Diagnostic Parameters to Differentiate Benign From Malignant Ovarian Masses With Contrast‐Enhanced Transvaginal Sonography

Objective. The aim of this study was to evaluate diagnostic parameters to differentiate between benign versus malignant ovarian masses using contrast‐enhanced transvaginal sonography (TVS). Methods. Thirty‐three consecutive patients with 36 morphologically abnormal ovarian masses (solid or cystic with papillary excrescences, focally thickened walls, or irregular solid areas) smaller than 10 cm received a microbubble contrast agent intravenously while undergoing pulse inversion harmonic TVS. The following parameters were assessed: presence of contrast enhancement, time to peak enhancement, peak contrast enhancement, half wash‐out time, and area under the enhancement curve (AUC). Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors. Results. Twenty‐six benign masses and 10 malignancies were studied. Of all examined criteria, an AUC of greater than 787 seconds^?1 was the most accurate diagnostic criterion for ovarian cancer, with 100.0% sensitivity and 96.2% specificity. Additionally, peak contrast enhancement of greater than 17.2 dB (90.0% sensitivity and 98.3% specificity) and half wash‐out time of greater than 41.0 seconds (100.0% sensitivity and 92.3% specificity) proved to be useful. Conclusions. Our data suggest that the AUC, peak enhancement, and half wash‐out time had the greatest diagnostic accuracy for contrast‐enhanced TVS in differentiation between benign and malignant ovarian masses.     

超声造影定量分析鉴别诊断卵巢良恶性肿瘤

目的 探讨CEUS在鉴别诊断卵巢良恶性肿瘤中的应用价值。 方法 纳入因卵巢肿瘤接受手术的患者48例,共51个肿块,于术前1周内行经腹CEUS检查,动态观察肿瘤的造影增强模式,绘制肿瘤ROI时间-强度曲线并获得峰值强度(I_max)、上升时间(RT)、达峰时间(TTP)、平均渡越时间(mTT)及曲线下面积(AUC);比较良恶性肿瘤间各参数差异。 结果 51个肿块中,良性肿瘤24个,恶性肿瘤27个;CEUS中良性肿瘤呈均匀增强,恶性肿瘤呈不均匀增强;恶性肿瘤造影剂I_max、AUC和mTT均大于良性肿瘤(P均<0.05), 而RT和TTP二者间差异无统计学意义(P均>0.05)。 结论 CEUS可准确评价肿瘤内血流灌注特点,在鉴别诊断卵巢良恶性肿瘤中有重要应用价值。     

卵巢-附件报告和数据系统(O-RADS)定性诊断卵巢肿瘤效能北大核心CSCD

目的观察卵巢-附件报告和数据系统(O-RADS)定性诊断卵巢肿瘤的效能。方法回顾性分析800例卵巢肿瘤患者的术前超声资料,以O-RADS对之分类。以病理结果为金标准,计算O-RADS定性诊断卵巢肿瘤的敏感度、特异度等;绘制受试者工作特征(ROC)曲线,获得曲线下面积(AUC)。结果共纳入800例患者、836个卵巢肿瘤病灶,病理诊断良性591个、恶性(含交界性)245个;包括617个上皮-间叶肿瘤(良性399个、恶性218个)、106个生殖细胞肿瘤(良性96个、恶性10个)及55个性索-间质肿瘤(良性40个、恶性15个)。以O-RADS>3类为最佳截断值,O-RADS分类鉴别卵巢良恶性肿瘤的敏感度为96.73%(237/245),特异度为86.29%(510/591),AUC为0.962;鉴别良、恶性上皮-间叶肿瘤、生殖细胞肿瘤及性索-间质肿瘤的敏感度分别为97.25%(212/218)、90.00%(9/10)及93.33%(14/15),特异度分别为84.96%(339/399)、86.46%(83/96)及85.00%(34/40),AUC分别为0.963、0.926及0.923。结论O-RADS可定性诊断卵巢肿瘤及鉴别诊断不同病理类型卵巢良、恶性肿瘤。     

