卵巢畸胎瘤的CT表现

目的研究卵巢畸胎瘤的CT表现.方法经病理证实卵巢畸胎瘤25例,全部女性,平均年龄32.8岁.其中良性囊性畸胎瘤21例,恶性未成熟畸胎瘤4例.全部病例作了CT扫描.结果右侧12例,左侧13例,平均最大直径81mm.20例圆或椭圆形,5例不规则形.24例见脂质成分存在.21例良性者16例显示壁结节,3例为实质性肿块,2例见脂/液平面;4例恶性者密度不均匀.20/25例见钙化或骨化.2例恶性者并有腹膜转移.结论发生于卵巢的含有脂质成分和钙化或骨化斑者应考虑本病诊断.     

卵巢恶性畸胎瘤的CT表现

目的:分析卵巢恶性畸胎瘤的CT表现,探讨CT诊断卵巢恶性畸胎瘤的价值.方法:回顾性分析5例良性畸胎瘤恶变和19例未成熟畸胎瘤的CT资料.结果:5例良性畸胎瘤恶变均为囊性肿块,平均直径13.1cm,均有散在钙化和脂质,3例囊壁不均匀性增厚并强化, 2例囊肿显示大而不规则形的头结节并有强化;19例未成熟畸胎瘤中有实性肿块17个和囊实性肿块2个,平均直径14.5cm,均有实性成分强化,18例可见散在钙化,大多有散在脂质和盘曲的带状略低密度影,7例部分肿块可见强化的血管,5例肿瘤向外突破包膜侵犯邻近脏器.全部24例中8例伴有腹水,4例有盆壁淋巴结肿大.结论:卵巢恶性畸胎瘤的CT具有一定的CT特征,了解这些特征有助于卵巢恶性畸胎瘤的诊断与鉴别.     

卵巢恶性生殖细胞肿瘤的CT诊断

目的 探讨卵巢恶性生殖细胞肿瘤的CT特点.资料与方法 回顾性分析62例卵巢恶性生殖细胞肿瘤的CT资料,包括卵黄囊瘤24例、未成熟畸胎瘤22例、无性细胞瘤11例和良性畸胎瘤恶变5例.结果 囊性肿块9例,囊实性肿块19例,实性肿块34例.26例肿块内可见钙化.22例显示脂质成分.14例未成熟畸胎瘤可见盘曲带状略低密度影.2例良性畸胎瘤恶变囊肿内可见不规则头结节.11例可见腹膜种植结节.22例累及邻近脏器.10例盆腔淋巴结肿大.29例腹腔积液.结论 卵巢恶性生殖细胞肿瘤的CT表现有一定特征性.结合临床,CT有助于本病的诊断和鉴别.     

卵巢畸胎瘤的螺旋CT表现

目的探讨卵巢畸胎瘤的CT表现及特征,提高术前诊断和鉴别诊断能力。方法回顾性分析经手术病理证实的31例卵巢畸胎瘤CT特征。结果 31例卵巢畸胎瘤共检出36个肿块,其中1例为多发性,直径2.5～28.0 cm;成熟性肿块34个,未成熟性2个;36个肿块中34个含脂质成分,2个呈单纯液性密度,25个含钙化,6个由实性成分构成为主,2个出现液脂面;36个肿块术前确诊率为83%。依据CT特征和肿块所含组织成分多少,把成熟性卵巢畸胎瘤归结为囊肿型、脂质型、液脂型、实性型、混杂型。结论发生于盆腔含有脂质、钙化、实性组织和液性成分等2个或3个胚层组织的肿块性病变应考虑卵巢畸胎瘤。     

卵巢原发性肿瘤的CT诊断

目的分析卵巢原发性肿瘤的CT影像特点,提高CT检查在卵巢原发性肿瘤术前诊断和鉴别诊断中的价值和准确性。方法回顾性分析经病理证实的62例卵巢原发性肿瘤患者的CT表现,其中良性20例,恶性42例。结果1)上皮性肿瘤42例53个肿瘤,多房囊性改变为主(28/53,52.8%)。上皮性肿瘤中恶性肿瘤45个(45/53,84.9%),其中浆液性囊腺癌39个,占恶性上皮性肿瘤的86.7%。恶性肿瘤中出现乳头状突起30个,占恶性上皮性肿瘤的66.7%;2)生殖细胞肿瘤13例,以囊实性为主(8/13)。其中成熟囊性畸胎瘤8例(8/13),未成熟畸胎瘤2例。畸胎瘤中见脂肪成分8例(8/13),钙化成分6例(6/13)。未成熟畸胎瘤平均最大截面积较成熟畸胎瘤大;3)性索间质肿瘤7例,以囊实性为主(4/7)。4例卵巢纤维瘤、1例卵巢纤维-卵泡膜细胞瘤和1例卵泡膜细胞瘤实质部分平扫均为均质低或等密度,增强后轻度强化。颗粒细胞瘤体积较大,多表现为多房囊性(2/3)。结论 CT能清晰显示盆腔结构,可提供对原发性卵巢肿瘤的定位、定性、病变范围的可靠信息。     

