卵巢畸胎瘤的MRI诊断

目的:分析卵巢畸胎瘤的MRI表现,提高MRI诊断的准确性.方法:搜集经手术和病理证实的68例共70个卵巢畸胎瘤,对其MRI表现作回顾性分析.结果:70个畸胎瘤中,成熟性畸胎瘤65个,未成熟性畸胎瘤4个,卵巢甲状腺肿1个.65个成熟性畸胎瘤均为囊性,其中单房46个(71％),双房11个(17％),多房5个(8％),不完全...     

卵巢囊性腺纤维瘤MR特征及病理分析

目的：探讨卵巢囊性腺纤维瘤的MRI表现特征及病理学基础,提高对该疾病的诊断准确性。方法收集并回顾性分析14例经手术病理证实的卵巢囊性腺纤维瘤患者MRI资料,所有患者术前均行MR平扫及增强扫描。重点对病变内部结构、信号特征及增强表现进行分析归纳,明确其具有诊断价值的图像特征。结果本组13例病灶为单侧发病,1例为双侧发病。病灶最大径为3．4-14．8cm,平均约8．15cm;8例呈囊性（多囊者6例,单囊者2例）,5例呈囊实性,1例呈实性。8例囊性病变于MRI-T2WI囊壁及分隔呈低信号;囊实性病灶实性成份主要表现为低信号,其中并见多发小囊样高信号灶,其中2例形成较典型的“黑色海绵征”。MR增强扫描所有病灶实性成份及囊壁均呈中度或明显强化效应。结论卵巢囊性腺纤维瘤多为单侧发病,主要呈多囊性表现;肿瘤中实性成份及囊壁T2WI呈低信号,增强扫描呈轻中度强化。“黑色海绵征”是其较典型的特征表现。     

继发性卵巢腺癌的CT和MR影像特点及诊断价值

目的:探讨继发性卵巢腺癌的CT和MR影像学征象及诊断价值。方法:收集有明确病理诊断的继发性卵巢腺癌29例,其中有完整CT资料者21例,有完整MR资料者8例。CT采用常规四期扫描(平扫、动脉期、静脉期、延迟期)。扫描范围包括肝顶部至耻骨联合下水平。MR采用常规轴、矢、冠平扫及增强扫描。体线圈、呼吸门控技术。影像征象与病理结果相对照,进行回顾性分析。结果:原发灶为胃癌的10例,结肠癌12例,直肠癌6例,胆管癌1例。双侧卵巢腺癌13例,单侧卵巢腺癌16例,共42个病灶。其中I型占14.3%、Ⅱa型占4.7%、Ⅱb型占9.5%、 c型占28.6%、Ⅲ型占42.9%。肿块多数分界清楚(71.4%),出现瘤内囊19%,腹水征34.5%,淋巴结转移发生率69%等。结论:继发性卵巢腺癌为单侧或双侧卵巢发生的Ⅱc型或Ⅲ型肿块。囊实性分界清楚或肿瘤内出现瘤内囊;增强后实性成分明显强化;高的淋巴结转移发生率;合并少量或无明显腹水等征象均为其特点。掌握并擅于利用各种影像学检查方法的优势,将达到对疾病的更加准确的诊断。     

Immature teratoma of the ovary: correlation of MR imaging and pathologic findings

The objectives of this study were to describe MR imaging findings of immature teratoma and to correlate imaging findings with histopathologic findings. The MR findings of ten patients (age range 12–29 years, mean age 19.0 years) with pathologically proven immature teratoma were retrospectively reviewed for tumor size, presence and characteristics of fatty content, presence and characteristics of solid components, and presence of ascites and implants. The MR findings were compared with gross (n=3) and microscopic (n=10) findings. Comparisons between relative amounts of solid components and histologic grades were evaluated by Spearman rank-order correlation. On MR images all lesions appeared to be fat-containing tumors with solid components consisting of numerous cysts of various sizes. Solid tissue exhibited a wide variety of signal intensities on T2-weighted images. Punctate foci of fat were identified in all lesions, whereas fatty fluid was observed only in two. Predominant fluid content exhibited signal intensities similar to simple fluid in nine lesions. Ascites was observed in six lesions, and peritoneal dissemination in three. Pathologic studies confirmed scattered foci of adipose tissue in the solid portions of all cases, and revealed numerous cystic structure formations in these solid components. The correlation coefficient between the amount of solid tissue and the tumor grade was not significant (r_s=0.266). The MR images of immature teratoma tended to show aqueous fluids and the solid components consisting of numerous cysts with punctate foci of adipose tissue, whereas predominant fluid is sebaceous fluid in the vast majority of mature cystic teratomas. Electronic Publication     