基于常规T2WI灰度共生矩阵纹理参数鉴别诊断卵巢实性肿瘤良恶性

目的 探讨基于常规T2WI的灰度共生矩阵（GLCM）纹理参数鉴别诊断良恶性卵巢实性肿瘤的价值。方法 回顾性分析经病理证实的19例卵巢原发实性良性肿瘤和27例恶性肿瘤患者的术前MRI和临床资料。采用Image J软件于轴位T2WI提取病灶的GLCM纹理参数,包括能量、对比、相关、逆差距和熵,比较卵巢实性良恶性肿瘤间各参数的差异;绘制ROC曲线,评价其鉴别诊断卵巢实性良恶性肿瘤的效能。结果 卵巢实性恶性肿瘤的熵和对比高于良性肿瘤,逆差距和能量低于良性肿瘤（P均<0.05）;而相关差异无统计学意义（P=0.074）。ROC曲线结果显示,能量、对比、逆差距和熵诊断卵巢实性良恶性肿瘤的AUC值分别为0.70、0.68、0.74和0.81（P均<0.05）,敏感度分别为68.4%、74.1%、73.7%和77.8%,特异度分别为77.8%、68.4%、77.8%和73.7%。结论 基于T2WI的GLCM纹理参数鉴别诊断良恶性卵巢实性肿瘤具有一定价值,其中熵值的诊断效能较高。     

Quantitative dynamic contrast-enhanced MR imaging for differentiating benign,borderline, and malignant ovarian tumors

Purpose

This study aimed to investigate the diagnostic performance of quantitative DCE-MRI for characterizing ovarian tumors.

Methods

We prospectively assessed the differences of quantitative DCE-MRI parameters (K^trans, k_ep, and v_e) among 15 benign, 28 borderline, and 66 malignant ovarian tumors; and between type I (n = 28) and type II (n = 29) of epithelial ovarian carcinomas (EOCs). DCE-MRI data were analyzed using whole solid tumor volume region of interest (ROI) method, and quantitative parameters were calculated based on a modified Tofts model. The non-parametric Kruskal–Wallis test, Mann–Whitney U test, Pearson’s chi-square test, intraclass correlation coefficient (ICC), variance test, and receiver operating characteristic curves (ROC) were used for statistical analysis.

Results

The largest K^trans and k_ep values were observed in ovarian malignant tumors, followed by borderline and benign tumors (all P < 0.001). K_ep was the better parameter for differentiating benign tumors from borderline and malignant tumors, with a sensitivity of 89.3% and 95.5%, a specificity of 86.7% and 100%, an accuracy of 88.4% and 96.3%, and an area under the curve (AUC) of 0.94 and 0.992, respectively, whereas K^trans was better for differentiating borderline from malignant tumors with a sensitivity of 60.7%, a specificity of 78.8%, an accuracy of 73.4%, and an AUC of 0.743. In addition, a combination with k_ep could further improve the sensitivity to 78.9%. The median K^trans and k_ep values were significantly higher in type II than in type I EOCs.

Conclusion

DCE-MRI with volume quantification is a technically feasible method, and can be used for the differentiation of ovarian tumors and for discriminating between type I and type II EOCs.

     

Contrast-enhanced sonography in the examination of benign and malignant adnexal masses.

Our objective was to characterize the properties of an intravascular ultrasonographic contrast agent in examination of adnexal masses and to compare contrast agent properties between benign and malignant adnexal tumors. Fifty-eight consecutively examined women with suspected ovarian tumors were examined preoperatively by power Doppler ultrasonography, first without and then with contrast agent enhancement (Levovist). Fourteen women had ovarian cancer, 3 had borderline ovarian tumors, 18 had benign ovarian neoplasms, and 23 had functional adnexal cystic masses or endometriomas. The effect of the contrast agent was evaluated visually and by using computerized power Doppler signal intensity measurements. In visual evaluation, the brightness of the power Doppler signal and the amount of recognizable vascular areas increased in each tumor after contrast agent administration. The number of vessels in power Doppler ultrasonograms, both before and after contrast agent enhancement, was significantly higher in malignant than in benign adnexal masses, as also was the increase in the number of recognizable vessels after contrast agent administration. Contrast agent uptake time was significantly shorter in malignant than in benign tumors. No significant differences were found in the power Doppler signal intensities or their changes between benign and malignant tumors. In conclusion, use of sonographic contrast agent facilitates imaging of tumor vessels. For differentiation of benign and malignant tumors, the kinetic properties of the contrast agent, such as uptake and washout times, may have more potential than the use of the contrast agent in anatomic imaging of the tumor vessels.     

