- 1. KỸ THUẬT CHỤP
- 1.1. Chỉ định
- 1.2. Chống chỉ định
- 1.3. Chuẩn bị dụng cụ
- 1.4. Chuẩn bị bệnh nhân
- 1.5. Tiến hành kỹ thuật
- 1.6. Thuốc đối quang từ
- 1.7. Cách đặt trường cắt, hướng cắt
- 1.8. Xử lý ảnh và in phim
- 1.9. Đánh giá phim chụp
- 3. KHỐI PHẦN PHỤ
- 3.1. Nang buồng trứng (Ovarian cysts)
- 3.2. Nang buồng trứng xuất huyết (Hemorrhagic ovarian cysts)
- 3.3. Nang lạc nội mạc tử cung (Cystic endometriosis) nằm lạc
- 3.4. U nang bì (Dermoid Cysts)
- 3.5. U nang tuyến (Cystadenoma) và u xơ nang tuyến (Cystadenofibroma)
- 3.6. U xơ buồng trứng (Ovarian fibroid)
- 3.7. Xoắn buồng trứng (Ovarian torsion)
- 3.8. Ứ nước ống dẫn trứng (Hydrosalpinx)
- 3.9. Khối u buồng trứng ác tính (Hydrosalpinx)
NỘI DUNG
Buồng trứng là tuyến sinh dục vừa sản sinh ra noãn vừa tiết ra những nội tiết tố quyết định đặc điểm nam nữ ở nữ. Vị trí. Mỗi buồng trứng của nữ giới chưa đẻ nằm ở một bên tử cung, phía sau và dưới phần không tính vòi tử cung, trong hố buồng trứng ở thành bên chậu hông bé; buồng trứng bị lệch vị trí sau lần có chửa đầu tiên và thường không bao giờ trở về vị trí ban đầu.
Tử cung là 1 cơ quan rỗng; thành dày của nó cốt tử do lớp cơ tạo nên. Tử cung thông ở trên với các vòi tử cung và ở dưới với âm đạo. Nếu sự thụ tinh đã sảy ra, túi phôi đang phát triển được vòi tử cung dẫn về buồng tử cung; túi này gắn vào niêm mạc tử cung và được giữ lại ở đây tới lúc vững mạnh đầy đủ.
Vị trí tử cung nằm trong chậu hông bé, giữa bàng quang và trực tràng; nó thông với các vòi tử cung ở trên và liên tiếp với âm đạo ở dưới. Thành tử cung gồm ba lớp mô, tuần tự từ bên cạnh vào trong là: Lớp phúc mạc, gồm lớp thanh mạc và tấm dưới thanh mạc. Ở mặt trước phúc mạc chỉ phủ tới eo tử cung; về phía sau, phúc mạc phủ tới phần trên âm đạo.
Lớp cơ gồm ba tầng trong đó tầng giữa là tầng cơ rối, gồm các thớ cơ đan chéo chằng chịt ôm quanh các mạch máu; khi lớp cơ này co có tác dụng cầm máu sau đẻ. Cổ tử cung không có lớp cơ rối.
Lớp niêm mạc dày mỏng theo giai đoạn của chu kỳ kinh nguyệt, có nhiều tuyến tiết chất nhầy. Hàng tháng, dưới ảnh hưởng của sự thay đổi nội tiết tố, niêm mạc ra bong ra làm chảy máu tạo nên kinh nguyệt.
1. KỸ THUẬT CHỤP
1.1. Chỉ định
– Phát hiện và phân công đoạn các khối u phụ khoa mang thuộc tính ác tính có khởi thủy trong âm đạo, cổ tử cung, tử cung, buồng trứng và ống dẫn trứng.
-– Khối u hay viêm phần phụ sở hữu biến chứng như: u nang buồng trứng xoắn, ứ dịch, mủ vòi trứng… Đau do nghi ngờ lạc nội mạc tử cung, hay u cơ trơn tuột tử cung.
