卵巢囊腺癌的MRI和CT诊断价值.doc

卵巢囊腺癌的MRI和CT诊断价值【摘要】目的探讨MRI和CT对卵巢浆液性囊腺癌和黏液性囊腺癌的应用价值与选择。方法回顾性分析22例MRI诊断卵巢囊腺癌经手术和病理证实的资料, 结合CT对照分析。结果MRI诊断14/22例为浆液性囊腺癌, 8/22例为黏液性囊腺癌。病理13/14 例为浆液性囊腺癌, 1/14例为浆、黏液性囊腺瘤; 5/8例为黏液性囊腺癌, 3/8例为黏液性囊腺瘤。CT诊断10/20例为浆液性囊腺癌, 10/20例为黏液性囊腺癌。病理9/10 例为浆液性囊腺癌, 1/10例为卵巢透明细胞癌; 9/10例为黏液性囊腺癌, 1/10例为浆液性囊腺癌伴出血。 MRI 及CT均可显示卵巢囊腺癌为囊实性病变, 即敏感性差异不大, 在特异性方面前者在平扫时显示更为优越, 但在增强后的特异性则后者又超过前者, 原因是MRI 在增强扫描时采用T1WI, 此时黏液改变亦为高信号与显示的对比剂相混杂导致增强失真的效果, 而CT增强扫描则可明确显示局部的不规则囊壁以及壁结节的形成。因此CT所显示的特异性更强, 亦即对诊断的正确性更高。结论浆液性囊腺癌 MRI 与 CT 应用价值相近, 黏液性囊腺癌CT定性优于MRI。 【关键词】 卵巢 囊腺癌 磁共振成像 体层摄影术 X线计算机The diagnostic value of ovarian cystadenocarcinoma with MRI and CTWU Chun-fang, ZHU Yong, WU You-hong, CAI Jin, LUO Xing-zhong(Department of Radiology, Shanghai Xu Hui District Central Hospital, Shanghai 200031, China)【Abstract】 Objective To discuss the value of clinical application and choice with MRI/CT for diagnosing ovarian serous cystadenocarcinoma and ovarian mucinous cystadenocarcinoma. Methods To analyse 22 cases of ovarian through MRI confirmed by surgicopathology and compare with those of the relevant CT cystadenocarcinoma retrospectively. Results MRI revealed 14/22 cases of ovarian serous cystadenocarcinoma,8/22 cases of ovarian mucinous cystadenocarcinoma, and pathology confirmed 13/14 cases as the serous cystadenocarcinoma,1/14 case as the ovarian seromucinous cystadenoma,5/8 cases for mucinous cystadenocarcinoma. 3/8 cases for mucinous cystadenoma. CT showed 10/20 cases as the serous cystadenocarcinoma, 10/20 cases as the mucinous cystadenocarcinoma, and pathology proved 9/10 cases for serous cystadenocarcinoma, 1/10 case for ovarian clear cell carcinoma, 9/10 cases for mucinous cystadenocarcinoma, 1/10 case for serous cystadenocarcinoma complicated with bleeding. Furthermore, the characteristic or unique features contributed with MRI and CT were comprehended as follows. Both of MRI and CT can demonstrate ovarian cystadenocarcinoma as cystic and consistent mass that means no significant difference in sensitivities. As regards to specificities, plain MRI can unveil more clearly the mass ingredients than those through CT, outcoming with profitable benefit in specificity; but conversely enhanced CT can demonstrate the enhanced regional wall irregularities and nodules while MRI cant do so clearly and precisely due to the presence of higher signal intensities caused by mucin on enhanced MRI. T1WI with intermingling of the paramagnetic substance (GD. DTPA), leading to comparatively lower specificity. Conclusion MRI and CT are nearly equal in application of diagnosing ovarian serous cystadenocarcinoma. But CT is superior to MRI in diagnosing the qualification of ovarian mucinous cystadenocarcinoma.