Ultrasound diagnosis of serous surface papillary borderline ovarian tumor: A case series with a review of the literature

Serous surface papillary borderline ovarian tumors (SSPBOTs) are a rare morphologic variant of serous ovarian tumors that are typically confined to the ovarian surface, while the ovaries themselves tend to appear normal in size and shape. In this report, we describe the findings from five premenopausal women diagnosed with SSPBOTs, in whom ultrasound showed grossly normal ovaries that were partially or wholly covered with irregular solid tumors. In all five cases, histologic examination showed evidence of borderline serous tumors. These findings demonstrate that SSPBOTs can be diagnosed on a preoperative sonographic examination, which could facilitate conservative, fertility‐sparing surgery in young women affected by this condition. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 43 :573–577, 2015     

Contrast-enhanced sonography helps in discrimination of benign from malignant adnexal masses.

OBJECTIVE: To investigate the potential efficacy of real-time contrast-enhanced power Doppler sonography in the differentiation of benign and malignant adnexal masses in a pilot study. METHODS: Before surgical treatment, adnexal masses were prospectively evaluated with power Doppler sonography before and after injection of a contrast agent. Real-time postinjection sequences were computerized with time-intensity analysis software to determine an enhancement curve and contrast parameters. The intraobserver and interobserver reproducibilities of these criteria were assessed on a subsample. These contrast parameters were compared between benign and malignant tumors using logistic regression. Sensitivity and specificity were used to compare contrast parameters with sonographic and Doppler variables. RESULTS: Ninety-nine women were included, for a total of 101 adnexal masses. There were 23 cases of ovarian malignancies and 78 benign adnexal lesions. Our procedure had excellent intraobserver and interobserver reproducibility, with an average intraclass correlation coefficient of 0.92. The time before enhancement and intensity ratio did not reliably differentiate between the benign and malignant masses. Washout times and areas under the curves were significantly greater in ovarian malignancies than in other benign tumors (P < .001), leading to sensitivity estimates between 96% and 100% and specificity estimates between 83 and 98%. Contrast parameters had slightly higher sensitivity and slightly lower specificity when compared with transvaginal sonographic variables of the resistive index and serum cancer antigen 125 levels. CONCLUSIONS: Contrast-enhanced power Doppler imaging may easily and precisely discriminate benign from malignant adnexal lesions. Larger studies are needed to determine the appropriate use and benefits of this new procedure.     

MRI tumor characterization using Gd‐GlyMe‐DOTA‐perfluorooctyl‐mannose‐conjugate (Gadofluorine M™), a protein‐avid contrast agent