– Xác định các bất thường bẩm sinh của các cơ quan vùng chậu nam và nữ
– Xác định số lượng, vị trí của u cơ trơn tru tử cung trước khi giải phẫu bóc u, giải phẫu cắt bỏ tử cung, hoặc nút động mạch tử cung…
– Đánh giá các khuyết tật sàn chậu thúc đẩy với tiểu, đi ngoài không tự chủ. Phát hiện và phân giai đoạn của các khối u ác tính của ruột (đại tràng xích ma, trực tràng), tuyến tiền liệt, bàng quang, dương vật và bầu
– Đánh giá cho sự tái phát của khối u của ruột, bàng quang, tuyến tiền liệt, hoặc các cơ quan phụ khoa sau khi giải phẫu cắt bỏ hoặc bóc tách (exenteration).
– Đánh giá những biến chứng sau phẫu thuật vùng chậu, bao gồm áp xe, u nang nước giải (urinoma), nang bạch huyết (lymphocele),viêm ruột do xạ trị và hình thành hố rò, đặc biệt là hố dò hậu môn.
– Xác định giải phẫu động mạch và tĩnh mạch.
– Xác định và phân giai đoạn các loại sarcom nguồn gốc mô.
– Xác định duyên cớ gây đau bụng ở phụ nữ sở hữu thai, bao gồm cả viêm ruột thừa và khối bất thường ở tử cung và buồng trứng.
– Đánh giá những thất thường của thai nhi.
1.2. Chống chỉ định
1.2.1. Chống chỉ định tuyệt đốI
– Người bệnh mang những trang bị điện tử như: máy điều hóa nhịp tim, máy chống rung, cấy ghép ốc tai, trang bị bơm thuốc tự động dưới da, Neurostimulator…
Các kẹp phẫu thuật bằng kim mẫu nội sọ, hốc mắt, huyết mạch 6 tháng.
– Người bệnh nặng cần có thiết bị hồi sức cạnh người.
1.2.2. Chống chỉ định tương đối
– Kẹp phẫu thuật bằng kim loại > 6 tháng
– Người bệnh sợ bóng tối hay sợ đơn độc 1 mình.
1.3. Chuẩn bị dụng cụ
– Máy cộng hưởng từ 1,5-3 tesla
– Coil body
– Máy bơm thuốc tự động
– Bông cồn khử khuẩn , băng keo dính, thuốc đối quang từ, hộp chống sốc thuốc , bơm kim tiêm chuyên dụng…
– Các loại phương tiện phụ trợ khác như : cuộn băng cố định, gối kê đệm.
– Quần áo chuyên dùng cho người bệnh chụp CHT, tai nghe chuyên dùng cho người bệnh chụp CHT.
1.4. Chuẩn bị bệnh nhân
– người bệnh cần nhịn ăn trước khi chụp CHT khoảng 4 giờ
– Thu thập kết quả hình ảnh siêu âm, xét nghiệm, bệnh án cũ của người bệnh nếu có…
– Yêu cầu bệnh nhân nhịn tiểu vừa trước khi vào chụp.
– Giải thích, hướng dẫn bệnh nhân thay đồ, mặc áo xống chuyên dùng cho chụp CHT
– Kiểm tra cẩn thận kỹ lưỡng một lần cuối sử dụng máy quét phát hiện từ tính trước khi cho người bệnh vào phòng chụp.
– Hướng dẫn người bệnh tập hít, thở, nhịn thở theo sự điều khiển của khoa học viên hoặc máy (Hít vào- nín thở- thở bình thường…).
– dặn dò người bệnh giữ nguyên tư thế khi đang chụp.
1.5. Tiến hành kỹ thuật
1.5.1. Đặt coil và tư thế người bệnh.
-Chọn coil body
– Người bệnh nằm ngửa trên bàn chụp, đầu hướng vào máy chụp , chân hướng ra ngoài máy chụp CHT.
– Đặt coil từ rốn đến dưới khớp mu 6cm của người bệnh
– Người bệnh hai chân duỗi thẳng trên bàn máy, có thể dùng đệm kê vào củ khoai chân cho người bệnh thoải mái, hai tay đặt xuôi theo cơ thể.
