卵巢上皮性肿瘤的MRI影像表现与病理学的对照研究
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摘要
目的探讨MRI检查在卵巢上皮性肿瘤诊断与鉴别诊断中的应用价值。方法选取南通市肿瘤医院2013年1月至2018年6月期间经过手术证实的37例56个卵巢癌及14例单发卵巢囊腺瘤患者,收集所有患者的临床、病理及影像资料,观察卵巢癌及卵巢囊腺瘤的MRI影像特征,并与病理检查结果进行对照,分析MRI诊断卵巢癌和卵巢囊腺瘤的准确率。结果 70个病变中有20个浆液性癌,4个黏液性癌,28个低分化腺癌,3个子宫内膜样癌,1个透明细胞腺癌,5个浆液性囊腺瘤,9个黏液性囊腺瘤;与病理结果对照,MRI诊断卵巢癌的准确率为92.9%,黏液性囊腺瘤准确率为100%,5例浆液性囊腺瘤有3例诊断正确,2例误诊为巧克力囊肿;MRI图像显示卵巢癌囊性部分T1WI低信号,T2WI高信号,实性部分T1WI低或等信号,T2WI稍高或高信号,实性部分DWI高信号,ADC低信号,囊性部分ADC均值为2.70×10~(-3)mm~2/s,实性部分ADC均值为1.06×10~(-3)mm~2/s,增强实性成分、囊壁、分隔明显强化,大部分卵巢癌边界不清;囊腺瘤体积较大,T1WI低信号,T2WI高信号,DWI低信号,ADC高信号,增强后不强化,边界清晰,其中黏液性囊腺瘤多房囊性或囊内多发分隔,增强后分隔及边缘可见线样强化。14例囊腺瘤的ADC均值为2.81×10~(-3)mm~2/s;卵巢癌囊性部分与囊腺瘤的ADC值比较差异无统计学意义(P>0.05),卵巢癌实性部分与囊腺瘤的ADC值比较差异有统计学意义(P<0.05)。结论 MRI在卵巢上皮性良恶性肿瘤的诊断与鉴别诊断中价值很高,值得临床推广应用。
Objective To explore the value of MRI in the diagnosis and differential diagnosis of epithelial ovarian tumor. Methods We selected 37 cases of ovarian cancer(56 tumors) and 14 cases of single ovarian cystadenoma confirmed by surgery during the period from January 2013 to June 2018 in Nantong Tumor Hospital. The clinical, pathological and imaging data of all patients were collected. The imaging features of ovarian cancer and ovarian cystadenoma were observed and compared with the pathological findings to analyze the accuracy of MRI in the diagnosis of the two diseases. Results Among the 70 lesions, there were 20 serous carcinomas, 4 mucinous carcinomas, 28 poorly differentiated adenocarcinomas, 3 endometrioid carcinomas, 1 clear cell adenocarcinoma, 5 serous cystic adenomas, and 9 mucinous cystadenoma. Compared with pathological findings, the accuracy of MRI in diagnosis of ovarian cancer was 92.9%, and 100% in diagnosis of mucinous cystadenoma. Of the 5 serous cystadenomas, 3 were correctly diagnosed and 2 were misdiagnosed as chocolate cysts. MRI images showed low signal on T1WI in cystic part, high signal on T2WI, low or equal signal on T1WI in solid part, slightly high or high signal on T2WI, high signal on DWI in solid part and low signal on ADC in ovarian cancer. The ADC mean value of cystic part was 2.70×10~(-3) mm~2/s and solid part was 1.06×10~(-3) mm~2/s. After injection of contrast medium, the solid components, cystic wall and septa of the tumors were obviously enhanced. Most ovarian cancers had unclear borders. Cystadenoma had large volume, low signal on T1WI,high signal on T2WI, low signal on DWI and high signal on ADC. It was not enhanced after enhancement, and its boundary was clear. Among them, mucinous cystadenoma was multi-sac cystic or intracapsular multiple separation. Linear enhancement had been seen in the separation and margins after enhancement. The ADC mean value of 14 cases of cystadenoma was 2.81×10~(-3) mm~2/s. The ADC values of cystic part and cystadenoma of ovarian cancer showed no statistically significant difference(P>0.05), while the ADC values of solid part of ovarian cancer and cystadenoma had significant difference(P<0.05). Conclusion MRI is of high value in the diagnosis and differential diagnosis of ovarian epithelial benign and malignant tumors, which is worthy of clinical application.