The rationale and objectives were to define the MRI tumor‐characterizing potential of a new protein‐avid contrast agent, Gd‐GlyMe‐DOTA‐perfluorooctyl‐mannose‐conjugate (Gadofluorine M?; Schering AG, Berlin, Germany) in a chemically induced tumor model of varying malignancy. Because of the tendency for this agent to form large micelles in water and to bind strongly to hydrophobic sites on proteins, it was hypothesized that patterns of dynamic tumor enhancement could be used to differentiate benign from malignant lesions, to grade the severity of malignancies and to define areas of tumor necrosis. Gadofluorine M, 0.05 mmol Gd kg^?1, was administered intravenously to 28 anesthetized rats that had developed over 10 months mammary tumors of varying degrees of malignancy as a consequence of intraperitoneal administration of N‐ethyl‐N‐nitrosourea (ENU), 45–250 mg kg^?1. These tumors ranged histologically from benign fibroadenomas to highly undifferentiated adenocarcinomas. Dynamic enhancement data were analyzed kinetically using a two‐compartment tumor model to generate estimates of fractional plasma volume (fPV), apparent fractional extracellular volume (fEV*) and an endothelial transfer coefficient (K^PS) for this contrast agent. Tumors were examined microscopically for tumor type, degree of malignancy (Scarff–Bloom–Richardson score) and location of necrosis. Eighteen tumor‐bearing rats were successfully imaged. MRI data showed an immediate strong and gradually increasing tumor enhancement. K^PS and fEV*, but not fPV obtained from tumors correlated significantly (p < 0.05) with the SBR tumor grade, r = 0.65 and 0.56, respectively. Estimates for K^PS and fEV* but not fPV were significantly lower in a group consisting of benign and low‐grade malignant tumors compared with the group of less‐differentiated high‐grade tumors (1.61 ± 0.64 vs 3.37 ± 1.49, p < 0.01; 0.45 ± 0.17 vs 0.78 ± 0.24, p < 0.01; and 0.076 ± 0.048 vs 0.121 ± 0.088, p = 0.24, respectively). It is concluded that the protein‐avid MRI contrast agent Gadofluorine M enhances tumors of varying malignancy depending on the tumor grade, higher contrast agent accumulation for more malignant lesions. The results show potential utility for differentiating benign and low‐grade malignant lesions from high‐grade cancers. Copyright © 2006 John Wiley & Sons, Ltd.     

Contrast-enhanced transvaginal sonography of benign versus malignant ovarian masses: preliminary findings.

OBJECTIVE: The aim of this prospective study was to evaluate differences in contrast enhancement and contrast enhancement kinetics in benign versus malignant ovarian masses with pulse inversion harmonic transvaginal sonography. METHODS: Seventeen consecutive patients with 23 morphologically abnormal ovarian masses (solid or cystic with papillary excrescences, focally thickened walls, or irregular solid areas) smaller than 10 cm received a microbubble contrast agent intravenously while undergoing pulse inversion harmonic transvaginal sonography. The following parameters were assessed in all tumors: detectable contrast enhancement, time to peak enhancement (wash-in), peak contrast enhancement, half wash-out time, and area under the enhancement curve. Tumor histologic analysis was used to distinguish benign from malignant ovarian tumors. RESULTS: Fourteen benign masses and 9 malignancies were studied. There was a statistically significant difference in the peak enhancement (mean +/- SD, 23.3 +/- 2.8 versus 12.3 +/- 3.9 dB; P < .01), half wash-out time (139.9 +/- 43.6 versus 46.3 +/- 19.7 seconds; P < .01), and area under the enhancement curve (2012.9 +/- 532.9 versus 523.9 +/- 318 seconds(-1); P < .01) in malignant masses compared with benign disease. There was no statistically significant difference in the time to peak enhancement (26.1 +/- 6.3 versus 24.9 +/- 7.6 seconds; P = .07). CONCLUSIONS: Overall, our data showed a significant difference in the contrast enhancement kinetic parameters between benign and malignant ovarian masses.     

妊娠合并卵巢肿瘤超声诊断分析

目的总结妊娠合并卵巢肿瘤超声及手术病理特征。方法以术后病理诊断为标准,对北京协和医院1990年10月至2013年9月收治的105例妊娠合并卵巢肿瘤孕妇的超声表现、手术治疗方法及妊娠结局进行总结分析,比较良性肿瘤与交界性和低度恶性肿瘤超声声像图特征。结果 105例孕妇妊娠期超声检查发现58例65个卵巢肿瘤,剖宫产手术发现49例49个卵巢肿瘤。105例114个卵巢肿瘤（单侧96例、双侧9例）超声及手术病理诊治结果：（1）65个卵巢肿瘤术前超声表现：二维超声显示58个肿瘤形态规则、边界清晰,内部多见强回声或中高回声区,且多数肿瘤内壁无乳头状突起（50/58）;超声诊断为良性肿瘤50个,8个肿瘤未作出定性诊断;术后病理诊断卵巢良性肿瘤58个;术前二维超声显示7个肿瘤形态规则,边界清晰,内壁多见乳头状突起（5/7）,超声诊断5个肿瘤不除外恶性,2个肿瘤未作出定性诊断,术后病理诊断交界性肿瘤6个,低度恶性肿瘤1个。（2）肿瘤来源：超声检查及剖宫产手术发现的114个卵巢肿瘤病理检查证实为良性肿瘤107个,交界性肿瘤6个,低度恶性肿瘤1个。其中卵巢生殖细胞肿瘤84个,上皮性肿瘤19个,性索间质肿瘤9个,生殖细胞肿瘤合并上皮性肿瘤2个。（3）手术治疗方法：早孕期手术治疗7例,剔除肿瘤8个,中孕期手术治疗11例,剔除肿瘤11个,晚孕期剖宫产术中治疗87例,剔除肿瘤95个。（4）妊娠结局：105例孕妇足月分娩82例,因重度子痫、胎膜早破等指征早产18例,早孕期人工流产4例,中孕期引产1例;105例孕妇手术治疗后围生儿均安全。结论妊娠合并卵巢肿瘤多为良性,超声多表现为单侧肿瘤、形态规则、边界清晰、内部可见强回声或中高回声区、内壁无乳头状突起;少数交界性及低度恶性肿瘤超声表现为单侧肿瘤、形态规则、边界清晰、内壁可见乳头状突起。妊娠期超声     

