卵巢囊性病变的MRI诊断与鉴别诊断
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摘要
目的分析卵巢囊性病变的MRI影像学特点,探讨低场强MRI扫描对卵巢囊性病变的诊断价值。
材料和方法选择2005年4月-2007年3月经临床检查拟诊卵巢囊性病变的患者34例,年龄18-76岁,平均37.5岁,所有病例术前行MR常规检查,常规扫描包括T1WI、T2WI、SPIR脂肪抑制序列,6例行T1WI增强扫描,之前均行超声波检查。22例临床症状中,主要表现下腹不适,坠胀,腹部包块,不规则阴道出血,月经失调,痛经进行性加重以及不孕等症状;12例无临床表现,仅由常规检查偶然发现。所有病例均行手术、腹腔镜得到相应病理结果,予以证实。
结果34例卵巢囊性病变共44个病灶。①卵巢单纯囊肿6例,表现为长T1长T2信号,直径1.2-4.8cm,呈单发类圆形,边界清,包膜完整,囊内信号均匀,薄壁光滑,增强后不强化;②巧克力囊肿5例7个病灶,单发3例,多发2例,椭圆形病变,厚壁3例,薄壁2例,短T1长T2有3例,短T1短T2有1例,T1T2混杂信号1例,3例病灶底部可见云絮状暗信号影沉积;③卵巢冠囊肿2例,圆形1例,椭圆形1例,呈长T1长T2信号,直径8-12cm;④卵巢腹膜包裹性囊肿2例,均有盆腔手术史,呈不规则的囊性包块,沿肠管走行,壁光整,未见乳头,增强后囊壁轻度强化;⑤卵巢囊性畸胎瘤10例14个病灶,直径5-20cm,10例均可见短T1长T2脂肪信号影,其中2例只见0.5cm的小球状脂肪信号,明显的囊内脂.液分层6例,并出现液平,附壁钙化2例,囊内漂浮物2例:⑥卵巢囊腺瘤6例,浆液性囊腺瘤4例6个病灶,2例单发,2例多发,5个病灶呈T1低信号,T2高信号,薄壁,直径为6-12cm,单房3例,1例1侧为多房,分房性质不一致,囊壁光滑3例,有乳头状突起1例;黏液性囊腺瘤2例,均为单侧,直径18-27cm,多房,各小房信号强度略不同,分隔纤细,呈蜂窝状,增强可见分隔明显强化;⑦卵巢囊腺癌3例,病灶轮廓欠清,不均匀长T1长T2信号,信号混杂,瘤壁厚薄不均,大小不等的乳头状结构,壁结节融合成块,瘤周分界不清。
结论MRI检查对卵巢囊性病变具有重要的诊断价值。由于MRI良好的软组织对比分辨率,任意方位成像,使MRI能较好的显示卵巢囊性病变,对卵巢囊性病变的检出率为100%,诊断准确率为90.9%(40/44)。对巧克力囊肿和卵巢囊性畸胎瘤通过脂肪抑制序列可做出明确诊断,较B超优势明显;可鉴别浆液性囊腺瘤和黏液性囊腺瘤,MR具有一定特异性,与B超相比,可以作为进一步鉴别的有效手段。
Objective:To analyze the MRI features of ovarian cystic diseases,to evaluate the value of MRI in 0.5 T diagnosing ovarian cystic diseases.
Material and Methods:34 cases(44 lesions)of ovarian cystic diseases were collected, aged 18 years-76 years with a mean of 37.5 years.All cases underwent MRI scanning and USG, 6 cases had Gd-DTPA enhanced scanning.MR scanning use T1WI-TSE.T2WI-TSE,T2WI-SPIR and parts use Gd-DTPA enhanced T1WI sequences.22 patients had symptoms,mainly lower abdominal discomfort,statistically,abdominal mass,irregular vaginal bleeding,menstrual disorders,Dysmenorrhea and sexual infertility.There are no symptoms of 12 patients with clinical manifestations,the conventional medical or gynecological examinations discovered accidentally.All patients underwent surgery,laparoscopic biopsy or corresponding pathologic findings be confirmed.