Objective To explore the value of MRI in the diagnosis and differential diagnosis of epithelial ovarian tumor. Methods We selected 37 cases of ovarian cancer(56 tumors) and 14 cases of single ovarian cystadenoma confirmed by surgery during the period from January 2013 to June 2018 in Nantong Tumor Hospital. The clinical, pathological and imaging data of all patients were collected. The imaging features of ovarian cancer and ovarian cystadenoma were observed and compared with the pathological findings to analyze the accuracy of MRI in the diagnosis of the two diseases. Results Among the 70 lesions, there were 20 serous carcinomas, 4 mucinous carcinomas, 28 poorly differentiated adenocarcinomas, 3 endometrioid carcinomas, 1 clear cell adenocarcinoma, 5 serous cystic adenomas, and 9 mucinous cystadenoma. Compared with pathological findings, the accuracy of MRI in diagnosis of ovarian cancer was 92.9%, and 100% in diagnosis of mucinous cystadenoma. Of the 5 serous cystadenomas, 3 were correctly diagnosed and 2 were misdiagnosed as chocolate cysts. MRI images showed low signal on T1WI in cystic part, high signal on T2WI, low or equal signal on T1WI in solid part, slightly high or high signal on T2WI, high signal on DWI in solid part and low signal on ADC in ovarian cancer. The ADC mean value of cystic part was 2.70×10~(-3) mm~2/s and solid part was 1.06×10~(-3) mm~2/s. After injection of contrast medium, the solid components, cystic wall and septa of the tumors were obviously enhanced. Most ovarian cancers had unclear borders. Cystadenoma had large volume, low signal on T1WI,high signal on T2WI, low signal on DWI and high signal on ADC. It was not enhanced after enhancement, and its boundary was clear. Among them, mucinous cystadenoma was multi-sac cystic or intracapsular multiple separation. Linear enhancement had been seen in the separation and margins after enhancement. The ADC mean value of 14 cases of cystadenoma was 2.81×10~(-3) mm~2/s. The ADC values of cystic part and cystadenoma of ovarian cancer showed no statistically significant difference(P>0.05), while the ADC values of solid part of ovarian cancer and cystadenoma had significant difference(P<0.05). Conclusion MRI is of high value in the diagnosis and differential diagnosis of ovarian epithelial benign and malignant tumors, which is worthy of clinical application.
引文
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[8]强金伟.磁共振功能成像在卵巢肿瘤中的临床应用价值[J].肿瘤影像学, 2016, 25(1):11-15.
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[12] PRAT J. Ovarian carcinomas:five distinct diseases with different origins, genetic alterations, and clinicopathological features[J]. Virchows Arch, 2012, 460(3):237-249.
[13] K?BEL M, KALLOGER SE, HUNTSMAN DG, et al. Differences in tumortype in low-stage versus high-stage ovarian carcinomas[J]. Int J Gynecol Pathol, 2010, 29(3):203-211.
[14] BOGER-MEGIDDO I, WEISS NS. Histologic subtypes and laterality of primary epithelial ovarian tumors[J]. Gynecol Oncol, 2005, 97(1):80-83.
[15] GURUNG A, HUNG T, MORIN J, et al. Molecular abnormalities in ovarian carcinoma:clinical, morphological and therapeutic correlates[J]. Histopathology, 2013, 62(1):59-70.
[16] HART WR. Mucinous tumors of the ovary:a review[J]. Int J Gynecol Pathol, 2005, 24(1):4-25.
[17] LEEN SLS, SINGH N. Pathology of primary and metastatic mucinous ovarian neoplasms[J]. J Clin Pathol, 2012, 65(7):591-595.