– Kiểm tra các dắc cắm đã đúng vị trí hay chưa
– Cho người bệnh đeo tai nghe chuyên dụng.
– Chỉnh tia laze vào khoảng ngang gai chậu trước trên của người bệnh:
1.5.2. Các thông số kỹ thuật
– Ảnh localizer được chia làm 3 hướng axial, coronal, sagital
Hình2b; Axial.
Hình 2c. Coronal
- Các chuỗi xung thường dùng.
1.6. Thuốc đối quang từ
– Một số tổn thương cần phải tiêm thuốc đối quang tử ví dụ như nghi ngờ a từ cung, u buồng trứng, áp xe… nên kiểm tra kỹ xem bệnh nhân có tiêm được không (suy thân, dị ứng )
– Tiêm 10 ml thuốc đối quang từ qua đường tĩnh mạch, sau đó tiến hành chụp các xung T1W FS ở các hướng khác nhau.
1.7. Cách đặt trường cắt, hướng cắt
– Hướng Sagital:
Hình 4a. Đặt hướng, đường cắt song song với trục cột sống
Hình4b. Đặt hướng cắt, đường cắt song song với trục cột sống
Hình 4c. FOV sagital 350 mm, bao phủ được toàn bộ phần tiểu khung
-Hướng Axial oblique theo trục tử cung:
Hình 5a. Hướng cắt vuông góc với trục dài tử cung
Hình 5b. Hướng cắt vuông góc với trục dài tử cung
Hình 5c. FOV 250mm bao phủ toàn bộ tử cung
-Hướng cắt Coronal oblique theo trục tử cung:
Hình 6b. FOV bao phủ toàn bộ tử cung,buồng trứng.
Hình 6c. FOV 250mm bao phủ toàn bộ tử cung.
1.8. Xử lý ảnh và in phim
– Chỉnh độ tương phản của hình ảnh mới chụp
– In đầy đủ các xung nhịp đã chụp (chú ý phải có ảnh định vị trên từng lát).
1.9. Đánh giá phim chụp
– Chụp đầy đủ các xung nhịp
– hình Ảnh có độ nét, tương phản rõ ràng, không rung, giật.
– Đặt hướng cắt phải đúng protoco
l -Tiêm thuốc phải đúng các thì.
2. GIẢI PHẪU VÙNG TIỂU KHUNG
Hình 7b 1. Động mạch và tĩnh mạch chậu 2. Cơ bịt trong; 3. Bàng quang 4. Tử cung; 5. Trực tràng
Hình 8a 1. Động mạch và tĩnh mạch chậu. 2.Cơ bịt trong 3. Xương cánh chậu; 4. Tử cung 5. Trực tràng
Hình 9b 1. Động mạch và tĩnh mạch chậu 2. Cơ bịt trong; 3. Xương cánh chậu 4. Tử cung; 5. Bàng quang; 6. Trực tràng ; 7. Cổ tử cung
Hình 10b 1. Đáy tử cung; 2. Thân tử cung 3. Bàng quang; 4. Xương mu 5. Cổ tử cung; 6. Trực tràng 7. Âm đạo
CỘNG HƯỞNG TỪ BỆNH LÝ SINH DỤC NỮ.
NỘI DUNG
3. KHỐI PHẦN PHỤ
Buồng trứng thường được thăm khám bằng siêu âm. Nếu thấy một khối nang phần phụ > 5cm ở phụ nữ trước mãn kinh hoặc > 3 cm ở phụ nữ sau mãn kinh hoặc tăng kích thước khi theo dõi bằng trên siêu âm, hoặc thấy khối đặc có dòng chảy mạch trên Doppler, khí đó cần chụp CHT cần được chỉ định để có thể được loại trừ khối u ác tính.