卵巢内膜样癌的MRI和MRS分析

目的 探讨卵巢内膜样癌的病理结构特点与MRI和MRS表现的相关性.资料与方法 对9例经病理证实的子宫内膜样癌的大体形态、结构特点,MRI的信号特征、增强后的强化方式和程度, MRS反映的肿瘤代谢表现进行回顾性分析.结果 9例卵巢内膜样癌中,发生于左侧卵巢6例,右侧卵巢3例,其中2例合并子宫内膜癌.9例肿瘤均呈圆形或类圆形实质性肿块, T1WI呈等信号,T2WI呈略高信号,增强后呈明显强化.MRS显示肿瘤的胆碱复合物(Cho)代谢浓度明显增高.结论 卵巢内膜样癌多呈实质性肿块,与卵巢表面上皮来源性囊腺性肿瘤多呈囊实性不同,MRS显示肿瘤Cho浓度的升高可进一步明确肿瘤的恶性程度,与肿瘤的分化程度具有明显的相关性.     

卵巢畸胎瘤的不典型MRI表现

目的:分析卵巢畸胎瘤的不典型MRI表现,提高其诊断准确性.方法:搜索医院信息系统和图像存档和传输系统,发现术前有盆腔MRI检查、手术和病理证实为卵巢畸胎瘤共172例,其中14例MRI发生误诊或漏诊,我们对其MRI表现进行回顾性分析.结果:9例成熟囊性畸胎瘤误诊为囊腺瘤4例、内膜异位囊肿3例、输卵管系膜囊肿1例和漏诊变性坏死1例;2例甲状腺肿分别误诊为纤维瘤和囊腺瘤;1例成熟实性畸胎瘤和2例混合性生殖细胞瘤均误诊为未成熟畸胎瘤.MRI表现为:成熟畸胎瘤(9例)表现为囊性肿块少脂肪(4例)或无脂肪(2例)、合并内膜异位囊肿(2例)、伴并发症(1例);卵巢甲状腺肿呈实性或无脂肪(各1例),实性成熟畸胎瘤罕见表现(1例),混合性生殖细胞肿瘤(2例)分别为卵黄囊瘤和成熟性囊性畸胎瘤的混合、未成熟畸胎瘤和无性细胞瘤的混合).结论:了解卵巢畸胎瘤的MRI不典型表现有助于进一步提高畸胎瘤诊断的准确性.     

子宫肿块的MRI诊断

目的：分析子宫肿块的MRI表现，探讨MRI的诊断价值及其诊断能力。方法：对经手术理证实的38例（69个病灶）子宫肿块的MRI表现进行回顾性分析，并与超声检查相对比。结果：良性病变26例，分别为子宫平滑肌瘤、腺肌病、慢性血肿。恶性病变15例，分别为子宫内膜癌、宫颈癌、子宫平滑肌肉瘤、滋养细胞肿瘤和转移瘤。有3例良恶性肿瘤同时并存。所有病例均于T2WI显示较好，T1WI对于判断肿瘤是否宫外侵犯较有帮助。MRI对子宫肿块的检出率和诊断的正确率分别为94．2％、89．8％，均高于B超（82．6％、75．3％）。结论：MRI能较准确地显示病灶数目、大小、范围、内部结构及与周围的关系，对于判断肿瘤的良恶性及肿瘤的分期有很大价值。     