Results:34 cases of ovarian cystic lesions(44 lesions).①simple ovarian cysts in 6 cases, long T1 and T2 signal,single round,the border-capsule integrity,intracystic signal uniform,thin smooth;②Chocolate cyst 5 cases 7 lesions,a single 3 cases,more than 2 case,the oval lesions,3 cases thick,thin 2 cases,short T1 and long T2 are 3 cases,short T1 short T2 1,T1T2 mixed signals 1,3 lesions can see the bottom surface of the dark clouds signal Shen;③Crown ovarian cysts in 2 cases,1 circular,oval 1,had long T1 and T2 signal diameter 8-12cm;④peritoneal fluid of ovarian cysts in 2 cases,the history of both pelvic surgery,along intestine course,was irregular cystic region,wall finishing,no nipple,enhanced wall slight enhancement;⑤ovarian cystic teratoma in 10 cases,14 lesion diameter 5-20cm.10 cases were found short short T1 T2 signal,and 2 cases have only 0.5cm small spherical fat signals Intracystic obvious fat-layered liquid 6 cases,and there was peace,mural calcification in 2 cases,the capsule floated 2 cases;⑥6 cases of ovarian cystadenoma,serous cystadenoma 4 cases 6 lesions,2 cases of bilateral lesions,5 lesions were low T1 signal T2 signal,thin diameter 6-12cm alone the three cases,one side of a room,took inconsistent nature,Smooth wall three cases,papillae 1;mucinous cystadenoma 2 cases,were unilateral,in diameter 18-27cm,room small signal intensity of the slightly different to separate the garbageman,was honeycomb,enhanced visibility segregation;⑦ovarian cystadenocarcinoma 3 cases,Contour owed unclear,uneven long T1 and T2 signal, mixed signal,tumor thickness thin uneven visibility ranging from the size of papillary structures, mural nodules integration into pieces,peritumoral boundaries unclear.
Conclusion:MRI of ovarian cystic lesions has an important diagnostic value.MRI well as soft tissue contrast resolution,arbitrary position imaging,MRI can better show ovarian cystic lesions,Ovarian cysts on the detection rate of 100%,Positioning accuracy of 100%,the rate of diagnosis of 90.9%(40/44),ovarian chocolate cysts and cystic teratoma through fat suppression sequences can make a clear diagnosis,more than ultrasound advantages;be able to identify serous cystadenoma and mucinous cystadenoma,with some specificity of MR and,As a further identification can be an effective tool.
材料和方法选择2005年4月-2007年3月经临床检查拟诊卵巢囊性病变的患者34例,年龄18-76岁,平均37.5岁,所有病例术前行MR常规检查,常规扫描包括T1WI、T2WI、SPIR脂肪抑制序列,6例行T1WI增强扫描,之前均行超声波检查。22例临床症状中,主要表现下腹不适,坠胀,腹部包块,不规则阴道出血,月经失调,痛经进行性加重以及不孕等症状;12例无临床表现,仅由常规检查偶然发现。所有病例均行手术、腹腔镜得到相应病理结果,予以证实。
结果34例卵巢囊性病变共44个病灶。①卵巢单纯囊肿6例,表现为长T1长T2信号,直径1.2-4.8cm,呈单发类圆形,边界清,包膜完整,囊内信号均匀,薄壁光滑,增强后不强化;②巧克力囊肿5例7个病灶,单发3例,多发2例,椭圆形病变,厚壁3例,薄壁2例,短T1长T2有3例,短T1短T2有1例,T1T2混杂信号1例,3例病灶底部可见云絮状暗信号影沉积;③卵巢冠囊肿2例,圆形1例,椭圆形1例,呈长T1长T2信号,直径8-12cm;④卵巢腹膜包裹性囊肿2例,均有盆腔手术史,呈不规则的囊性包块,沿肠管走行,壁光整,未见乳头,增强后囊壁轻度强化;⑤卵巢囊性畸胎瘤10例14个病灶,直径5-20cm,10例均可见短T1长T2脂肪信号影,其中2例只见0.5cm的小球状脂肪信号,明显的囊内脂.液分层6例,并出现液平,附壁钙化2例,囊内漂浮物2例:⑥卵巢囊腺瘤6例,浆液性囊腺瘤4例6个病灶,2例单发,2例多发,5个病灶呈T1低信号,T2高信号,薄壁,直径为6-12cm,单房3例,1例1侧为多房,分房性质不一致,囊壁光滑3例,有乳头状突起1例;黏液性囊腺瘤2例,均为单侧,直径18-27cm,多房,各小房信号强度略不同,分隔纤细,呈蜂窝状,增强可见分隔明显强化;⑦卵巢囊腺癌3例,病灶轮廓欠清,不均匀长T1长T2信号,信号混杂,瘤壁厚薄不均,大小不等的乳头状结构,壁结节融合成块,瘤周分界不清。
结论MRI检查对卵巢囊性病变具有重要的诊断价值。由于MRI良好的软组织对比分辨率,任意方位成像,使MRI能较好的显示卵巢囊性病变,对卵巢囊性病变的检出率为100%,诊断准确率为90.9%(40/44)。对巧克力囊肿和卵巢囊性畸胎瘤通过脂肪抑制序列可做出明确诊断,较B超优势明显;可鉴别浆液性囊腺瘤和黏液性囊腺瘤,MR具有一定特异性,与B超相比,可以作为进一步鉴别的有效手段。
Objective:To analyze the MRI features of ovarian cystic diseases,to evaluate the value of MRI in 0.5 T diagnosing ovarian cystic diseases.
