Paraovarian/paratubal cysts: comparison of transvaginal sonographic and pathological findings to establish diagnostic criteria.

OBJECTIVES: To describe the sonographic features of paraovarian cysts and to compare these features with pathological findings in order to define the best treatment options (surgical vs. conservative). METHODS: Fifty patients (mean age 48 (range, 14-68) years), each with a surgically proven paraovarian cyst, were retrospectively recruited. Preoperative transvaginal ultrasonographic B-mode and power Doppler observations were re-evaluated and histological reports were analyzed. RESULTS: All cysts were correctly diagnosed as paraovarian at preoperative transvaginal sonography (TVS). Paraovarian cysts appeared as unilocular ('simple') cysts in 33 (66%) cases and multilocular in two (4%). In 15 patients (30%) the cyst showed a variable number of papillary projections growing from the cyst wall (unilocular-solid cysts). Power Doppler examination of the papillae showed the presence of blood vessels in four of these patients (27%). Histological analysis of the masses containing papillary projections diagnosed eight cystadenofibromas, five cystadenomas and two serous papillary borderline tumors, while analysis of paraovarian cysts without papillations revealed benign, serous cysts of paramesonephric or mesothelial origin. CONCLUSIONS: Paraovarian cysts can show a wide range of sonographic features. Their risk of malignancy is low if no papillary projections are detected at transvaginal sonography, but when mural proliferations are present a borderline tumor can be found at pathological examination.     

Struma ovarii: MR appearances

Background: Analysis of unenhanced and contrast-enhanced magnetic resonance (MR) images of struma ovarii, a rare benign neoplasm of the ovary, is the aim of this study. Methods: T2-weighted and Gd-DTPA-enhanced T1-weighted MR images of five histologically proven struma ovarii were evaluated retrospectively. Results: In all patients, unenhanced and contrast-enhanced T1-weighted MR images showed complex cystic masses composed of multiple cysts and a solid component, indicating the presence of large and small thyroid follicles. In four patients, the cyst fluid was hypointense on T1-weighted images and hyperintense on T2-weighted images. In one patient, the fluid was hyperintense on T1-weighted images and hypointense on T2-weighted images due to hemorrhage. Conclusion: A complex mass composed of multiple cysts and a solid component, indicating the presence of large and small thyroid follicles, appeared to be a characteristic MR finding of struma ovarii. Received: 11 December 1995/Accepted: 15 December 1995     

椎管内肠源性囊肿的MRI诊断

目的:研究椎管内肠源性囊肿的MRI特征表现。材料与方法:搜集6例经手术病理证实的椎管内肠源性囊肿的资料,分析其MRI表现,其中男4例,女2例,年龄12~26岁,平均17岁。均行轴位T1WI成像,矢状位T1WI、T2WI成像。结果:4例位于颈胸交界处,1例位于颈段,1例位于胸段,6例囊肿均位于椎管中线部位,与脑脊液相比T1WI,囊内容物等信号4例,稍高信号2例,T2WI等信号。结论:MR可以清楚地显示肠源性囊肿,根据其信号特点和位置,可提示肠源性囊肿的诊断。     

Multiple paraovarian cysts requiring emergency surgery: A rare clinical finding

This report presents an unusual case of multiple paraovarian cysts that required emergency surgery due to a paraovarian cyst being entrapped by another paraovarian cyst. Laparoscopic surgery is considered useful for diagnostic and therapeutic purposes and is, therefore, recommended owing to difficulty in differentiating paraovarian cysts from ovarian cysts.     

Cysts in pregnancy discovered by sonography

The incidence of cysts in pregnancy was established with ultrasound. In 3,330 pregnant patients who underwent sonography, 38 adnexal cystic lesions (1.14%) were found. All but two cysts were discovered before 16 weeks. Follow-up showed that the majority of the cystic lesions resolved spontaneously; these were presumed to represent corpus luteum cysts. Five patients underwent surgery because of persistent cystic lesions; a mucinous cystadenoma, a benign cystic teratoma, a paraovarian cyst, an inclusion cyst, and a tuboovarian abscess were found. Septations and echogenic material were seen within the cystic teratoma and the tuboovarian abscess but the sonographic features of the other operated lesions were identical to those seen in the corpus luteum cysts.     