卵巢子宫内膜异位囊肿低场MR表现及诊断价值

目的:探讨卵巢子宫内膜异位囊肿的低场MRI表现及其诊断价值。方法:回顾性分析24例卵巢子宫内膜异位囊肿MRI和B超检查,全部病例手术病理证实。结果:24例32个卵巢病变共63个卵巢子宫内膜异位囊肿,单侧16例,双侧8例;21个卵巢为单发囊肿,11个卵巢为多发囊肿共42个囊肿,其中8个卵巢大囊肿周围伴有小囊肿,5个囊肿内有分隔;T1WI及T2WI均呈高信号23(36.5%)个囊肿,T1WI高信号而T2WI呈低信号19(30.2%)个囊肿,呈混杂信号17(27.0%)个囊肿,T1WI呈等或低信号而T2WI呈高信号4个囊肿;囊肿边缘光滑6个,边缘部分毛糙不清19个,边缘完全毛糙不清38个。低场MR术前诊断63个卵巢子宫内膜异位囊肿,60个与病理相符,3个病理诊断为囊腺瘤;B超术前诊断卵巢子宫内膜异位囊肿50个,未定性8个,未发现病变5个。结论:MRI和B超对卵巢子宫内膜异位囊肿的诊断检出率100%(63/63)、95%(60/63),特异性95%(60/63)、79%(50/63),低场MR对卵巢子宫内膜异位囊肿的诊断明显优于B超。     

Soft-tissue tumors update: MR imaging features according to the WHO classification

Soft-tissue tumors are a large and heterogeneous group of neoplasms. Hence, classification is often difficult. The most effective management decisions are made when a working group participates in the same diagnostic standard criteria in the evaluation of soft-tissue tumors. The purpose of this pictorial review is to highlight the new and the less well-known features on magnetic resonance (MR) imaging of soft-tissue tumors according to the World Health Organization (WHO) classification established in 2002. The article depicts the major changes of the WHO classification since it was established in 2002 and the most significant findings on MR imaging, thereby providing an update.     

卵巢冠囊肿的MRI研究

目的：分析卵巢冠囊肿的MRI表现,提高术前诊断准确性。方法：回顾性研究经手术和病理证实的50例卵巢冠囊肿患者的MRI图像,分析病灶部位、大小、形态、管壁、分隔厚度、囊液信号、增强表现及其与卵巢的关系等影像学特征。结果：50例患者共54个卵巢冠囊肿,MRI检出41个（76％）,其中囊肿同侧见相邻或分开的正常或病变卵巢25个（6l％）;囊肿边界清晰、壁薄（41／41,100％,平均厚度1．5±0．3mm）、单房（39／41,95％）、囊液信号均匀如水（41／41,100％）;囊肿因张力低而形态略欠规则的类圆形或类椭圆形（20／41,49％）;最大径大于2．0cm的囊肿易误诊（25／30,83％）,小于2．0cm者易漏诊（11／11,100％）。结论：卵巢冠囊肿的MRI表现有一定特征性,显示病灶同侧卵巢或卵巢病变为诊断的重要征象。     

磁共振弥散加权成像在肝脏占位性病变诊断中的应用

目的：探讨磁共振弥散加权成像（DWI）在肝脏占位性病变中的应用价值。方法：对30例无肝脏病变者的正常肝组织及92例肝占位性病灶（肝囊肿16例,肝血管瘤29例,肝细胞癌19例,肝转移瘤16例,胆管细胞癌12例）行DWI检查,并测量表观弥散系数值（ADC值）。结果：正常肝组织的ADC值为（0．0011790±0．0000960）mm^2／s。肝囊肿、肝血管瘤、肝细胞癌、肝转移瘤及胆管细胞癌的ADC值分别为（0．0029894±0．0003620）、（0．0021921±0．0006004）、（0．0016763±0．0003620）、（0．0020450±0．01302446）、（0．0011615±0．0002702）mm^2／s。结论：分析DWI图像及测量ADE值对肝脏占位性病变的鉴别诊断有一定价值,有利于小病灶的显示,可作为肝脏MRI检查的常规序列之一。     