3.1. Nang buồng trứng (Ovarian cysts)
Một nang buồng trứng đơn thuần kích thước < 5cm thấy trên siêu âm không phải là một chỉ định của chụp CHT, vì nó là một nang phát hiện ngẫu nhiên thường gặp ở cả phụ nữ trước và sau mãn kinh. Trên CHT, nang đơn thuần có tín hiệu dịch đặc trưng là giảm trên xung T1W và tăng trên xung T2W với thành mỏng đều.
3.2. Nang buồng trứng xuất huyết (Hemorrhagic ovarian cysts)
Hầu hết các nang buồng trứng là nang chức năng và có thể có biến chứng xuất huyết trong nang. Các đặc điểm CHT của chúng có thể thay đổi tùy thuộc vào thời gian và số lượng của thành phần xuất huyết. Nói chung, chúng thường tăng tín hiệu tương đối mạnh trên xung T1W và giảm tín hiệu trên xung T2W. Tăng tín hiệu mạnh trên xung T1W xoá mỡ, giúp phân biệt với u nang bì (Hình 5.9). Hơn nữa, các u nang bì khác với nang đơn thuần là thường có thành dày hơn và có thể ngấm thuốc đối quang từ
3.3. Nang lạc nội mạc tử cung (Cystic endometriosis) nằm lạc
Nang lạc nội mạc tử cung là một dạng nang tạo thành từ tổ chức nội mạc nằ chỗ trong buồng trứng hoặc bất kỳ vị trí cơ quan nào vùng tiểu khung. Đặc điểm CHT của lạc nội mạc tử cung giống như với nang xuất huyết, thay đổi tín hiệu theo giai đoạn và số lượng các sản phẩm máu. Thường tăng tín hiệu trên xung TW và tín hiệu từ trung gian đến thấp trên hình ảnh T2W và có thể thấy mức dịch-dịch giúp khẳng định bản chất nang (Hình12). Tín hiệu thấp trên xung T2W là máu giáng hoá thành methemoglobin, protein do nhiều lần xuất huyết.
3.4. U nang bì (Dermoid Cysts)
Là một trong các u tế bào mầm của buồng trứng thường gặp nhất (95%). Hầu hết là khối nang đơn thuần, chứa chất lỏng bã nhờn, và cũng được gọi là u nang quái trưởng thành (mature cystic teratoma). Mặc dù chúng thường không có triệu chứng và phát hiện ngẫu nhiên ở phụ nữ trẻ, nhưng điều trị tốt nhất vẫn là phẫu thuật cắt bỏ vì chúng có thể gây xoắn buồng trứng hoặc bị vỡ. Ngoài ra còn có nguy cơ thoái hóa ác tính thành ung thư biểu mô tế bào vảy.
Trên CHT cho thấy rõ tín hiệu của mỡ trong thành phần bã nhờn, đặc trưng cho gần như tất cả các u nang bì, thể hiện tăng tín hiệu rất cao trên ảnh xung T1W, có thể có vách (10%); trên xung T2W tín hiệu thay đổi xung T2W. Hình T1W xoá mỡ giúp phân biệt thành phần mỡ với các tổn thương xuất huyết có tăng tín hiệu trên ảnh T1W, như u nang xuất huyết và khối nội mạc tử cung (Hình 13).
3.5. U nang tuyến (Cystadenoma) và u xơ nang tuyến (Cystadenofibroma)
U nang tuyến và u xơ nang tuyến cũng là u lành tính thường gặp của buồng trứng. Chúng có thể chứa thanh dịch hoặc chứa nhày. U nang tuyến thanh dịch thường là nang một ổ giống như nang đơn thuần. U nang tuyến nhày thường nhiều ổ bên trong (có thể chứa các thành phần dịch hoặc máu, hoặc cả hai).