颅内皮样囊肿破裂的MRI诊断

目的探讨MRI对颅内皮样囊肿破裂的诊断价值。方法收集经手术病理证实的颅内皮样囊肿破裂7例,回顾性分析MRI特征。结果7例皮样囊肿均为单发,位于前颅窝底4例,鞍上池2例,中颅窝底部1例。病变在MRI上呈信号不均的表性病灶,其内均可见短T1脂肪信号,其中1例可见脂一液平面,邻近脑沟均可见短T1信号脂滴,脂肪抑制序列短T1信号均可被抑制;增强扫描2例出现脑膜强化,其中1例并室管膜强化。结论颅内皮样囊肿破裂MRI表现具有特征性,脂肪抑制序列具有重要价值,皮样囊肿破裂可引起化学性脑膜炎或室管膜炎。     

原发动脉瘤样骨囊肿的X线平片、CT和MRI表现与诊断价值

目的探讨原发动脉瘤样骨囊肿的X线平片、CT和MR等不同影像学检查的征象,评价其诊断价值。方法回顾性分析41例经手术病理证实的原发动脉瘤样骨囊肿的临床特点和影像学征象。影像学检查方法包括X线平片（n=35）、CT（n=23）和MR（n=13）。结果X线平片显示30例（86%）病变骨皮质膨胀形成骨包壳,其中17例（57%）骨皮质完整,但其中有5例在CT上显示骨包壳不完整;2例（6%）病灶内出现钙化;7例（20%）出现病理骨折,其中57%为脊柱病变。CT显示21例（91%）病变由大小和数量不等的囊腔构成,其中19例（90%）CT扫描出现液-液平面;4例（17%）病变内出现局部实性区域,其中1例为完全实性病变;3例病变侵犯了邻近关节和骨。MR检查发现12例（92%）出现液-液平面;囊间隔与囊壁厚薄不等、强化明显,T1WI显示不明显,T2WI为中高信号。结论X线平片呈膨胀性溶骨改变,CT和MRI出现囊腔、液-液平面、强化明显的囊壁及囊间隔征象是诊断的重要依据。CT和MR在显示ABC特异征象方面具有独特优势。     

磁共振FLAIR序列对颅内表皮样囊肿的诊断价值

目的:分析液体衰减反转恢复(fluid-attenuatedinversionrecovery,FLAIR)对颅内表皮样囊肿的显示能力。材料和方法:18例经手术和病理证实的颅内表皮样囊肿,均经常规磁共振检查和FLAIR序列检查,通过主观目测和定量分析对比FLAIR对颅内表皮样囊肿的显示能力。结果:FLAIR序列对颅内表皮样囊肿的显示能力明显优于常规磁共振T2,T1及增强后扫描,统计学显示有显著性差异。结论:FLAIR能较清晰显示颅内表皮样囊肿,对颅内表皮样囊肿的鉴别诊断及术前边界的确定均有价值。     

卵巢子宫内膜异位囊肿的MRI 表现

目的 探讨卵巢子宫内膜异位囊肿的ＭＲＩ表现。方法 回顾性分析３０例经手术、病理证实的卵巢子宫内膜异位囊肿ＭＲＩ和Ｂ超征象。结果 ３０例囊肿中,ＭＲＩ检出率１００％（３０／３０）,定性诊断准确率９３．３％（２８／３０）。卵巢子宫内膜异位囊肿的主要征象：囊肿在Ｔ１ＷＩ和ＡＴ２ＷＩ均呈高信号,囊内有分隔,囊周纤维包膜形成,囊肿与周围结构界限不清。结论 ＭＲＩ是诊断卵巢子宫内膜异位囊肿的重要手段。     