【Key Words】Ovary; Cystadenocarcinoma; Magnetic resonance imaging; Tomography, X ray-computed卵巢囊腺癌是妇科常见疾病。随着MRI 技术的不断提高, 目前已成为妇科检查的重要手段。 本文回顾性分析22例 MRI诊断卵巢囊腺癌经手术病理证实的资料, 结合 CT 对照分析, 探讨其临床应用价值, 为临床提供最有效的检查方法, 以提高影像学诊断的准确率, 为临床制定治疗方案提供可靠的依据。1资料与方法1.1临床资料本文收集22例MRI诊断卵巢囊腺癌经手术和病理证实的资料进行回顾性分析。患者年龄2186岁, 中位年龄52岁。临床症状主要有腹块、腹胀、部分有腹痛及便秘。 MRI 诊断14/22例为浆液性囊腺癌(其3/14例伴腹水), 8/22例为黏液性囊腺癌。病理13/14例为浆液性囊腺癌, 1/14例为浆、黏液性囊腺瘤; 5/8例为黏液性囊腺癌(其3/5例含CT诊断资料), 3/8例为黏液性囊腺瘤。1.2CT对照组资料本文另收集20 例CT诊断卵巢囊腺癌经手术和病理证实的资料。CT诊断10/20例为浆液性囊腺癌, 10/20例为黏液性囊腺癌。病理9/10 例为浆液性囊腺癌, 1/10例卵巢透明细胞癌; 9/10例为黏液性囊腺癌, 1/10例为浆液性囊腺癌伴出血。1.3检查方法MRI 扫描采用 Siemens 1.5T 超导 MRI成像系统扫描仪, 扫描时应用体部线圈, 以横断位和冠状位为主, 辅以矢状位。应用自旋回波序列(TSEFS T2WI TR2500ms TE 80-100ms 层厚34mm, 间隔1mm, SE T1WI TR 300-500ms TE为10-20ms)和梯度回波序列(T1WI TR100200ms TE4 cm)、囊实性、壁厚、分隔厚(3 mm)、菜花状或结节状突起等征象作为卵巢恶性肿瘤MRI诊断的第一标准; 腹腔种植(盆壁、腹膜、大网膜及肠系膜种植)、腹水、淋巴结肿大等征象作为卵巢恶性肿瘤MRI诊断的第二标准; 如果MRI发现第一标准中两个以上征象, 再结合发现第二标准中任何一个征象, 则MRI对卵巢癌诊断的可性度达95%。3.5囊腺癌鉴别诊断囊腺瘤Fukrda等9认为肿瘤呈完全囊性者诊断为良性, 并提出无囊壁间隔增厚, 也无乳头状突起物及实质性成分。囊性畸胎瘤: 脂质与黏液 T1WI 和T2WI均为高信号, 不同的是囊性畸形胎瘤可见脂液面, 抑脂后含脂的高信号部分信号降低。但对巨大型囊性畸胎瘤含少量脂肪时MRI信号复杂, 鉴别有难度。如作CT检查既简单又正确。 卵巢子宫内膜异位囊肿: 血液和黏液 T1WI 和T2WI均为高信号, 子宫内膜异位囊肿的囊壁也可以不规则, 不同的是子宫内膜异位囊肿有周期性出血, 因血清与血球分离可形成液液平, 增强后囊壁信号的强度同子宫内膜, 再结合囊性肿块周围有粘连的特征就可鉴别。 Krukenberg, s瘤： Krukenberg, s瘤比双侧卵巢浆液性囊腺癌相对要小, 实质部分相对多一些。如怀疑Krukenberg, s瘤而又否认胃癌史, 可向上扩大扫描范围。周洁等10报道胃癌双侧卵巢转移瘤占76.9% 。3.6囊腺癌影像学检查的方法比较卵巢囊腺癌常用B超、CT和MRI三大影像学的检查。B超为首选的检查方法,经济实用, 但对肥胖和肠管积气等患者诊断能力受到限制。MRI与CT比较: MRI可区分囊腺癌内浆液或黏液的成分, 但不能显示钙化。对于浆液性囊腺癌MRI T1WI平扫和增强相当CT平扫和增强, 两者MRI和CT的定性价值相近。黏液性囊腺癌CT定性优于MRI, 因MRI采用T1WI增强, 此时黏液改变亦为高信号与显示的对比剂相混杂, 因增强失真使良恶性肿瘤的鉴别受到限制。而CT虽不能准确判断囊腺癌内浆液或黏液的成分, 但CT增强能准确判断囊实性肿块内强化的实质部分。因此, CT对卵巢黏液性肿瘤的良恶性鉴别优于MRI。【参考文献】 1. 李巍, 崔恒, 冯捷, 等. 卵巢癌诊断的研究进展J. 中华妇产科杂志, 2005, 40(7): 496-4982. Kim SH, Choi BI, Lee HP, et al. Uterine cervical carcinoma: comparison of CT and MR findingsJ. Radiology, 1990, 175(1): 45-513. 汤钊猷, 主编. 卵巢恶性肿瘤.现代肿瘤学M. 上海: 上海医科大学出版社, 1993. 949-9694. 张亮亮, 赵红星. 卵巢囊腺瘤及囊腺癌的MRI诊断J. 临床医学杂志, 2005, 25(6):42-435. 强金伟, 周康荣, 廖治河, 等. 卵巢囊腺瘤的CT诊断J. 实用放射学杂志, 2004,20(3)：253-2566. Thurnher S,Hodler J,Baer S,et al. Gadolinium-DOTA enhanced MR imaging of adnexal tumorsJ. Journal of Computer Assisted Tomography, 1990,14(6): 939-9497. Ghossain MA, Buy J-N, Ligneres C, et al. Epithelial tumors of the ovary: comparison of MRI and CT findingsJ. Radiology, 1991,181(3):863-8708. Stevens SK, Hricak H, Stern JL, et al. Ovarian lesions: detection and characterization with gadolinium-enhanced MR imaging at 1.5 TJ. Radiology, 1991, 181