卵巢生殖细胞肿瘤的CT诊断

目的探讨卵巢生殖细胞肿瘤的CT表现特点.方法回顾性分析经手术病理证实的37例46个卵巢生殖细胞肿瘤的CT资料,结合病理讨论其CT表现特点.结果本组卵巢生殖细胞肿瘤中,畸胎瘤43个,内胚窦瘤2个,混合性生殖细胞瘤1个.对卵巢畸胎瘤,CT和B超的敏感性均为100%,特异性分别为93.02%和58.14%.30例38个成熟囊性畸胎瘤,CT明确诊断27例35个,均含有脂肪密度区,5个见脂液平面,11个有浮球征,16个有钙化或牙齿状影.5个未成熟畸胎瘤呈囊性或实性为主肿块,肿块内均见多发斑点状钙化和少许小片状脂肪密度影,其中1例实性成分内见盘曲的带状略低密度影.内胚窦瘤呈囊性1例,呈实性为主1例,实性肿块内见较大的不规则低密度坏死区.混合性生殖细胞瘤呈实质性,不规则形.结论卵巢畸胎瘤和内胚窦瘤的CT表现具有各自的特点,尤其是畸胎瘤,具有特征性表现,与B超相比,CT是更好的检查方法.     

卵巢囊性畸胎瘤的CT表现

本文对38例41个良性和2例恶性卵巢囊性畸胎瘤的CT表现进行分析。CT显示了所有的肿瘤。在43个肿瘤中,有40个显示有脂肪(93％),25个发现牙齿或钙化(56％),35个显示Rockitansky(罗基坦斯基)隆起(81％),28个有毛发团(65％),5个显示脂肪——液面(12％)。上述征象使CT对43个肿瘤中的42个做出卵巢囊性畸胎瘤的定性诊断(98％)。在2例恶性肿瘤中,囊内显示有单一较大的团块,直径10cm(其中1例的团块具有增强效应),呈莱花样,周边不规则,与囊内壁形成钝角等。这些征象均提示为肿瘤恶变。病检时发现有3例良性囊性畸胎瘤的病人,在生长畸胎瘤的同一卵巢上并发粘液性肿瘤(1例为良性,1例为临界性肿瘤,1例为恶性),但CT只诊断了其中的2例。2例发生附件扭转,CT显示有输卵管的增粗。CT表现有30例与腹部平片和子宫输卵管造影的表现进行了比较,31例与us表现做了比较,3例同MRI做了比较。本研究结果说明,CT是卵巢囊性畸胎瘤最好的影象学检查方法。     

CT对卵巢良性囊性畸胎瘤的诊断价值(附21例分析)

目的：探讨卵巢良性囊性畸胎瘤的CT表面特点及其诊断价值。方法：分析21例经手术病理证实的卵巢成熟性囊性畸胎瘤的CT及B超资料，讨论CT表现特点与病理的关系。结果：21例囊性畸胎瘤均显示脂肪密度区。11个“浮球征”，9个脂液平面，10个囊壁钙化呈点状、条块状，4个分房间隔内钙化，2个囊内骨化影和软组织混杂密度影,3个未见钙化影。5例发生蒂扭转。结论：CT能显示良性囊性畸胎瘤的特殊表现，反映其病理特点。     

卵巢畸胎瘤的MRI诊断价值

目的：探讨卯巢畸胎瘤的MRI征象特点及其诊断价值。方法：搜集经手术病理证实的12例卵巢畸胎瘤的MRI资料进行回顾性分析。结果：12例卵巢畸胎瘤中,左侧9例,右侧3例,最大直径13．8cm,9例为圆形或椭圆形,3例为不规则形。10例见脂质信号,6例见明显的双低钙质信号。11个良性者5例显示壁结节,2例实性肿块,1例恶性者信号欠均匀,并有腹膜转移、腹腔积液。结论：对于发生于卵巢的肿瘤,含有脂质的双高信号或钙质的双低信号考虑为卵巢畸胎瘤。     