Correlation of Quantified Contrast‐Enhanced Sonography With In Vivo Tumor Response

Objective.. The purpose of our study was to establish in vivo criteria for monitoring tumor treatment response using 3‐dimensional (3D) volumetric gray scale, power Doppler, and contrast‐enhanced sonography. Methods.. Twelve mice were implanted with Lewis lung carcinoma cells on their hind limbs and categorized to 4 groups: control, chemotherapy, radiation therapy, and chemoradiation. A high‐frequency ultrasound system with a 40‐MHz probe was used to image the tumors. Follow‐up contrast‐enhanced sonography was performed on days 7 and 14 of treatment with two 50‐μL boluses of a perflutren microbubble contrast agent injected into the tail vein. The following contrast‐enhanced sonographic criteria were quantified: time to peak, peak intensity, α (microvessel cross‐sectional area), and β (microbubble velocity). Three‐dimensional power Doppler images were also obtained after the acquisition of contrast data. On day 15, the tumors were excised for immunohistochemical analysis with CD31 fluorescent staining. Results.. The tumor size and 3D power Doppler vascular index showed no statistically significant correlation with microvascular density in all examined groups. Among all of the analyzed contrast‐enhanced sonographic parameters, relative α showed the strongest correlation with the histologic microvessel density (Pearson r = 0.93; P < .01) and an independent association with the histologic data in a multiple regression model (beta = .93; R² = 0.86; P < .01). Conclusions.. Of the various examined sonographic parameters, α has the strongest correlation with histologic microvessel density and may be the parameter of choice for the noninvasive monitoring of tumor angiogenic response in vivo.     

Ultrasound features of different histopathological subtypes of borderline ovarian tumors.

OBJECTIVE: To describe the gray-scale sonographic and color Doppler imaging features of the most common histopathological subtypes of borderline ovarian tumors. METHODS: We analyzed retrospectively the preoperative transvaginal sonographic reports of patients with a histological diagnosis of borderline ovarian tumor. All patients were scanned consecutively by two of the investigators using transabdominal and transvaginal gray-scale imaging to assess the morphology and color Doppler to obtain indices of the blood flow. Sonographic findings were compared to histopathological data. RESULTS: A total of 113 consecutive cases were reviewed from two referral centers for gynecological oncology. At histological examination 50 tumors (44%) were classified as being serous borderline ovarian tumors (SBOT), 61 (54%) were mucinous borderline ovarian tumors (MBOT) (42 intestinal type and 19 endocervical type), and two patients (2%) presented with borderline endometrioid tumors. SBOTs and endocervical-type MBOTs had very similar sonographic features and a smaller diameter, fewer locules (usually unilocular-solid lesions) and a higher color score than intestinal-type MBOTs. Intestinal-type MBOTs were characterized by a significantly higher percentage of lesions with > 10 locules when compared with the endocervical-type MBOTs. CONCLUSION: Intestinal-type MBOTs have different sonographic features from other common borderline ovarian tumors.     

