女性盆腔肿瘤的MRI诊断和评价

目的 分析和总结女性盆腔肿块在ＭＲＩ上的表现,评价Ｇｄ－ＤＴＰＡ对肿瘤诊断的意义。阐述ＭＲＩ在女性盆腔疾患诊断和鉴别诊断中的作用。材料与方法 ６５例女性盆腔肿块患者,年龄１８天～８５岁,平均５１岁。４７例同时行增强扫描。结果 （１）来源于生殖系统肿块包括子宫肌瘤１０例,子宫内膜癌４例,宫颈癌２例,卵巢囊肿７例,卵巢子宫内膜异位６例,卵巢囊腺瘤５例,畸胎瘤１１例,卵巢癌９例,卵巢卵泡膜细胞瘤２例,输     

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.     

超声引导下卵巢囊肿穿刺术与腹腔镜卵巢囊肿剥除术治疗卵巢囊肿的疗效比较

目的比较超声引导下卵巢囊肿穿刺术与腹腔镜卵巢囊肿剥除术治疗卵巢囊肿的疗效。方法选取2016年1月至2018年10月我院卵巢囊肿患者50例,随机数字表法分为观察组和对照组,各25例。对照组行腹腔镜卵巢囊肿剥除术治疗,观察组行超声引导下卵巢囊肿穿刺术治疗。比较2组手术相关指标及卵泡数、卵巢体积。结果观察组手术用时、住院用时、术中出血量、术后排气用时均低于对照组,差异具有统计学意义(P<0.05);手术后,2组卵泡数以及卵巢体积低于手术前,而观察组高于对照组,差异有统计学意义(P<0.05)。结论超声引导下卵巢囊肿穿刺术治疗卵巢囊肿的效果优于腹腔镜卵巢囊肿剥除术治疗,且对卵巢的影响较小,利于改善患者预后。     

IL-17在卵巢上皮性癌中的表达及临床意义

目的探讨白细胞介素17（IL-17）在卵巢上皮性癌组织中的表达及临床意义。方法采用免疫组织化学SP法检测25例正常卵巢组织、25例良性卵巢肿瘤与25例卵巢上皮性癌原发灶中IL-17蛋白表达,酶联免疫吸附试验检测患者术前、术后1周外周血中IL-17水平。结果卵巢癌患者癌组织中IL-17表达强度和外周血中IL-17水平均明显高于正常对照组和卵巢良性肿瘤组（P〈0.01）;卵巢癌患者术后血清IL-17水平比术前显著下降（P〈0.01）。术前血清IL-17水平在卵巢癌组织学类型中无显著性差异（P〉0.05）;Ⅲ～Ⅳ期卵巢癌患者术前血清IL-17水平显著高于Ⅰ～Ⅱ期患者,差异有统计学意义（P〈0.05）;高中分化卵巢癌患者术前血清IL-17水平显著低于低分化患者,差异有统计学意义（P〈0.05）。结论上皮性卵巢癌组织中IL-17表达上调,IL-17在上皮性卵巢癌的生长和转移过程中发挥重要作用。     

Magnetic resonance findings of clear-cell adenocarcinofibroma of the ovary

We report the magnetic resonance (MR) findings of clear-cell adenocarcinofibroma of the ovary. A huge multilocular cystic tumor with solid components was seen in the lower abdominal and pelvic cavity. Thickened cyst wall had low intensity on T2-weighted images, which suggested abundant fibrous tissue. Its mural nodules were strongly enhanced on contrast enhancement, which reflected malignant epithelial growth. Adenocarcinofibroma of the ovary is a rare tumor, but MR findings may be helpful to reach the correct diagnosis.     

卵巢纤维瘤的CT诊断

目的 探讨卵巢纤维瘤的CT影像特点,提高术前诊断准确率.方法 回顾性分析9例经手术病理证实的卵巢纤维瘤的CT表现及临床资料.结果 9例均表现为单侧附件肿块,大小约4.8 cm×4.0 cm×3.6 cm～17.5 cm×16.0 cm×11.7 cm.4例(44.4％)呈圆形或类圆形,4例(44.4％)呈分叶状,1例(11.1％)形态不规则.8例(88.9％)边界清楚,与子宫分界清楚.8例(88.9％)表现为不均匀实性包块伴不规则坏死区.增强扫描9例中有8例为无或轻度强化(强化幅度约0～10 HU),1例(11.1％)呈不均匀结节状明显强化.5例合并腹水,其中1例为大量腹水.结论 卵巢纤维瘤CT表现有一定特征,常表现为单发的边界清楚的实性包块,可有囊变、坏死及钙化等,增强扫描多为无或轻度强化.合并腹盆腔积液时需与卵巢恶性肿瘤鉴别.     