MR梯度回波T2^＊WI检出脑微出血

目的：MR梯度回波T2^＊WI可检出无症状性脑微出血,本研究旨在探讨脑微出血的发生率、部位以及与高血压、脑卒中、脑室周围白质高信号的相关性。方法：在1年时间内共有375例患者在常规MRI／序列的基础上加扫T2^＊加权序列,排除了存在脑血管畸形出血、颅内占位、外伤、手术史等病例,共有324例进行分析处理。结果：脑微出血37例,总的发生率为11．4％,尤其位于基底节／放射冠（n=22）、丘脑（n=15）、小脑（n=14）和脑叶区域（n=15）,脑微出血主要见于存在脑中风史病例,与年龄、高血压、脑白质疏松症（脑室周围白质高信号）存在相关性（P〈0．001）。在2年多的影像学随访过程中,共发现2例（5．4％）出现新鲜脑出血。结论：MR T2^＊加权像可用于检出脑微出血,其发生提示存在脑微小血管病变,存在继发出血的可能性,建议对于60岁以上的老年人尤其是存在脑中风的病例,MR T2^＊加权应作为常规扫描序列。     

The role of magnetic resonance imaging and ultrasound in patients with adnexal masses

AIMS: To evaluate the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in characterizing adnexal masses, and to determine which patients may benefit from MRI. METHODS: We prospectively studied 72 women (mean age 53 years, range 19 to 86 years) with clinically suspected adnexal masses. A single experienced sonographer performed transabdominal and transvaginal greyscale spectral and colour Doppler examinations. MRI was carried out on a 1.5T system using T1, T2 and fat-suppressed T1-weighted sequences before and after intravenous injection of gadolinium. The adnexal masses were categorized as benign or malignant without knowledge of clinical details, according to the imaging features which were compared with the surgical and pathological findings. RESULTS: For characterizing lesions as malignant, the sensitivity, specificity and accuracy of MRI were 96.6%, 83.7% and 88.9%, respectively, and of US were 100%, 39.5% and 63.9%, respectively. MRI was more specific (p<0.05) than US. Both MRI and US correctly diagnosed 17 (24%) cases with benign and 28 (39%) cases with malignant masses. MRI correctly diagnosed 19 (26%) cases with benign lesion(s), which on US were thought to be malignant. The age, menopausal status and CA-125 levels in these women made benign disease likely, but US features were suggestive of malignancy (large masses and solid-cystic lesions with nodules). CONCLUSION: MRI is more specific and accurate than US and Doppler assessment for characterizing adnexal masses. Women who clinically have a relatively low risk of malignancy but who have complex sonographic features may benefit from MRI.     

Solid non-invasive ovarian masses on MR: Histopathology and a diagnostic approach

Purpose

The purpose is to clarify the histopathology of the solid, non-invasive ovarian masses and to investigate the MR characteristics that distinguish benign from malignant.

Materials and methods

From 1996 to 2008, we identified 38 cases with predominantly solid non-invasive ovarian masses examined by contrast MR. We evaluated the signal intensity on T2WI and degree of contrast enhancement. In 31 of these cases with dynamic contrast study, we classified the enhancing patterns of the masses into gradually increasing and plateau after rapid increase patterns.

Result

Sixteen cases were benign sex-cord stromal tumors, three were other types of benign tumors, nine cases were diagnosed with primary malignant ovarian tumors, and 10 showed metastatic tumors. Low intensity on T2WI was observed in 15 benign and 2 malignant tumors. The gradually increasing pattern was observed in all 17 benignancies and 5 of the 14 malignancies. In the equilibrium phase, the masses were weakly enhanced in all 19 benignancies and only 4 of 19 malignancies. The diagnostic criteria, that low signal intensity masses with gradual weak enhancement are benign showed 93.3% accuracy and 100% positive predictive value.

Conclusion

Benign solid ovarian masses tended to show low signal intensity on T2WI and gradual weak enhancement.     