Tổn thương nang một hoặc nhiều ổ chứa dịch thường giảm tín hiệu trên xung T1W, tăng tín hiệu trên xung T2W, có thể có tổ chức dày thành vách ngấm thuốc đối quang từ (14). Trường hợp có vách sùi ngấm thuốc cần phân biệt u xơ nang tuyến với u biểu mô nang tuyến ác tính (cystadenocarrcinoma)
3.6. U xơ buồng trứng (Ovarian fibroid)
Là những tổn thương lành tính bao gồm các mô xơ dày đặc. Trên CHT, chúng thể hiện cường độ tín hiệu thấp trên xung T2W và xung T1W, ngấm nhẹ đối quang từ (Hình15). Các tổn thương lớn có thể có những ổ nhỏ thoái hóa nang và phù. Tổn thương có hình ảnh như u cơ trơn tử cung, cần phân biệt nếu u này của tử cung dạng có cuống. Với những u nhỏ thường dễ xác định ở vị trí buồng trứng do thấy nang trong mô buồng trứng xung quanh.
3.7. Xoắn buồng trứng (Ovarian torsion)
Siêu âm phụ khoa cấp cứu là phương thức được lựa chọn. Tuy nhiên, nếu kết quả siêu âm không rõ ràng thì chụp CHT có thể được thực hiện. Xoắn buồng trứng thường là hậu quả của một tổn thương buồng trứng, hay gặp nhất là u nang bì hoặc nang buồng trứng. Trên CHT cho thấy hình ảnh khối như đối với u nang xuất huyết và lạc nội mạc tử cung, còn thấy biểu hiện của xoắn và nhồi máu, như: co kéo tử cung về phía tổn thương, các mạch máu căng trên bề mặt khối và không ngấm thuốc đối quang từ, và có ít dịch ở túi cùng Douglas.
3.8. Ứ nước ống dẫn trứng (Hydrosalpinx)
Ứ nước vòi trứng thường là kết quả của viêm vòi trứng, lạc nội mạc tử, hoặc dính vòi trứng. Mặc dù có thể dễ dàng xác định bằng siêu âm, nhưng chụp CHT rất hữu ích trong trường hợp tổn thương sẹo dày và trong việc xác định buồng trứng liền kề. Trường hợp ứ nước vòi trứng lớn, chụp CHT dễ dàng thấy hình thái hình ống với ngấn của nó, giúp phân biệt với khối nang buồng trứng (Hình16). Khi có biến chứng vòi trứng ứ mủ, trên xung T2W cho thấy dịch tăng tín hiệu có thể chuyển thành giảm tín hiệu do mủ có hàm lượng protein cao, tương tự như của một khối lạc nội mạc tử cung. Khi có biến chứng áp xe vòi trứng-buồng trứng, sẽ thấy tổn thương viêm ngấm thuốc mạnh trong các mô xung quanh.
3.9. Khối u buồng trứng ác tính
U ác tính thường bao gồm ung thư biểu mô tuyến (cystadenocarcinomas) nang nhầy hoặc thanh dịch và ung thư tế bào sáng (clear-cell carcinoma).
Không có phương pháp thăm khám hình ảnh và xét nghiệm nào đặc hiệu trong phát hiện ung thư buồng trứng, đặc biệt ở giai đoạn sớm tiền lâm sàng (được ước tính là <2 năm). Chụp CHT có thể giúp loại trừ khối lành tính (như u nang bì và nang nội mạc tử cung), nhưng cần chẩn đoán phân biệt với u nang tuyến hoặc u xơ tuyến lành tính, với những trường hợp này cần chụp có tiêm thuốc đối quang (Hình 17).
CHT có thể phát hiện ra 2 yếu tố dự báo quan trọng nhất của u ác tính là có nụ sùi thành trong tổn thương nang và hoại tử trong tổn thương đặc. Các dấu hiệu khác của u ác tính bao gồm thành hoặc vách dày > 3 mm, đường kính tối đa lớn hơn 4-6 cm, có thể thấy hạch vùng chậu và dịch ổ bụng hoặc di căn phúc mạc
4. KHỐI TỬ CUNG
Tử cung bình thường trên CHT gồm có 3 vùng (thấy rõ trên T2W đứng dọc): tổ chức cơ phía ngoài (tín hiệu từ trung gian đến cao), tổ chức cơ phía trong hoặc vùng chuyển tiếp (tín hiệu thấp), và tổ chức mạc tử cung (tăng tín hiệu gần với tín hiệu của dịch). Độ dày nội mạc tử cung rất khác nhau, tùy thuộc vào giai đoạn của chu kỳ kinh nguyệt và độ tuổi của phụ nữ. Nó thường là nhỏ hơn 15 mm ở người tiền mãn kinh và nhỏ hơn 8 mm ở người sau mãn kinh, bất kể chu kỳ nào hoặc kích thích nội tiết tố nào. Vùng chuyển tiếp có tín hiệu thấp trên xung T2W và thường đo nhỏ hơn 12 mm. Sự tương phản T2W giữa lớp cơ bên ngoài và vùng nối ít được thấy rõ ở người sau mãn kinh vì giảm dịch trong các mô.