Magnetic resonance imaging of the kidneys and adrenal glands

A simple renal cyst will have low signal intensity on T1-weighted SE images with short TE and short TR because of the long T1 values of the cyst fluid. With increasing TE and TR, cysts demonstrate increased signal intensity due to the long T2 values of the cyst fluid. On T1-weighted images a complicated cyst will have higher signal intensity than a simple cyst; it may not be possible to differentiate these complicated cysts from solid masses. MRI seems to be useful in identifying simple cyst fluid and, therefore, has potential in characterization of cystic lesions considered complex by CT or ultrasound. Unfortunately, imaging techniques have not yet been optimized, diagnostic criteria are somewhat vague, and accuracy has not been established in a representative patient population. Solid masses often can be identified and differentiated from simple, uncomplicated cysts on MR images. The inability to differentiate among various types of solid tumors or to separate these from complicated cysts or inflammatory masses remains a limitation. Most lesions are more readily seen on contrast-enhanced CT than on MR images and therefore the role of MRI in the detection and diagnosis of renal cell carcinoma remains limited. Although the high detection rate of renal cell carcinoma is encouraging, CT is still more sensitive than MR in demonstrating solid lesions less than 3 cm in diameter. MRI cannot be used as a screening modality for renal tumors. MRI seems quite helpful in the staging of renal cell carcinoma. Macroscopic extension into the perinephric fat, tumor extension into the renal vein and the inferior vena cava, and macroscopic metastases to other organs are readily seen. Furthermore, differentiation between enlarged nodes and vessels is possible with MRI. Some authors recommended the use of MRI to stage renal cell carcinoma in patients with known contraindication to contrast, prior suboptimal bolus contrast enhanced CT scan, and equivocal CT findings. MRI can replace the inferior vena cavagram in the staging work-up and MR may be superior to CT for planning the surgical approach in Stage IIIA lesions by determining the upper extent of tumor thrombus within the inferior vena cava or the right atrium.(ABSTRACT TRUNCATED AT 400 WORDS)     

前交叉韧带黏液样变性的MRI表现和伴随征象

目的：探讨前交叉韧带黏液样变性的MRI表现与伴随征象。材料与方法回顾性分析3年内4540例膝关节MRI数据库,所有MRI检查由2台1.5 T磁共振机检查完成。由2名有多年经验的骨放射医师依据先前的MRI表现和关节镜结果诊断前交叉韧带黏液样变性、韧带腱鞘囊肿、骨内腱鞘囊肿,评价前交叉韧带黏液样变性的MRI特征表现以及与伴随征象的共存性。结果在所有4540例膝关节MRI中,34例（34/4540,0.7%）诊断为前交叉韧带黏液样变性,13例（13/34,38%）为前交叉韧带单独黏液样变性,21例（21/34,62%）为黏液样变性伴有韧带腱鞘囊肿,腱鞘囊肿最大直径平均为16 mm （最小6 mm,最大30 mm）,18例（18/21,86%）发生在近端,2例（2/21,9%）发生在远端,1例为近端与远端均有（1/21,5%）。24例（24/34,71%）伴有骨内腱鞘囊肿。11例（11/34,32%）伴有严重的膝关节骨性关节病。结论前交叉韧带黏液样变性在MRI上表现为特征性的“芹菜梗”征,多伴有韧带腱鞘囊肿和骨内腱鞘囊肿。     

Sonography of fetal choroid plexus cysts: detection depends on cyst size and gestational age.

OBJECTIVE: To establish diagnostic criteria for the diagnosis of fetal choroid plexus cysts across gestation. METHODS: Prenatal sonographic images of 166 fetuses without choroid plexus cysts were prospectively collected from 13 weeks to term. Texture characteristics of the choroid plexus regions were analyzed to quantify changes as a function of gestational age. A set of 20 fetal sonographic images with choroid plexus cysts were used to create cyst prototypes (1.5-2.5 mm), which were randomly embedded into normal choroid plexus images from varying gestational ages. A test set of 544 images was created, which included 408 images with choroid plexus cysts and 136 images without choroid plexus cysts. Four observers following a blinded study design evaluated the presence of choroid plexus cysts in the images. The influence of cyst size and gestational age on the detection of cysts was measured with receiver operating characteristic analysis and analysis of variance. Observer agreement was characterized by agreement kappa statistics. RESULTS: Texture analysis indicated greater echo texture heterogeneity at earlier gestational ages. The receiver operating characteristic analysis showed a corresponding decrease in diagnostic accuracy for cyst detection at earlier gestational ages. The cyst detection threshold (area under the receiver operating characteristic curve, 0.8) was 2.4 mm (SE, 0.2 mm) for 13 to 21 weeks' gestation and decreased to 1.9 mm (SE, 0.17 mm) for 22 to 38 weeks' gestation. Average interobserver and intraobserver kappa statistics were 0.37 and 0.53, respectively. CONCLUSIONS: Because of the changing echo texture of the choroid plexus through gestation, choroid plexus cysts must be at least 2.5 mm in diameter for confident diagnosis before 22 weeks' gestation and at least 2 mm after 22 weeks.     

