目 的 探讨弥散加权成像 (diffusion weighted imaging, DWI)联 合表观弥散系数(apparent diffusion coefficient, ADC)鉴别诊断变性子宫肌 瘤的价值及影像特点。方法 回顾性分析 72例变性子宫肌瘤患者临床资料，所有患 者均行DWI检查并获取ADC值，以病理学检 查结果为“金标准”，分析患者DWI影像 特点，比较DWI影像、ADC值及DWI影像联 合ADC值鉴别变性子宫肌瘤的准确度、特 异度与敏感度差异。结果 72例患者经病 理学确诊，其中子宫肉瘤22例，良性变性 子宫肌瘤50例。变性子宫肌瘤在DWI影像 中大多可表现出囊变、坏死征象；其中 子宫肉瘤多见信号强度较高，肿瘤边缘 模糊，周围内膜受累明显；而良性变性 子宫肌瘤信号强度高低不定，多见规整 肿瘤边缘，周围内膜基本无受累情况。 DWI联合ADC鉴别诊断结果准确度、特异 度均明显高于单独DWI与单独ADC诊断(P ＜0.05)；其灵敏度明显高于单独DWI诊断 (P＜0.05)，而与单独ADC诊断比较无统计 学意义(P＞0.05)。结论 两类变性子宫肌 瘤DWI影像特点差异明显，联合ADC可提高 诊断准确性。

Objective To investigate the value and imaging characteristics of diffusion weighted imaging (DWI) combined with apparent diffusion coefficient (ADC) in differential diagnosis of degenerative uterine fibroids (DUF). Methods The clinical data of 72 patients with DUF were analyzed retrospectively. All patients were examined by DWI and the ADC value was obtained. With results of pathological examination as a the golden standard, DWI image characteristics were analyzed, the accuracy, specificity and sensitivity in differential diagnosis of DUF were compared between DWI images, ADC value and DWI inages combined with ADC value. Results Pathological confirmed diagnosis showed that there were 22 cases (30.56%) of uterine sarcomas and 50 cases (69.44%) of benign DUF. DWI images of DUF showed cystic change and necrosis signs. DWI images of uterine sarcoma showed relatively higher signal intensity, fuzzy tumor edges and obvious surrounding endometrial involvement. The signal intensity of benign DUF was uncertain, the tumor edges were regular, and there almost was no involvement of surrounding endometrium. The diagnostic accuracy and specificity of DWI combined with ADC were significantly higher than those of DWI alone or ADC alone (P<0.05). The sensitivity of combined diagnosis was significantly higher than that of DWI alone (P<0.05), but there was no significant difference, compared with the diagnosis of ADC alone (P>0.05). Conclusion DWI imaging characteristics of two kinds of DUF are obviously different, and the combined detection with ADC can improve the diagnostic accuracy.