4.1. U cơ trơn (Leiomyomas)
U cơ trơn tử cung là u lành tính phổ biến nhất của hệ sinh dục nữ. Vị trí có thể gặp ở thân tử cung là trong thành, dưới niêm mạc, dưới thanh mạc. Hầu hết là không có triệu chứng, tuy nhiên có thể có các triệu chứng, thường gặp là rong kinh hay cường kinh, nhất là khối nằm dưới niêm mạc. Siêu âm qua âm đạo giúp phát hiện u cơ trơn cũng có hiệu quả như chụp CHT, tuy nhiên CHT đánh giá tố hơn về giải phẫu tổn thương, nhất là với u có kích thước lớn và với trường hợp đa u cơ trơn.
Trên CHT, u cơ trơn tăng tín hiệu trên xung T2W và giảm tín hiệu trên xung T1W, có viền tín hiệu thấp, ngấm thuốc mạnh sau tiêm , có thể có viền tăng tín hiệu xung quanh, thường gặp u trong thành hoặc dưới thanh mạc. U có thể có vôi hoá, đặc biệt là ở phụ nữ lớn tuổi, biểu hiện vùng trống tín hiệu gây nhiễu ảnh khó đánh giá giới hạn với các mô lân cận. U lớn hơn từ 3 đến 5 cm đường kính thường không đồng nhất vì thoái hoá ở nhiều mức độ khác nhau. CHT là thăm khám lựa chọn trong việc đánh giá u cơ trơn trước và sau khi điều trị bằng nút tắc động mạch tử cung. CHT giúp xác định vị trí u và đánh giá chính xác cuống mạch nuôi. Tín hiệu xuất huyết hoặc hoại tử do nhồi máu trong khối có thể dẫn đến hạn chế giảm thể tích khối sau nút. Ngoài ra, nó hữu ích trong đánh giá hiệu quả nút mạch bằng cách so sánh hình ảnh trước và sau nút mạch
4.2. Lạc cấu trúc tuyến trong cơ (Adenomyosis)
Các tuyến nội mạc tử cung lạc chỗ từ lớp đáy của nội mạc tử cung vào trong cấu trúc cơ, thường liên quan đến tăng sản cấu trúc cơ tuyến. Nó là một rối loạn phụ khoa phổ biến mà thường ảnh hưởng đến phụ nữ trước mãn kinh. Các triệu chứng không đặc hiệu và bao gồm đau vùng chậu, đau bụng kinh, rong kinh, ra máu bất thường. Điều trị gồm liệu pháp hormon hoặc cắt bỏ nội mạc tử cung hoặc cắt bỏ tử cung. Với sự ra đời của phương pháp gây tắc mạch, CHT có thể đóng một vai trò trong việc theo dõi đáp ứng điều trị. Lạc nội mạc trong thành tử cung có hình ảnh đặc trưng trên CHT là vùng nối dày (> 12 mm), thấy rõ trên xung T2W. Phát hiện khác có thể thấy bao gồm giới hạn vùng nối không rõ và có những ổ tăng tín hiệu trên xung T1W hoặc xung T2W biểu hiện của nang của nội mạc tử cung lạc chỗ giãn hoặc xuất huyết . CHT giúp phân biệt đáng tin cậy giữa lạc nội mạc khu trú và u xơ cơ, điều này quan trọng vì điều trị hai bệnh này là khác nhau, dựa vào khác nhau về đặc điểm tín hiệu của tổn thương và vị trí các ổ tăng tín hiệu nằm rải rác làm cho bờ của lạc nội mạc không rõ ràng
4.3. Ung thư nội mạc tử cung (Endometrial canner)