MR扩散加权成像在眼眶良恶性肿块鉴别诊断中的应用

目的 分析眶内良恶性肿块的扩散加权成像(DWI)特征,评价表观扩散系数(ADC)值对其诊断价值.方法 对77例眶内肿块进行常规MRI及DWI,其中良性肿块55例,恶性肿块22例.扩散敏感系数(b)值=0、1000 s/mm2,测量病变对侧颞叶脑白质感兴趣区DWI信号,获得相应的肿块区ADC(ADCM)值、病变对侧颞叶脑白质ADC(ADCw)值,计算二者比值(ADCR).以不同ADCM值及ADCR作为临界点区分眶内良恶性肿块绘制出受试者工作特征曲线(ROC).结果 眶内良性肿块ADCM值及ADCR分别为(1.56±0.75)×10-3mm2/s、1.85±0.91;恶性肿块ADCM值及ADCR分别为(1.09±0.42)×10-3mm2/s、1.28±0.53;良性肿块ADCM值及ADCR显著高于恶性肿块(t值分别为2.803、2.735,P值均＜0.01).以不同ADCM值、ADCR作为临界点判断眶内良恶性肿块绘制ROC,曲线下面积均为0.71±0.07.以ADCM值为1.05×10-3mm2/s作为判断眶内良恶性肿块的决定值,灵敏度、特异度和准确率分别为59.1%(13/22)、78.2%(43/55)和72.7%(56/77);以ADCR为1.24作为决定值,灵敏度、特异度和准确率分别为59.1%(13/22)、76.4%(42/55)和71.4%(55/77).结论 DWI可揭示眼眶肿块的扩散特征,ADC值对于良恶性肿块的鉴别诊断具有辅助诊断价值.     

眼眶肿瘤的氢质子磁共振波谱的临床应用研究

目的:总结眼眶病变MRS特征,研究其生化指标,以及对诊断和鉴别诊断的意义。方法:全部病例共40例,均为单发病灶,行MRI和MRS检查。术后均得到病理证实。其中良性肿瘤和类肿瘤病变30例,恶性肿瘤10例。结果:对照组和肿瘤组比较,不同的眼眶肿瘤,各化合物的变化不同,同对照组比较,眼眶肿瘤NAA均有不同程度下降(P<0.05),海绵状血管瘤下降达52.5%,而小细胞性恶性肿瘤和腺样囊性癌升高明显。良性肿瘤和恶性肿瘤的比较,Cho、Ace和Lac峰有明显差异,恶性肿瘤组明显高于良性肿瘤组。Cr峰相差不明显。Cho/Cr比值有明显增高。结论:肿瘤和正常脑组织的波谱有区别。表现在Lac、Ace的不同变化特征。良性肿瘤和恶性肿瘤的MRS波峰有明显差异,表现为Cho,Cr峰值增高,尤其是Cho/Cr比值的增高,此外Lac和Ace在恶性肿瘤增高明显,提示可作为区别肿瘤与非肿瘤的标志之一。     

卵巢内膜样腺癌的MRI表现

目的:探讨卵巢内膜样腺癌(OEC)的MRI表现,提高对该病的认识.方法:回顾性分析经手术和病理证实的20例OEC的MRI表现,观察肿瘤的部位、形态、大小、肿块质地、壁结节、信号强度、强化程度、腹膜种植灶、腹水、同时伴发子宫内膜癌的双原发癌(DPC)、子宫内膜息肉、子宫内膜异位症及临床分期等情况.结果:20例OEC共22个病灶,单侧发病18例(90％),双侧2例(10％),DPC 10例(50％).13个(59％)病灶呈卵圆形,最大径约(11.2±5.1) cm(3.7～22.5 cm).病灶呈囊性为主伴壁结节15个(68％),囊实性病灶5个(23％),实性病灶2个(9％).囊液T1 WI呈均匀等或高信号者17例(85％),T2 WI呈均匀高信号者15例(75％),DWI呈低信号者10例(63％,10/16).实性成分T1 WI均呈等信号,19个(86％,19/22)病灶T2 WI呈不均匀高信号,14个(82％,14/17)病灶DWI呈高信号.出现卵圆形病灶、囊性为主伴壁结节、囊液T1WI呈均匀等或高信号时,诊断OEC的准确率分别为59％、68％和85％,联合上述3种征象诊断OEC的准确率为91％.结论:OEC的MRI表现有一定特征性,结合DWI有助于OEC的诊断.     