电视腹腔镜下手术治疗卵巢良性畸胎瘤126例临床分析

目的：探讨电视腹腔镜下卵巢良性畸胎瘤手术的技巧及临床应用价值。方法：对126例卵巢成熟型囊性畸胎瘤患者在腹腔镜下行囊肿剔除术或附件切除术，分析其手术适应证、术中、术后情况及并发症。结果：本组卵巢畸胎瘤均在腹腔镜下完成手术，单侧118例，双侧8例，囊肿直径3—9cm，104例行囊肿剥除术，22例行患侧附件切除术。平均手术时间50min，术中出血量平均45ml。术后体温第2天恢复正常115例，占91．3％。术后住院平均4．2d。术后无1例切口感染、出血、脏器损伤或化学性腹膜炎及肉芽肿等并发症发生。随访6—40个月，所有病例均无复发。结论：该手术是一种安全、有效的方法，具有损伤小、出血少、恢复快、并发症少等优点。     

卵巢囊腺癌的CT诊断

目的：评价卵巢囊腺癌的CT诊断价值。资料与方法：对41例经手术病理证实的卵巢囊腺癌（瘤）进行CT回顾性分析。结果：卵巢囊腺癌（瘤）的CT表现与文献报道基本一致。浆液性囊腺瘤表现为典型的I型，囊液密度均匀，浆液性囊腺癌呈Ⅱ型，其中Ⅱa型良恶性有部分重叠；当发现粘液性囊腺癌存在时，应考虑交界性甚至浆液性、粘液性囊腺癌存在的可能性。结论：卵巢囊腺癌（瘤）最常见部位为附件区。最常见的类型为Ⅰ、Ⅱ型。良性肿瘤以Ⅰ型常见，恶性肿瘤以Ⅱ型常见。CT可很好的显示卵巢肿瘤的内部特征，对缺乏浸润或转移证据的卵巢肿瘤的诊断和鉴别诊断有一定价值。     

晚期卵巢上皮癌的巩固化疗——一项前瞻性随机对照试验

目的探讨巩固化疗对于延缓晚期卵巢上皮癌复发的作用。方法自2000年3月起连续收集北京协和医院晚期卵巢上皮性癌住院患者,经过初次规范的治疗,截止到2004年4月,达到临床完全缓解的患者共44例,随机分为巩固化疗组和对照组,观察其肿瘤复发率和无瘤生存期。结果巩固化疗组22例,对照组22例,随访至2005年7月。肿瘤复发率巩固化疗组为45·5%,对照为59·1%(P=0·365);肿瘤复发时间巩固化疗组为25·3±9·3个月,对照组为16·9±6·7个月(P=0·019);无瘤生存时间巩固化疗组为31·9±14·8个月,对照组为22·7±12·9个月(P=0·033);经Kaplan-Meier生存曲线比较,巩固化疗组与对照组生存率无明显差异(P=0·22)。结论对于初次治疗达到临床完全缓解的晚期卵巢上皮癌患者实施巩固化疗,可能延缓肿瘤复发,延长无瘤生存期,但尚不能证实其可降低复发率和提高生存率。     

卵巢肿瘤的MRI评价(附59例报告)

目的 :着重探讨卵巢恶性肿瘤的 MRI特征及女性盆腔 MRI扫描技术。方法 :分析 5 9例中经病理证实的卵巢恶性肿块37个 (31例 )的 MRI征象 ;5 9例卵巢肿块 ,经超声、CT、MRI检查及手术病理证实 ,其中良性 2 8例 (33个肿块 ) ,恶性 31例 (37个肿块 )。15例用常规自旋回波序列和体线圈、18例用快速自旋回波序列和体线圈、2 6例用快速自旋回波序列和盆腔相控线圈。结果 :在37个卵巢恶性肿块中 ,MRI诊断的准确性为 87%、敏感性为 86 %、特异性为 88%、阳性预检值 (PPV)为 85 %、阴性预检值 (NPV)为89%。结论 :应用快速自旋回波序列和盆腔相控线圈所获得的图像质量好、速度快。应用快速自旋回波序列和盆腔相控线圈的 MRI是诊断卵巢恶性肿块最好的影像学方法 ,为临床治疗和预后提供可靠的依据     