睾丸表皮样囊肿的MRI诊断

目的探讨睾丸表皮样囊肿(TEC)的MRI表现。方法回顾性分析8例经手术病理证实的TEC的MRI资料,8例均采用MRI平扫及增强扫描,并结合文献讨论。结果 8例TEC在T_1WI、T_2WI上边缘部有低信号环,即"黑环征",厚度均匀,约1~2 mm。T_1WI上5例病灶内部呈等低或等高信号;1例在T_1WI见"靶征";在T_2WI上6例病灶内部有"洋葱皮征";1例病灶内部"洋葱皮征"显示不清;另1例TEC最大径达4.8 cm,但内部无典型"洋葱皮征"。8例TEC MRI增强均无强化。结论睾丸实质内TEC的MR征象有一定特点,有助于明确诊断。     

Tornwaldt囊肿的低场MRI表现

目的探讨低场磁共振成像（MRI）Tornwaldt囊肿的影像表现。方法观察15例Tomwaldt囊肿的MRI信号强度、形状、大小和位置。结果15例病变在T2WI上均与脑脊液等信号,T1WI上7例病变与肌肉信号相同,8例病变信号低于肌肉。13例病变呈圆形,2例呈椭圆形,病变最大径自2～14mm不等。结论Tornwaldt囊肿较少见,在常规头部MRI中占0．83％,在低场T1WI上低于或等于肌肉信号,T2WI上等同于脑脊液信号。     

卵巢子宫内膜异位囊肿的超声表现及误诊分析

目的探讨卵巢子宫内膜异位囊肿二维及彩色多普勒超声特征性表现,分析超声误诊原因。方法对手术病理证实为卵巢子宫内膜异位囊肿93例患者的术前超声表现进行回顾性分析并行超声分型。结果 93例107个囊肿超声分型表现:Ⅰ型囊肿(正常卵巢型)表现为稍增大卵巢内可见小无回声区,术前超声均未检出(0/3),仅提示卵巢稍增大或含液性改变;Ⅱ型囊肿(单纯囊肿型)表现为无回声区,边界清晰,伴后方回声增强;术前超声仅检出1个囊肿,误诊10个囊肿(10/11);Ⅲ型囊肿(囊内点状高回声型)表现为无回声区,内部见均匀点状高回声,似云雾状;术前超声检出26个囊肿,仅误诊2个囊肿(2/28);Ⅳ型囊肿(多囊型)表现为无回声区,内部见带状间隔或伴密集点状高回声;术前超声检出16个囊肿,误诊13个囊肿(13/29);Ⅴ型囊肿(混合型)表现为无回声区内见稍高回声或伴密集点状高回声及带状间隔,或表现分层征;术前超声检出22个囊肿,误诊11个囊肿(11/33);Ⅵ型囊肿(实质型)表现为低回声,内部可见稍高回声;术前超声均未检出囊肿(0/3)。107个囊肿术前超声以Ⅲ型囊肿检出个数居多(26/28),误诊个数少(2/28);6型中共误诊42个囊肿(39.3%),分别为Ⅰ型(3/3)、Ⅱ型(10/11)、Ⅳ型(13/39)、Ⅴ型(11/33)和Ⅵ型(3/3)。其中误诊为卵巢单纯囊肿15个、卵巢囊腺瘤7个、卵巢畸胎瘤2个、卵巢肿瘤6个、子宫浆膜下肌瘤2个、炎性包块2个、囊肿性质待定5个,卵巢稍大或含液性改变3个。结论Ⅲ型卵巢子宫内膜异位囊肿声像图表现为无回声区,边界清晰,壁毛糙或稍增厚,内部可见点状高回声,结合临床表现超声易于作出正确诊断;Ⅰ、Ⅱ、Ⅳ、Ⅴ及Ⅵ型卵巢子宫内膜异位囊肿均易误诊,需与卵巢单纯囊肿、畸胎瘤、囊腺瘤、子宫浆膜下肌瘤及盆腔炎性肿块声像图相鉴别。     

鞍区生殖细胞瘤CT、MRI表现

目的探讨鞍区生殖细胞瘤的CT和MRI表现.方法选择过去10年经病理或临床证实的13例鞍区生殖细胞瘤患者作为研究对象,回顾性分析其治疗前CT和MR图像.结果 13例患者均表现为垂体柄增粗达16 mm以上和垂体后叶正常短T1高信号消失,其中12例有中枢性尿崩症.MR图像上10例肿瘤呈等T1信号,但在T2WI上信号表现为多样性.肿瘤囊变6例,其中5例可见肿瘤延伸入第三脑室.CT平扫图像显示所有肿瘤均无钙化,11例肿瘤实体部分表现为高密度.结论鞍区生殖细胞瘤的影像学特征表现为:CT平扫呈高密度,钙化少见;MRI为垂体柄增粗,垂体后叶短T1高信号消失.     