卵巢畸胎瘤的CT诊断

目的 分析卵巢畸胎瘤的CT表现，提高CT诊断的准确性。资料与方法 搜集经手术和病理证实的43例49个卵巢畸胎瘤，对其CT表现作回顾性分析。结果 49个卵巢畸胎瘤中，成熟性畸胎瘤45个，未成熟性畸胎瘤3个，卵巢甲状腺肿1个。45个为囊性，其中单房29个(64％)，双房8个(18％)，多房8个(18％)。2个为囊实性，2个为实性，后者均为未成熟性。46个(96％)畸胎瘤含脂肪密度组织，16个(32％)瘤内见毛发，25个(51％)见向囊内突起的头结节，25个(5l％)瘤内见钙化或牙齿。根据CT表现，成熟性畸胎瘤可分为液性为主型、液脂型、头结节型、脂肪瘤型和囊肿型。术前CT诊断敏感性和准确性分别为96％和88％。结论 绝大多数卵巢畸胎瘤有典型的CT表现，少数不含脂肪的囊肿型肿瘤定性仍有困难。     

Cystic teratoma of the ovary: CT detection

Computed tomography (CT) was performed in 38 patients with 41 benign cystic teratomas of the ovary and two patients with malignant transformation. CT depicted all tumors. The presence of fat in 40 of 43 cases (93%), tooth or calcification in 24 of 43 (56%), Rokitansky protuberance in 35 of 43 (81%), tufts of hair in 28 of 43 (65%), and a fat-fluid level in five of 43 (12%) allowed a definite diagnosis of ovarian cystic teratoma in 42 of 43 cases (98%). In the two cases of malignancy, single large (greater than 10 cm) plugs (with uptake of contrast medium in one) with a cauliflower appearance and an irregular border forming an obtuse angle with the inner wall of the cyst suggested malignant transformation. In three cases of benign cystic teratoma, a mucinous tumor (one benign, one borderline, one malignant) arising in the same ovary was seen at pathologic examination but was only diagnosed with the help of CT in two of three cases. Thickening of the tube was noted in two cases of torsion of the adnexa. CT findings were compared with findings at radiography of the abdomen and hysterosalpingography in 30 cases, ultrasound in 31, and magnetic resonance imaging in three. This study demonstrated that CT was the best procedure for imaging cystic teratomas of the ovary.     

卵巢良性病变的CT表现

目的 提高对卵巢良性病变ＣＴ表现的认识。材料与方法 回顾性分析经手术病理证实的６６例共８０个卵巢良性肿块的ＣＴ及Ｂ超资料,讨论其ＣＴ表现特点及ＣＴ在诊断中的作用。结果 本组２５个功能性囊肿ＣＴ发现２３个;１８个卵巢子宫内膜异位囊肿,长径多与同侧的盆壁近科平行（１２／１８）,甚至大于横径达１．５倍（９／１８）;１５个囊腺瘤均呈边缘光滑的囊性肿块,其中浆液性囊腺瘤（ｎ＝９）密度均匀,多为单房（６／９）     

卵巢囊性畸胎瘤的CT诊断

目的：探讨卵巢囊性畸胎瘤的ＣＴ表现及其诊断价值。材料和方法：２０例卵巢畸胎瘤均作ＣＴ扫描和Ｂ超检查，全部病例均经手术病理证实。结果：２０例均显示肿瘤内脂肪存在，１８例囊内出现Ｒｏｋｉｔａｎｓｋｙ结节，１７例显示有钙化，牙齿或骨骼影。１９例为良性囊性畸胎瘤，１例恶变。４例发生皮样囊肿扭转，其中二例伴有同侧附件出血坏死。ＣＴ和Ｂ超对本病的确诊率分别为１００％和６５％。结论：ＣＴ是确诊囊性畸胎瘤及其并发症的主要检查方法。肿瘤内脂肪是其最基本的表现，结合囊内Ｒｏｋｉｔａｎｓｋｙ结节或／和钙化、牙齿、骨骼，诊断即可成立。     

卵巢畸胎瘤的CT诊断（附21例分析）

笔者分析了２１例卵巢畸胎瘤的ＣＴ表现。囊性畸胎瘤表现为脂肪密度肿块；囊实性畸胎瘤伴有结节状软组织密度影，可伴有钙化和骨化。并对卵巢畸胎瘤的ＣＴ诊断与鉴别诊断作了简要的讨论。     

卵巢成熟性囊性畸胎瘤的CT诊断价值(附23例分析)

目的：探讨卵巢成熟性囊性畸胎瘤的CT表现特点及其诊断价值。方法：回顾性分析23例经手术病理证实的24个卵巢成熟性囊性畸胎瘤的CT及B超影像资料,结合病理讨论其CT表现特点。结果：本组成熟性囊性畸胎瘤均显示脂肪密度区。13个显示“浮球征”,12个有脂－液平面,123个囊壁钙化呈点状,条状或小团块状,4个分隔软组织内钙化,3个囊内骨化影和软组织混杂密度影,4个未见钙化影,7例发生蒂扭转。CT与B超对本病的诊断准确率分别为100％和69．6％。结论：成熟性囊性畸胎瘤有其特殊的CT表现,与B超相比,诊断上CT更具优越性。     