Gd-DTPA在诊断卵巢肿块中的应用及评价

目的：正确评价Ｇｄ－ＤＴＰＡ在诊断卵巢病变中的作用。材料和方法：采用ＭＲ的Ｔ２加权成像（Ｔ２ＷＩ）和增强前后Ｔ１加权成像（Ｔ１ＷＩ）３种序列，对具有手术病理结果的７５例１１０个卵巢肿块进行回顾性分析。结果：静注Ｇｄ－ＤＴＰＡ后有以下变化特征：（１）恶性肿瘤特征显示正确率由８３．３％升至１００．０％。（２）良、恶性肿块的实质均有明显强化，其强化率之间无显著性差异（Ｐ＞０．０５）；不同强化时程，绝大多数病变的强化率也无明显差异（Ｐ＞０．０５）。（３）２２例手术病理明确分期的恶性肿瘤患者中，常规平扫Ｔ１ＷＩ及Ｔ２ＷＩ，分期正确率为５９．１％，运用造影剂后升至７７．３％，结合ＭＲＩ的３个序列可达８１．８％。结论：Ｇｄ－ＤＴＰＡ可改善对肿瘤的描述和对其内部结构的显示，提高对恶性肿瘤诊断及分期的正确率，但Ｇｄ－ＤＴＰＡ增强无特异性，尚不能依据信号的强化程度来判断病灶的性质，恰当的选择使用对临床具有重要的指导意义。     

Dynamic contrast enhanced MRI in correlation with diffusion weighted (DWI) MR for characterization of ovarian masses

Introduction

Ovarian tumors; are the second most common gynecological tumor and are the fifth commonest tumor in women. It is desirable to preoperatively differentiate benign from malignant tumor to decide whether surgery is required, and which type of surgery is appropriate avoiding unnecessary surgery, adding dynamic contrast and diffusion weighted to conventional images can help in differentiation of benign ovarian tumor from malignant. DWI depends on the fact that water molecules can diffuse freely in low cellular environment, while tissue hyper cellularity causes its restriction. As a result, malignant ovarian tumors due to its hypercellular nature show restriction of diffusion, unlike most benign tumors. This study aims at reviewing and emphasizing the role of dynamic contrast enhanced MRI and diffusion-weighted MR in characterization of ovarian lesions.

Patients and methods

This study was performed on 30 patients referred to the radiology department from surgical department by ovarian masses. Pelvic MR with DWI was done for all patients, DCE-MR was done for 29 out of 30 patients. Twenty-five patients underwent surgery with pathologic correlation. Five patients were put under regular follow up US for 3 months.

Results

The sensitivity of MRI was 99.9% while that of DWI was 100%. The specificity was higher for DWI (75%) compared to conventional MRI (58.3%), as well as the accuracy which was 73.9% for MRI while that of DWI was 86.9%. The mean ADC values for malignant lesions were (0.84 × 10⁻³ ± 0.1 SD mm²/s), while that for benign lesions were (1.8 × 10⁻³ ± 0.5 SD mm²/s), with cut off 1.2 × 10⁻³ and p value = 0.005. Mature teratomas showed restricted diffusion with ADC values 0.8 × 10⁻³ mm²/s (false positive), due to mixed cellularity of the teratoma. Hemorrhagic cysts and endometriomas showed high signal not only on diffusion images but also on corresponding ADC map and ADC values 1.3–1.4 × 10⁻³ (T2 Shine-through). Sensitivity of MRI was 99.9% while that of DCE-MRI was 60%. The specificity was higher for DCE 91% compared to conventional MRI sequences 58.3%, as well as the accuracy which was 73.9% for MRI while that of DCE was 77% and so addition of DCE to the MRI is expected to increase the specificity and the accuracy of examination.

Conclusion

Combination of DWI and DCE to conventional MRI improves the specificity of MRI and thus increasing radiologist’s confidence in image interpretation which will finally reflect on patients’ outcome and prognosis.     

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。