Material and Methods:34 cases(44 lesions)of ovarian cystic diseases were collected, aged 18 years-76 years with a mean of 37.5 years.All cases underwent MRI scanning and USG, 6 cases had Gd-DTPA enhanced scanning.MR scanning use T1WI-TSE.T2WI-TSE,T2WI-SPIR and parts use Gd-DTPA enhanced T1WI sequences.22 patients had symptoms,mainly lower abdominal discomfort,statistically,abdominal mass,irregular vaginal bleeding,menstrual disorders,Dysmenorrhea and sexual infertility.There are no symptoms of 12 patients with clinical manifestations,the conventional medical or gynecological examinations discovered accidentally.All patients underwent surgery,laparoscopic biopsy or corresponding pathologic findings be confirmed.
Results:34 cases of ovarian cystic lesions(44 lesions).①simple ovarian cysts in 6 cases, long T1 and T2 signal,single round,the border-capsule integrity,intracystic signal uniform,thin smooth;②Chocolate cyst 5 cases 7 lesions,a single 3 cases,more than 2 case,the oval lesions,3 cases thick,thin 2 cases,short T1 and long T2 are 3 cases,short T1 short T2 1,T1T2 mixed signals 1,3 lesions can see the bottom surface of the dark clouds signal Shen;③Crown ovarian cysts in 2 cases,1 circular,oval 1,had long T1 and T2 signal diameter 8-12cm;④peritoneal fluid of ovarian cysts in 2 cases,the history of both pelvic surgery,along intestine course,was irregular cystic region,wall finishing,no nipple,enhanced wall slight enhancement;⑤ovarian cystic teratoma in 10 cases,14 lesion diameter 5-20cm.10 cases were found short short T1 T2 signal,and 2 cases have only 0.5cm small spherical fat signals Intracystic obvious fat-layered liquid 6 cases,and there was peace,mural calcification in 2 cases,the capsule floated 2 cases;⑥6 cases of ovarian cystadenoma,serous cystadenoma 4 cases 6 lesions,2 cases of bilateral lesions,5 lesions were low T1 signal T2 signal,thin diameter 6-12cm alone the three cases,one side of a room,took inconsistent nature,Smooth wall three cases,papillae 1;mucinous cystadenoma 2 cases,were unilateral,in diameter 18-27cm,room small signal intensity of the slightly different to separate the garbageman,was honeycomb,enhanced visibility segregation;⑦ovarian cystadenocarcinoma 3 cases,Contour owed unclear,uneven long T1 and T2 signal, mixed signal,tumor thickness thin uneven visibility ranging from the size of papillary structures, mural nodules integration into pieces,peritumoral boundaries unclear.
Conclusion:MRI of ovarian cystic lesions has an important diagnostic value.MRI well as soft tissue contrast resolution,arbitrary position imaging,MRI can better show ovarian cystic lesions,Ovarian cysts on the detection rate of 100%,Positioning accuracy of 100%,the rate of diagnosis of 90.9%(40/44),ovarian chocolate cysts and cystic teratoma through fat suppression sequences can make a clear diagnosis,more than ultrasound advantages;be able to identify serous cystadenoma and mucinous cystadenoma,with some specificity of MR and,As a further identification can be an effective tool.
引文
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[31]Janio Szklaruk,,Eric P.Tamm,Haesun Choi,et al.MR Imaging of common and uncommon large pelvic masses.Radiographics.2003.23 403-424;
[32]Yong-Yeon Jeong,Eric K.Outwater,and Heoun Keun Kang.Imaging Evaluation of Ovarian Masses.Radiographics 2000.20.1445-1470;
[33]Seung Eun Fung,MD.Fae Mun lee,MD.Sung Eun Rha,MD.et al.CT and MR Imaging of Ovarian Tumors with Emphasis on Differential Diagnosis.RadioGraphics2002;22:1305-1325;
[34]RossJS,DelamarterSR,HueffleM,etal.GaddiniumDTPA-enhanced MR imaging or the postoperative lunbaspine:time course and mechanism of enhancement.AJR 1989;152:825
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[36]Evan S.Siegelman,and Eric K.Outwater,Tissue Characterization in the Female Pelvis by Means of MR Imaging.Radiology 1999.212.5-18;
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