CT在外突性子宫肌瘤与卵巢性索间质肿瘤的鉴别诊断价值

目的:探讨CT对外突性子宫肌瘤与卵巢性索间质肿瘤的鉴别诊断价值。方法:回顾性分析2015年1月~2019年2月重庆医科大学附属第一医院收治的外突性子宫肌瘤(n=43)和卵巢性索间质肿瘤(n=36)患者资料。分析CT平扫及增强图像,将数据传输至ADW4.5工作站完成多平面重建、最大密度投影和容积再重建等CT后处理重建。观察并记录肿瘤与输尿管位置、肿瘤供血动脉、卵巢静脉与肿瘤关系、肿瘤强化程度及方式、有无腹水。以病理结果为金标准,计算CT诊断准确率。结果:外突性子宫肌瘤位于输尿管前或内前方,主要由子宫动脉供血,分支多且于瘤体内呈较均匀分布,肌瘤实性部分呈漩涡样中度或明显强化改变,追踪卵巢静脉可见正常卵巢组织,不易合并腹水;卵巢性索间质肿瘤位于输尿管前或内前方,主要由卵巢动脉供血,分支少且于肿瘤实质内呈较均匀分布,静脉期见卵巢血管蒂征,肿瘤实性部分呈无或轻度强化改变,追踪卵巢静脉不能显示正常卵巢组织,常合并腹水,可见卵巢血管蒂征。以病理结果为金标准,术前CT诊断外突性子宫肌瘤准确率为93.03%,术前CT诊断卵巢性索间质肿瘤准确率为80.56%。结论:根据CT特点并结合临床表现可较好地对外突性子宫肌瘤与卵巢性索间质肿瘤做出鉴别诊断,值得临床推广应用。

Diagnostic value of CT in outprojecting uterine leiomyoma and ovarian sex cord-stromal tumor

Objective To investigate the value of computed tomography (CT) in the differential diagnosis of outprojecting uterine leiomyoma and ovarian sex cord-stromal tumor. Methods The clinical data of patients with outprojecting uterine leiomyoma (n=43) and patients with ovarian sex cord-stromal tumor (n=36) treated in the First Affiliated Hospital of Chongqing Medical University from January 2015 to February 2019 were analyzed retrospectively. The plain and enhanced CT images were analyzed, and the data were transmitted to ADW4.5 workstation for postprocessing, such as multiplanar reconstruction, maximum intensity projection and volume rendering. The locations of tumors and the ureter, tumor-feeding artery, the relationship between ovarian veins and tumors, the enhancement degrees and modes of tumors, and the presence or absence of ascites were observed and recorded. The diagnostic accuracy of CT was analyzed based on pathological results. Results The lesions of outprojecting uterine leiomyoma were located in front of or inside the ureter, and were mainly supplied by uterine arteries. A large number of branches within the tumors were evenly distributed. The solid part of the myoma showed moderate or obvious whirlpool-like enhancement, and normal ovarian tissues could be observed in the ovarian vein, without being complicated with ascites. The lesions of ovarian sex cord-stromal tumor were located in front of or inside the ureter, and the tumor were mainly supplied by ovarian arteries. A small number of branches within the tumors were evenly distributed, and ovarian vascular pedicle sign was observed in venous phase. No or mildly enhancement was observed in the solid part of the tumor. No normal ovarian tissues could be observed in the ovarian vein, and there were ascites and ovarian vascular pedicle sign. Taking pathological results as the gold standard, the accuracy of preoperative CT in the diagnosis of outprojecting uterine leiomyoma and ovarian sex cord-stromal tumor was 93.03% and 80.56%, respectively. Conclusion CT signs combined with clinical manifestations can accurately diagnose outprojecting uterine leiomyoma and ovarian sex cord-stromal tumor, worthy of clinical promotion.