超声造影在卵巢肿瘤良恶性鉴别诊断中的意义

目的 使用造影剂SonoVue分析卵巢病变的超声造影特点,评估其对卵巢良恶性病变的鉴别诊断价值。方法 使用常规超声和超声造影观察卵巢病变,分析经手术后病理证实的36例卵巢良恶性病变的超声造影特点。结果 36例卵巢病变患者中良性病变22例,恶性病变14例。22例良性病变中,常规超声检出19例为混合性病变,1例为囊性病变,2例无明显病变;超声造影检出6例为混合性病变,14例为囊性或类囊性病变,2例无明显病变。14例恶性病变中,常规超声检出9例为实性病变,5例为混合性病变;超声造影检出5例为实性病变,9例为混合性病变。时间强度曲线显示良性病变呈缓升缓降型,恶性病变呈速升速降型。与良性病变比较,恶性病变的始增时间、达峰时间、始增强度及峰值强度差异无统计学意义,但增强时间、增强强度及增强速率比较,差异有统计学意义。结论 超声造影能准确判断病变的囊实性,分析卵巢良恶性病变的灰阶造影增强方式、时间强度曲线形态及各参数值,能进一步提高鉴别诊断率。     

胃肠道间质瘤的多层螺旋CT诊断

目的提高对胃肠道间质瘤(GIST)的认识和影像学诊断水平。方法回顾性分析17例GIST的临床及多层螺旋CT(MSCT)资料。结果病灶分布于胃11例,十二指肠1例,空肠1例,回肠1例,结肠1例,直肠2例;肿瘤平均直径5.5cm。病理分型:良性5例,交界性2例,恶性10例。CT主要表现为圆形或类圆形软组织肿块,具有跨越腔内外生长或以腔外生长为主特性。良性5例,直径均小于5cm,平扫密度均匀,增强扫描肿块明显均匀强化。恶性及交界性GIST中有8例直径大于5cm(8/12),肿块不规则,密度不均匀,增强后肿块不均匀强化,内部出血、坏死、囊变明显,局部淋巴结无转移。结论 GIST是一类潜在恶性的肿瘤,MSCT检查对GIST的定位、定性诊断及治疗方案的制定具有重要作用。     

乳腺X线摄影及超声鉴别诊断乳腺叶状肿瘤与纤维腺瘤

目的 探讨乳腺X线摄影及超声诊断及鉴别诊断乳腺叶状肿瘤与纤维腺瘤的价值。方法 回顾性分析并比较经病理证实的110例乳腺叶状肿瘤和102例纤维腺瘤患者的临床、X线和超声特征。结果 乳腺纤维腺瘤最大径（2.71±1.44）cm,叶状肿瘤最大径（4.61±3.35）cm,差异有统计学意义（P<0.001）。乳腺良性与恶性叶状肿瘤最大径差异有统计学意义（P=0.024）。X线检查发现乳腺叶状肿瘤与纤维腺瘤在形状、边界、密度及内部钙化差异均有统计学意义（P均<0.05）;超声发现两者形状、边界、内部囊变、后方回声及血流分级差异均有统计学意义（P均<0.05）。良性、交界性与恶性叶状肿瘤中,肿块内部是否囊变差异有统计学意义（P=0.006）。结论 综合分析乳腺X线、超声及临床特点可以初步鉴别乳腺纤维腺瘤与叶状肿瘤,当肿块最大径>3.0 cm,呈分叶状高密度、伴有内部囊变、血流信号较丰富时提示叶状肿瘤。     