卵巢上皮性肿瘤的MRI表现

目的:探讨卵巢上皮性肿瘤的MRI表现特点,对其常见组织学类型进行鉴别诊断。材料和方法:收集经手术病理证实的卵巢上皮性肿瘤61例,共75个病灶。对其MRI表现进行回顾性分析研究。结果:①20例浆液性肿瘤中,单房囊性病灶16例,病灶以实质成分为主者4例。16例囊性病灶中,囊壁薄而光滑者及囊壁伴结节状乳头状增生者各8例。囊液信号均表现为T_1WI低信号、T_2WI高信号。②20例黏液性肿瘤均呈多房囊性病灶,其中明显分房分隔者13例;伴有明显的实质性成分者7例。囊液的信号强度各种各样,8例表现为典型的"染色玻璃样"。③12例内膜样癌无典型MRI表现,主要为囊实性病灶。④7例明细胞癌主要为囊实性病灶,5例单房性囊性病灶的内壁可见结节状实质性病灶,且结节表面较光滑。⑤2例Brenner肿瘤,T_1WI表现为等信号、T_2WI表现为低信号。结论:卵巢上皮性肿瘤MRI表现多样,囊性多见,浆液性和黏液性肿瘤较有特征。     

原发性卵巢恶性肿瘤的CT诊断

目的:探讨原发性卵巢恶性肿瘤的CT表现。方法:回顾经CT检查并手术病理证实的原发性卵巢恶性肿瘤20例的资料,分析其CT特征表现。结果:浆液性囊腺癌11例,交界性浆液性囊腺瘤1例,粘液性囊腺癌2例,交界性粘液性囊腺瘤2例,颗粒细胞瘤2例,恶性畸胎瘤2例。结论:CT可显示肿瘤的内部特征,对原发性卵巢恶性肿瘤的病理类型有一定的诊断价值。     

16排螺旋CT在卵巢肿瘤中的诊断价值

目的：探讨16排螺旋CT对卵巢肿瘤的诊断价值,为临床诊断鉴别提供参考。方法回顾性分析经手术病理证实的21例卵巢肿瘤的CT影像学特点。结果根据卵巢病变的CT表现,对12例良性卵巢肿瘤及8例恶性肿瘤做出了准确诊断,1例恶性肿瘤误诊。结论16排螺旋CT扫描检查对卵巢肿瘤的定位,定性诊断具有重要价值。     

难治性妇科恶性肿瘤的介入化疗(附58例报告)

目的：探讨难治性妇科肿瘤介入化疗的应用价值。方法：对58例妇科肿瘤（宫颈癌35例,宫颈癌术后复发8例,卵巢癌6例,卵巢癌术后复发7例,子宫内膜癌2例）行介入治疗,并对其疗效,毒副反应进行了观察与评定。结果：介入治疗有效率为89．6％,其中33例行子宫癌根治术,2例癌细胞消失,6例地效,无并发症发生。结论：介入治疗疗效好,不良反应少,是治疗妇科难治性肿瘤的有效方法。     

Ovarian clear cell carcinoma arising in a large endometrioma — A case report with pathological correlation and literature review

Endometriosis-associated ovarian cancer represents the most common form of malignancy associated with this benign disease. It has a better prognosis than most types of ovarian cancer, with endometrioid adenocarcinoma and clear cell carcinoma as the main histological types. Clinical presentation is usually nonspecific and tumor biomarkers can be misleading, since they can also be elevated in the presence of benign ovarian endometriosis. We report a case of a 52-year-old woman with known ovarian and deep pelvic endometriosis, who developed ovarian clear cell carcinoma within a large endometrioma. The imaging findings highlight the key role of magnetic resonance imaging in detecting suspicious features such as loss of the “T2 shading” sign, loss of high T1 signal of an endometrioma, or the presence of mural nodules. Early detection of these malignancies is fundamental for adequate surgical treatment and overall outcome.     

Pearls and Potential Pitfalls for Correct Diagnosis of Ovarian Cystadenofibroma in MRI: A Pictorial Essay

Ovarian cystadenofibroma is a benign ovarian tumor that is characterized by a consistent percentage of masses, which remain indeterminate in ultrasonography and require magnetic resonance (MR) investigation; they may mimic borderline or malignant lesions. Three main morphologic patterns, resembling different ovarian neoplasms, can be identified in cystadenofibromas: multilocular solid lesions, unilocular cystic lesions with parietal thickening, and purely cystic masses. However, a cystoadenofibroma has typical features, such as T2-weighted hypointensity associated with no restrictions in diffusion-weighted imaging (the so-called “dark-dark appearance”) and progressive post-contrast enhancement (type I perfusion curve). The purpose of this study was to review the features of ovarian cystadenofibromas in MR imaging and to suggest pearls and pitfalls regarding their correct diagnosis.     