半月板囊肿的关节镜治疗

目的:探讨半月板囊肿的临床、MRI、关节镜手术治疗。方法:2004年～2008年我院共完成18例膝关节半月板囊肿的关节镜手术,3例行单纯囊肿切除,13例行囊肿切除及半月板部分切除、全切,2例行囊肿切除半月板缝合。术前、术后均采用Lysholm评分,对膝关节功能进行评估。结果:18例患者均得到随访,术前Lysholm的评分(70.5±8.6),术后提高到(93.2±4.7),术前、术后有显著差异。结论:半月板囊肿是一种少见的膝关节疾患,MRI检查是主要诊断依据,采用关节镜手术治疗创伤小、疗效佳,是首选治疗方法。     

MR findings in pericardial hydatid cyst

Pericardial hydatid cyst is rare. We present a 32-year-old man with a pericardial hydatid cyst. Chest x-ray film showed a spherical mass located left mediastinum. A pericardial cyst with low signal intensity was noted on T1 weighted magnetic resonance (MR) images. The cyst had high signal intensity, but signal intensity of folded parasitic membranes in the cyst were seen lower intensity on T2 weighted MR images. Based on these MR findings, pericardial hydatid cyst was diagnosed. The patient underwent surgical removal of the cyst. Histologic study of the cyst confirmed hydatid cyst diagnosis.     

颅骨动脉瘤样骨囊肿CT及MRI表现

目的 观察颅骨动脉瘤样骨囊肿的CT和MRI表现。方法 回顾性分析8例经手术病理证实的颅骨ABC患者的CT和MRI图像,发生于脑颅骨者5例,其中枕骨3例,顶骨1例,颞顶枕骨1例,发生于颌骨2例,发生于颅中凹1例、累及蝶骨、颞颌关节。对8例均行CT平扫和MRI常规平扫,位于脑颅骨的5例同时行MR常规增强扫描,位于颅中凹的1例加做MR动态增强扫描、并后处理得到时间-信号强度曲线(TIC)及其半定量参数。结果 CT表现:8例均表现为单房或多房状膨胀性骨质破坏区伴内部骨质分隔影,其内软组织肿块密度不均匀,内见斑片状低密度区。位于颅中凹的1例骨质破坏范围较大,对周围组织具有侵袭性。MRI表现:8例病变均表现为病变主体呈等长T1长T2信号,病变内部含有数量、大小不等的囊性部分,信号不均一,其中5例病灶囊内可见液-液平面,8例病变边缘均可见低信号界线。位于颅中凹的1例TIC呈平坦型,峰值信号强度(SI_peak)为1080,峰值时间(T_peak)为第9个时相,最大上升斜率(MSI)为0.81%。结论 颅骨ABC具有较为典型的影像学征象。     

Placental surface cysts detected on sonography: histologic and clinical correlation.

OBJECTIVE: To evaluate the clinical outcome and histologic findings of pregnancies in which placental surface cysts were detected on prenatal sonography. METHODS: A computerized search of our obstetric sonographic database from 1988 through 2000 identified 34 cases. Results of pathologic examinations, when performed, were obtained. Sonographic features were correlated with histologic findings and clinical parameters. RESULTS: On review of available microscopic slides, in all cases in which the cyst was seen at pathologic examination, there was subchorionic fibrin with central cyst formation. All pregnancies resulted in live births, although intrauterine growth restriction occurred in 4 (12%) of 34. Three (11%) of 28 cases with placental pathologic findings had maternal floor infarction. Only 2 significant associations between sonographic features and postnatal findings were found. In all cases of intrauterine growth restriction, average cyst size was larger than 4.5 cm. Of 12 cysts larger than 4.5 cm, 4 (33%) had intrauterine growth restriction. Of 22 cysts smaller than 4.5 cm, there were no instances of intrauterine growth restriction (P = .01). Of 32 cases with 3 or fewer cysts, only 2 had intrauterine growth restriction, whereas in 2 cases with more than 3 cysts, both had intrauterine growth restriction (P = .01). CONDUSIONS: Most placental surface cysts are associated with a normal pregnancy outcome. Most such cysts are related to cystic change in an area of subchorionic fibrin. Cysts larger than 4.5 cm or more than 3 in number are more frequently associated with intrauterine growth restriction.