卵巢囊腺癌的MRI和CT診斷價值.doc

卵巢囊腺癌的MRI和CT診斷價值【摘要】目的探討MRI和CT對卵巢漿液性囊腺癌和黏液性囊腺癌的應(yīng)用價值與選擇。方法回顧性分析22例MRI診斷卵巢囊腺癌經(jīng)手術(shù)和病理證實的資料, 結(jié)合CT對照分析。結(jié)果MRI診斷14/22例為漿液性囊腺癌, 8/22例為黏液性囊腺癌。病理13/14 例為漿液性囊腺癌, 1/14例為漿、黏液性囊腺瘤; 5/8例為黏液性囊腺癌, 3/8例為黏液性囊腺瘤。CT診斷10/20例為漿液性囊腺癌, 10/20例為黏液性囊腺癌。病理9/10 例為漿液性囊腺癌, 1/10例為卵巢透明細胞癌; 9/10例為黏液性囊腺癌, 1/10例為漿液性囊腺癌伴出血。 MRI 及CT均可顯示卵巢囊腺癌為囊實性病變, 即敏感性差異不大, 在特異性方面前者在平掃時顯示更為優(yōu)越, 但在增強后的特異性則后者又超過前者, 原因是MRI 在增強掃描時采用T1WI, 此時黏液改變亦為高信號與顯示的對比劑相混雜導(dǎo)致增強失真的效果, 而CT增強掃描則可明確顯示局部的不規(guī)則囊壁以及壁結(jié)節(jié)的形成。因此CT所顯示的特異性更強, 亦即對診斷的正確性更高。結(jié)論漿液性囊腺癌 MRI 與 CT 應(yīng)用價值相近, 黏液性囊腺癌CT定性優(yōu)于MRI。 【關(guān)鍵詞】 卵巢 囊腺癌 磁共振成像 體層攝影術(shù) X線計算機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卵巢囊腺癌是婦科常見疾病。隨著MRI 技術(shù)的不斷提高, 目前已成為婦科檢查的重要手段。 本文回顧性分析22例 MRI診斷卵巢囊腺癌經(jīng)手術(shù)病理證實的資料, 結(jié)合 CT 對照分析, 探討其臨床應(yīng)用價值, 為臨床提供最有效的檢查方法, 以提高影像學(xué)診斷的準確率, 為臨床制定治療方案提供可靠的依據(jù)。1資料與方法1.1臨床資料本文收集22例MRI診斷卵巢囊腺癌經(jīng)手術(shù)和病理證實的資料進行回顧性分析?；颊吣挲g2186歲, 中位年齡52歲。臨床癥狀主要有腹塊、腹脹、部分有腹痛及便秘。 MRI 診斷14/22例為漿液性囊腺癌(其3/14例伴腹水), 8/22例為黏液性囊腺癌。病理13/14例為漿液性囊腺癌, 1/14例為漿、黏液性囊腺瘤; 5/8例為黏液性囊腺癌(其3/5例含CT診斷資料), 3/8例為黏液性囊腺瘤。1.2CT對照組資料本文另收集20 例CT診斷卵巢囊腺癌經(jīng)手術(shù)和病理證實的資料。CT診斷10/20例為漿液性囊腺癌, 10/20例為黏液性囊腺癌。病理9/10 例為漿液性囊腺癌, 1/10例卵巢透明細胞癌; 9/10例為黏液性囊腺癌, 1/10例為漿液性囊腺癌伴出血。1.3檢查方法MRI 掃描采用 Siemens 1.5T 超導(dǎo) MRI成像系統(tǒng)掃描儀, 掃描時應(yīng)用體部線圈, 以橫斷位和冠狀位為主, 輔以矢狀位。應(yīng)用自旋回波序列(TSEFS T2WI TR2500ms TE 80-100ms 層厚34mm, 間隔1mm, SE T1WI TR 300-500ms TE為10-20ms)和梯度回波序列(T1WI TR100200ms TE4 cm)、囊實性、壁厚、分隔厚(3 mm)、菜花狀或結(jié)節(jié)狀突起等征象作為卵巢惡性腫瘤MRI診斷的第一標準; 腹腔種植(盆壁、腹膜、大網(wǎng)膜及腸系膜種植)、腹水、淋巴結(jié)腫大等征象作為卵巢惡性腫瘤MRI診斷的第二標準; 如果MRI發(fā)現(xiàn)第一標準中兩個以上征象, 再結(jié)合發(fā)現(xiàn)第二標準中任何一個征象, 則MRI對卵巢癌診斷的可性度達95%。3.5囊腺癌鑒別診斷囊腺瘤Fukrda等9認為腫瘤呈完全囊性者診斷為良性, 并提出無囊壁間隔增厚, 也無乳頭狀突起物及實質(zhì)性成分。囊性畸胎瘤: 脂質(zhì)與黏液 T1WI 和T2WI均為高信號, 不同的是囊性畸形胎瘤可見脂液面, 抑脂后含脂的高信號部分信號降低。但對巨大型囊性畸胎瘤含少量脂肪時MRI信號復(fù)雜, 鑒別有難度。如作CT檢查既簡單又正確。 卵巢子宮內(nèi)膜異位囊腫: 血液和黏液 T1WI 和T2WI均為高信號, 子宮內(nèi)膜異位囊腫的囊壁也可以不規(guī)則, 不同的是子宮內(nèi)膜異位囊腫有周期性出血, 因血清與血球分離可形成液液平, 增強后囊壁信號的強度同子宮內(nèi)膜, 再結(jié)合囊性腫塊周圍有粘連的特征就可鑒別。 Krukenberg, s瘤： Krukenberg, s瘤比雙側(cè)卵巢漿液性囊腺癌相對要小, 實質(zhì)部分相對多一些。如懷疑Krukenberg, s瘤而又否認胃癌史, 可向上擴大掃描范圍。周潔等10報道胃癌雙側(cè)卵巢轉(zhuǎn)移瘤占76.9% 。3.6囊腺癌影像學(xué)檢查的方法比較卵巢囊腺癌常用B超、CT和MRI三大影像學(xué)的檢查。B超為首選的檢查方法,經(jīng)濟實用, 但對肥胖和腸管積氣等患者診斷能力受到限制。MRI與CT比較: MRI可區(qū)分囊腺癌內(nèi)漿液或黏液的成分, 但不能顯示鈣化。對于漿液性囊腺癌MRI T1WI平掃和增強相當CT平掃和增強, 兩者MRI和CT的定性價值相近。黏液性囊腺癌CT定性優(yōu)于MRI, 因MRI采用T1WI增強, 此時黏液改變亦為高信號與顯示的對比劑相混雜, 因增強失真使良惡性腫瘤的鑒別受到限制。而CT雖不能準確判斷囊腺癌內(nèi)漿液或黏液的成分, 但CT增強能準確判斷囊實性腫塊內(nèi)強化的實質(zhì)部分。因此, CT對卵巢黏液性腫瘤的良惡性鑒別優(yōu)于MRI?！緟⒖嘉墨I】 1. 李巍, 崔恒, 馮捷, 等. 卵巢癌診斷的研究進展J. 中華婦產(chǎn)科雜志, 2005, 40(7): 496-4982. 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