浆液性卵巢肿瘤的CT诊断

目的 分析浆液性卵巢肿瘤的CT影像特征，探讨其良恶性表现。资料与方法 回顾分析1996年1月－2001年4月39例53个经手术病理证实为浆液性卵巢肿瘤的CT影像资料，对肿瘤进行定位、定性分析，重点观察肿瘤部位、内部密度、分隔、瘤壁、囊内外赘生物、软组织成分以及腹水、腹膜、网膜种植及淋巴结转移，并与手术病理所见对照，比较浆液性卵巢肿瘤良恶性的影像特点。结果 肿瘤位于附件区者占66％（35／53），最大直径3－40cm。肿块影像分3型：I型囊性（n=13);Ⅱ型囊实性，包括Ⅱa型以囊性为主（n=19),Ⅱb型混合性（n=12),Ⅱc型以实性为主（n=7)；Ⅲ型实性（n=2)。结论 浆液性卵巢肿瘤最常见部位为附件区。最常见的类型为I、Ⅱa、Ⅱb型。良性肿瘤以I型常见，恶性肿瘤以Ⅱa、Ⅱb型常见。CT可很好地显示卵巢肿瘤的内部特征，对I、Ⅱa、Ⅱb型浆液性卵巢肿瘤的良恶性鉴别有一定价值。     

Prospective evaluation of contrast-enhanced MRI in the depiction of peritoneal spread in primary or recurrent ovarian cancer

The purpose of this study was to assess the accuracy of MRI in the staging of intra-abdominal tumor seeding of ovarian carcinoma. Fifty-seven patients with suspected primary or recurrent ovarian carcinoma were included in this study. All patients received laparotomy within 8 weeks after MRI. The MRI protocol included fat-saturated T1-weighted spin-echo (SE) sequences pre- and post i.v. application of gadopentetate dimeglumine. The criteria for tumor manifestation was contrast enhancement of intra-abdominal soft tissue lesions or peritoneum. The image review was performed by a blinded radiologist, a specialist in gynecological and abdominal MR imaging. Results were compared with findings during laparotomy. Sensitivity, specificity, positive and negative predictive values, and corresponding 95% confidence intervals were calculated for single intra-abdominal locations and for groups of locations defined according to surgical strategies for intra-abdominal cytoreduction. Laparotomy and histopathology confirmed 251 abdominal tumor locations. Sensitivity was high in lower pelvis locations (73–83%) except for ureter or bladder infiltration (40%). Bowel or mesentery locations displayed sensitivity values from 73 to 77%. Sensitivity was very low for pelvic lymph nodes (28%), greater omentum (38%), and lesser sac (43%). Magnetic resonance imaging based on contrast-enhanced fat-saturated T1 SE sequences improves planning of cytoreduction preceding chemotherapy in advanced primary or relapsed ovarian carcinoma. Electronic Publication     

18F-FDG PET-CT在卵巢癌术后监测中的应用

目的:探讨18氟-脱氧葡萄糖(18F-FDG)正电子发射计算机体层摄影(PET-CT)在卵巢癌术后监测中的应用价值。方法:16例卵巢癌患者经肿瘤细胞减灭术和术后化疗或放疗,临床完全缓解6个月以上。行18F-FDG PET-CT检查,结果与手术病理结果对照。结果:18F-FDG PET-CT发现了9例患者,有复发或转移,共发现病灶直径0.3~3.2cm 23处病灶。手术病理证实9例(56%)无假阳性,无假阴性,诊断准确率100%;诊断复发或转移灶的敏感性、特异性、准确率、阳性预测值和阴性预测值分别为78%、78%、78%、90%和58%。PET-CT显示与术中所见病灶的大小、部位均一致。结论:18F-FDGPET-CT在卵巢癌的术后监测中有很高的诊断价值。     

Sclerosing stromal tumor of the ovary with atypical magnetic resonance imaging findings in a middle-aged woman

We encountered a case of atypical sclerosing stromal tumor of the ovary (SST) in a middle-aged woman. This 52-year-old woman presented with a 2-year history of abdominal distention. Magnetic resonance imaging (MRI) showed a large mass extending from the pelvis to the epigastrium. T2-weighted MRI showed an island-shaped area of slight hyperintensity. Dynamic MRI demonstrated gradual light enhancement of the area in which T2-weighted imaging showed low intensity. The diagnosis of the tumor proved difficult because neither MRI findings nor the age of getting sick were atypical. We report this case with MRI findings and correlated pathology.