[18]朱才松,杨军,杨静,等. MRI扩散加权成像对女性附件复杂肿块预测良恶性的临床应用价值[J].医学影像学杂志, 2017, 27(5):254-255.
[19]袁昌咸,彭晞. 3.0T MRI检查在卵巢肿瘤鉴别诊断中的应用价值分析[J].中国现代药物应用, 2017, 11(10):157-158.
[20]回允中.女性生殖道病理学[M].北京:北京大学医学出版社, 2005:543.
[2] NIRAVKUMAR R, PATEL A, SRINIVAS G, et al. In Vitro and In Vivo evaluation of a novel folate-targeted theranostic nanoemulsion of docetaxel for imaging and improved anticancer activity against ovarian cancers[J]. Cancer Biol Ther, 2018, 19(7):554-564.
[3] MUKUDA N, FUJII S, INOUE C, et al. Bilateral ovarian tumors on MRI:how should we differentiate the lesions?[J]. Yonago Acta Med,2018, 61(2):110-116.
[4] AN H, LEE EYP, CHIU K, et al. The emerging roles of functional imaging in ovarian cancer with peritoneal carcinomatosis[J]. Clin Radiol, 2018, 73(7):597-609.
[5] SHARMA S, NEMIEBOKA B, SALA E, et al. Molecular imaging of ovarian cancer[J]. J Nucl Med, 2016, 57(6):827-833.
[6] ZHANG H, ZHANG GF, HE ZY, et al. Prospective evaluation of 3T MRI findings for primary adnexal lesions and comparison with the final histological diagnosis[J]. Arch Gynecol Obstet, 2014, 289(2):357-364.
[7] SALA E, ROCKALL A, RANGARAJAN D, et al. The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis[J]. Eur J Radiology, 2010, 76(3):367-385.
[8]强金伟.磁共振功能成像在卵巢肿瘤中的临床应用价值[J].肿瘤影像学, 2016, 25(1):11-15.
[9] SEIDAM JD, RUSSEL P, KURMAN RJ. Surface epithelial tumors of the ovary[J]//KURMAN RJ(ed). Blaustein’s Pathology of the Female Genital Tract. New-York:Springer, 2002:791-904.
[10] PRAT J. New insights into ovarian cancer pathology[J]. Ann Oncol,2012, 23 Suppl 10:x111-x117.
[11] LALWANI N, PRASAD SR, VIKRAM R, et al. Histologic, molecular, and cytogenetic features of ovarian cancers:implications for diagnosis and treatment[J]. Radiographics, 2011, 31(3):625-646.
[12] PRAT J. Ovarian carcinomas:five distinct diseases with different origins, genetic alterations, and clinicopathological features[J]. Virchows Arch, 2012, 460(3):237-249.
[13] K?BEL M, KALLOGER SE, HUNTSMAN DG, et al. Differences in tumortype in low-stage versus high-stage ovarian carcinomas[J]. Int J Gynecol Pathol, 2010, 29(3):203-211.
[14] BOGER-MEGIDDO I, WEISS NS. Histologic subtypes and laterality of primary epithelial ovarian tumors[J]. Gynecol Oncol, 2005, 97(1):80-83.
[15] GURUNG A, HUNG T, MORIN J, et al. Molecular abnormalities in ovarian carcinoma:clinical, morphological and therapeutic correlates[J]. Histopathology, 2013, 62(1):59-70.
[16] HART WR. Mucinous tumors of the ovary:a review[J]. Int J Gynecol Pathol, 2005, 24(1):4-25.
[17] LEEN SLS, SINGH N. Pathology of primary and metastatic mucinous ovarian neoplasms[J]. J Clin Pathol, 2012, 65(7):591-595.
[18]朱才松,杨军,杨静,等. MRI扩散加权成像对女性附件复杂肿块预测良恶性的临床应用价值[J].医学影像学杂志, 2017, 27(5):254-255.
[19]袁昌咸,彭晞. 3.0T MRI检查在卵巢肿瘤鉴别诊断中的应用价值分析[J].中国现代药物应用, 2017, 11(10):157-158.
[20]回允中.女性生殖道病理学[M].北京:北京大学医学出版社, 2005:543.
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