不同勾画感兴趣区方法鉴别肾富血供良、恶性小肿瘤

目的 评估不同勾画ROI方式对于鉴别肾富血供良、恶性肿瘤的价值。方法 回顾性分析经病理证实的88例肾富血供小肿瘤的术前腹部CT。其中肾细胞癌（RCC）62例（RCC组）,包括60例肾透明细胞癌（CCRCC）和2例肾嫌色细胞癌（CCRC）;26例良性肿瘤（良性组）,包括24例乏脂肪型肾血管平滑肌脂肪瘤（MFAML）和2例肾嗜酸细胞腺瘤（RO）。分别采用传统方法（tROI,50~100 mm²）及小ROI法（sROI,10~20 mm²）勾画ROI,测量并比较组间CT值相关参数;针对差异有统计学意义的参数绘制其鉴别RCC与良性肾肿瘤的受试者工作特征（ROC）曲线,评价其诊断效能。结果 以tROI法测量的RCC组的皮质期净强化值及相对强化值均高于良性组（P均<0.05）,其鉴别RCC与良性肾肿瘤的ROC曲线下面积（AUC）分别为0.692及0.667;以sROI法测量的RCC组皮质期CT值、实质期CT值、皮质期和实质期净强化值及相对强化值均高于良性组（P均<0.05）,其AUC分别为0.783、0.748、0.837、0.815、0.841及0.812。结论 相比tROI法,采用sROI法测量CT值定量参数对于鉴别肾富血供良、恶性肿瘤具有更高价值。     

应用超声造影时强曲线诊断盆腔肿块

目的探讨时强曲线在盆腔良恶性肿块诊断及鉴别诊断中的应用价值。方法对24例盆腔肿块患者术前进行超声造影检查,并进行时间-强度曲线(TIC)分析。结果24例中,良性肿块15例,恶性9例。良、恶性肿块在造影剂进入方式上差异无统计学意义(P>0.05);良性肿块以周边先增强为主,恶性肿块以中央先增强为主(P<0.01);造影后恶性肿块内造影剂信号上升斜率明显高于良性组(P=0.002),且恶性组增强时间短(15.22svs25.89s,P=0.049)、造影剂信号绝对强度增加值高(19.1,15.25,P=0.022)、相对强度增加值高(0.26vs0.23,P=0.04),差异有统计学意义(P<0.05)。良恶性肿块在始增时间、始增强度、峰值时间、峰值强度指标上无明显统计学差异。结论超声造影时间-强度曲线分析在盆腔良恶性肿块诊断与鉴别诊断中有较高的应用价值。     

比较乳腺动态增强MRI定量和半定量血流动力学参数鉴别乳腺良恶性病变

目的 比较乳腺动态增强MRI定量和半定量血流动力学参数鉴别诊断乳腺病变良恶性的效能。方法 采用杂合动态增强MR序列对59例患者共66个乳腺病变进行扫描，获得半定量参数和定量参数。半定量参数为时间-信号强度曲线（TIC）、初始增强曲线下面积（IAUGC）、最大增强斜率（MaxSlope）、对比增强比率（CER）及正向增强积分（PEI）；定量参数为前向容积转移常数（K^trans）、反向容积转移常数（K_ep）和每单位体积组织的血管外细胞外间隙容积（V_e）。以非参数检验比较良恶性病变间各参数的差异，并绘制ROC曲线，分析其诊断效能。结果 66个乳腺病变中，恶性31个（恶性组），良性35个（良性组），2组间K^trans、K_ep、TIC、IAUGC、MaxSlope差异均有统计学意义（P均<0.05），V_e、PEI、CER差异无统计学意义（P均>0.05）；K^trans、K_ep、TIC、IAUGC、MaxSlope的AUC均>0.7。半定量参数联合诊断乳腺病变良恶性的AUC较单个参数均有显著提高（P均<0.05）；定量参数联合后的AUC较K^trans无显著提高（P=0.134），较K_ep和V_e有显著提高（P均<0.001）。半定量联合与定量参数联合诊断诊断乳腺病变良恶性的AUC差异无统计学意义（P=0.614）。结论 K^trans、K_ep、TIC、IAUGC及MaxSlope对鉴别诊断乳腺良恶性病变具有较高效能；多参数联合，乳腺动态增强MRI半定量和定量参数诊断效能相似。     

Borderline Brenner tumor of the ovary: MRI findings

Ovarian Brenner tumor is an uncommon epithelial tumor that accounts for 1.5% to 2.5% of all ovarian neoplasms. These tumors are usually benign. Whereas the magnetic resonance imaging features of benign Brenner tumors have been described, reports of malignant findings are limited. We report a case of borderline malignant Brenner tumor that imaged as a cystic lesion with papillary projections and solid elements. Correspondence to: J. Takahama.