Ung thư nội mạc tử cung là loại ung thư thường gặp thứ tư ở phụ nữ, độ tuổi 60-70. Lâm sàng có ra máu bất thường chiếm 75% đến 90% các trường hợp. CHT không được khuyến cáo như là thăm khám thường qui trong chẩn đoán ung thư nội mạc tử cung. Tuy nhiên, nó là một công cụ quan trọng đối với đánh giá giai đoạn ung thư nội mạc tử cung. CHT giúp định hướng phẫu thuật bằng cách xác định mức độ xâm lấn nông hoặc sâu vào cơ hoặc xâm lấn cổ tử cung, di căn hạch… thấy trên ảnh T2W và ảnh tiêm thuốc. Ung thư nội mạc tử cung đồng tín hiệu so với cơ và nội mạc tử cung trên hình ảnh T1W, trên ảnh T2W thường tăng tín hiệu, ngấm thuốc kém hơn so với cơ và ít khác biệt nếu ở thì muộn. Xâm lấn cơ thấy rõ trên T2W, biểu hiện vùng nối giảm tín hiệu không đều hoặc bị gián đoạn. Xâm lấn xuyên thành thấy khi u làm mất liên tục lớp thanh mạc giảm tín hiệu, thấy rõ trên T1W vì thay đổi tín hiệu lớp mỡ quanh tử cung. Xung này cũng thấy xâm lấn âm đạo tốt hơn khi có sự gián đoạn của tín hiệu thấp của thành âm đạo. Hạch gợi ý di căn thấy trên T1W có đường kính ngang > 1 cm. CHT cũng có thể phát hiện xâm lấn rộng bên ngoài tiểu khung như bàng quang và trực tràng.
4.4. Ung thư cổ tử cung (Cervical cancer)
Như tử cung, cổ tử cung có giải phẫu rõ trên hình ảnh T2W. Ung thư cổ tử cung là bệnh ác tính phụ khoa phổ biến thứ ba ở phụ nữ. Chụp CHT không sử dụng để chẩn đoán ung thư cổ tử cung nhưng được sử dụng đánh giá giai đoạn bệnh. Trên xung T2W ở mặt phẳng đứng dọc và mặt phẳng ngang theo trục của cổ tử cung, ung thư cổ tử cung là một khối tín hiệu cao hơn so với tổ chức đệm cạnh cổ tử cung, nhưng khối có tín hiệu thấp hơn so với nội mạc tử cung. CHT giúp phát hiện xâm lấn xung quanh , nhất là xâm lấn xương chậu và niệu quản gây ứ nước thận.
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Working with our team, you’re selecting a trusted partner in financial recovery.
Retrieving your lost funds shouldn’t be complicated.
That’s why our methodology is simple and open.
You just need to supply the necessary details, and we’ll take care of the
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Don’t let technical problems keep you from your
hard-earned money. It’s our mission to help you recover every penny.
Lost QIWI wallet funds?
Let us handle the stress in retrieving what isrightfully yours.
Contact us today and start the recovery journey.
Retrieving what’s yours shouldn’t be troublesome. That’s why our methodology is simple and open.
Just provide us with some basic information, and we’ll take care
of the rest.
Don’t allow fraudsters prevent you from your hard-earned money.
We’re committed to ensure the return of every cent.
Overwhelmed by how to proceed with recovery of your QIWI wallet funds?
Our customer support is on standby to help to guide you through the process and answer any concerns you might have.
With us, you’re choosing a dependable partner in financial recovery.
Our knowledge in cyber finance and online transactions means we’re well-prepared to tackle your QIWI wallet issues.
Be assured, we use state-of-the-art techniques and are well-versed in the latest fraud prevention strategies.
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