卵巢肿瘤的CT诊断与鉴别诊断

目的：提高卵巢肿瘤CT诊斯的正确性。材料和方法：回顾28例37个经手术病理证实卵巢肿瘤CT资料，分析肿块车身CT特征(囊性，实性，囊实性)，及其伴同变化。讨论良、恶性卵巢肿瘤的定位与定性诊斯。结果：全腹部，大间距，多次的CT检查技术可对较大的卵巢肿瘤与卵巢外肿块作出鉴别。囊性肿块80%为良性，实性肿块87．6%为恶性，而囊实性肿块的良、恶性分别为57.14%与与42．86％。结合肿块外形轮廓、囊实性成分比例、伴发的腹水及邻近脏器变化等CT表现可对本组术前误诊病例及CT表现不典型者作出良、恶性鉴别。结论：CT检查可对卵巢肿瘤的定位及良、恶性作出定性诊断。     

Lipomatous tumors of the pelvis in women: spectrum of imaging findings

Pelvic tumors that contain fat are common findings in women. Although the majority of these lipomatous tumors are benign cystic ovarian teratomas, other diseases should be considered in the differential diagnosis: malignant degeneration of a benign cystic ovarian teratoma, nonteratomatous lipomatous ovarian tumors, lipomatous uterine tumors, benign pelvic lipomas, and pelvic liposarcomas. Although these diseases are rare, their differentiation can be clinically significant. While most of these tumors are treated by surgical excision, asymptomatic lipomatous uterine tumors and benign pelvic lipomas may require no therapy. Additionally, correct identification of a malignant lipomatous tumor will affect both prognosis and surgical planning. The purpose of this essay is to illustrate the imaging findings of these conditions.     

Role of diffusion MRI and proton magnetic resonance spectroscopy in characterization of ovarian neoplasms

Introduction

Adnexal masses are a common clinical problem and considered as the leading indication for gynecological surgery. The ovary and adnexal structures are relatively difficult to image with any technology. Magnetic resonance spectroscopy (MRS) can detect metabolic changes. As molecular changes often precede morphologic alterations, sensitivity is expected to improve by MRS. Diffusion weighted magnetic resonance imaging (DW-MRI) is sensitive to molecular diffusion which is due to random microscopic translational motion of molecules (known as Brownian motion). In the event of morphologic evaluation of cystic ovarian tumors, whether benign or malignant, DW-MR imaging and calculated apparent diffusion coefficient (ADC) values would be useful for evaluation.

Purpose

The aim of this study is to evaluate the role of diffusion MRI & proton magnetic resonance spectroscopy (H-MRS) in diagnosis of ovarian neoplasms.

Subjects and methods

This study included 20 patients, their ages ranged from 20 to 72 years. In all cases, diagnosis was proven by surgical and pathological examination. Trans-abdominal ultrasound (n = 20) and trans-vaginal ultrasound (n = 11) were included in our routine protocol to obtain baseline information preceding MR examination. The routine MR examination protocol included: T1WI, T2WI, and post contrast fat suppressed T1WI. Diffusion weighted imaging (DWI) was done to all patients at b0, b500, b1000 and ADC values were calculated. MRS was performed in all cases using multi-voxel point resolved surface coil spectroscopy (PRESS sequence) for volume localization.

Results

Fourteen cases (70%) had benign ovarian masses while the remaining six cases (30%) had malignant masses. High lipid peak was detected in all three cases of mature cystic teratoma. All cases of simple serous cysts showed choline and creatine signals that were higher than the average noise level but lower than the two fold higher noise level. Sharp choline peak was detected in all malignant ovarian masses (except a case of metastases under chemotherapy) as well as the case of fibroma. Creatine signal was detected in all benign and malignant masses except two cases of mature cystic teratoma and cases of endometrioma. Lactate signal was detected only in cases of hemorrhagic cysts, mature cyst teratoma and one case of endometrioma and not obtained in any of malignant lesions except dysgerminoma. High NAA signal was detected in dysgerminoma and all three cases of mature cystic teratomas. The mean Cho/Cr ratio was significantly higher in malignant than benign ovarian masses (<0.05), there was no significant difference in mean and lowest ADC values between malignant and benign lesions.

Conclusion

Proton MRS using Cho/Cr ratio added useful information for the diagnosis of different ovarian neoplasms. Direct visual assessment of DWI of ovarian lesions is not useful in differentiating benign from malignant ovarian lesions; determining the threshold of the ADC for diagnosing cystic ovarian tumors is difficult because of their large variance. Further experience with a larger and more biologically variable range of tumors is recommended.