enhancedturbospin-echoT1-weightedMRimage(782/14)demonstratesrelativelyhomogeneousenhancementwithpersistentlowsignalintensityofthesepta(arrows)andunenhancednecroticareas(arrowheads).

Endometrioidcarcinomaoftheovaryandendometrialcarcinomaoftheuterusina38-year-oldwoman.(a)Contrast-enhancedlowerabd