磁共振成像在卵巢畸胎瘤中的诊断价值

目的探讨卵巢畸胎瘤在磁共振成像（MRI）中的特征性表现,以提高对该病的诊断水平。方法收集本院医学影像信息系统（PACS）中经手术和病理证实的32例共36个卵巢畸胎瘤,对MRI表现进行回顾性研究。结果 36个畸胎瘤中,成熟性畸胎瘤33个（92%）,未成熟性畸胎瘤2个（6%）,卵巢甲状腺肿1个（3%）;33个成熟畸胎瘤均为囊性,见脂肪成分,其中29个（88%）肿瘤以脂肪成分为主,4个（12%）含有少量脂肪;20个（61%）见头结节,10个（30%）瘤内见钙化或骨骼信号;30个（91%）瘤内见碎屑及毛发信号,增强后囊壁成轻度强化。2个未成熟畸胎瘤均呈囊实性混杂信号,1例实性成分偏于一侧,1例见多发大小不等长T₁长T₂信号囊状影,呈"葡萄状"聚集。1例甲状腺肿成双房改变,未见脂肪信号,其中一分房内T₁W、T₂W均为极低信号。结论卵巢畸胎瘤在MRI中大多具有特征性表现,少数脂肪成分不明显病例容易误诊。     

卵巢未成熟畸胎瘤的CT表现

【摘要】目的：探讨卵巢未成熟畸胎瘤的CT表现。方法：回顾性分析21例经手术或病理证实的卵巢未成熟畸胎瘤的病例资料,分析其CT征象。患者年龄5～70岁,中位年龄25岁。17例CA125升高,15例AFP升高,8例CA199升高。结果：21例卵巢未成熟畸胎瘤患者共有23个病灶。CT上病灶以实性为主型14例,囊性为主型6例,混合型1例。瘤体最大径105～290mm,中位最大径175mm。分叶状11例,类圆形10例。边界清晰14例,包膜完整18例,14例伴有腹水。19例平扫呈囊实性混杂密度,实性部分呈片絮状,实性部分内或肿瘤包膜周围散在不规则形、条形、点线状钙化及不规则形、裂隙状、簇状脂肪密度,囊内见多个大小不等小囊腔,壁厚薄不一,增强扫描实性部分及囊壁呈轻度不均匀渐进性强化。2例未见钙化及脂肪密度,主要表现为分叶状、界限清楚、有包膜的低密度肿块,以实性为主,增强扫描呈中度不均匀渐进性强化。结论：卵巢未成熟畸胎瘤CT上呈囊实性,体积较大,边界清楚,有包膜、钙化及脂肪,并伴有腹水,增强呈不均匀强化时有助于本病的诊断。少数卵巢未成熟畸胎瘤无钙化及脂肪。     

MRI对双侧卵巢病变的诊断价值

目的:探讨MRI对双侧卵巢病变的诊断价值。方法:以病理结果为金标准,回顾性分析41例双侧卵巢病变患者的MRI及相关临床资料。结果:41例中,浆液性囊腺癌19例,转移瘤2例,畸胎瘤2例,无性细胞瘤1例,子宫内膜样腺癌1例,子宫内膜异位症14例,化脓性炎症2例。MRI的诊断敏感度为100%,诊断准确率为70.7%。所有病灶均表现为双侧附件区占位性病变。浆液性囊腺癌呈囊实性肿块,实性部分呈不均匀明显强化,囊性部分强化不明显;转移瘤呈类圆形囊实性肿块,增强扫描后实性部分明显强化。畸胎瘤信号混杂,内见T1高信号影,T2压脂序列呈低信号,增强扫描后实性病灶可见强化。无性细胞瘤表现为腹腔至盆腔内见一巨大软组织肿块影,T1WI呈低信号,T2WI呈不均匀高信号,DWI呈高信号,增强扫描后呈不均匀明显强化。子宫内膜样癌T1WI及T2WI压脂序列呈等高混杂信号,增强扫描后部分病灶可见轻度强化。子宫内膜异位症呈短T2或短T1信号,增强扫描后未见明显强化。化脓性炎症DWI呈明显高信号,可见多房环形强化。结论:MRI是双侧卵巢病变首选的检查方法。     

卵巢透明细胞癌的CT、MRI表现与病理对照分析

目的探讨卵巢透明细胞癌(OCCA)的CT和MRI影像表现,以提高对该病的影像诊断水平。方法选取并分析16例经手术、病理确诊OCCA的CT、MRI表现,11例行CT平扫和增强,7例行MRI平扫和增强,3例同时行CT和MRI检查,并与病理结果相对照。结果 16例均发生于单侧附件,7例来源于右侧卵巢,9例来源于左侧卵巢。11例呈圆形或椭圆形,5例呈不规则形,边缘见分叶。肿瘤主要表现为囊实性肿块,13例以囊性为主"囊中有实",内见乳头状、结节状、团块状实性成分向囊内突起,呈岛屿状、栓子样改变,其中5例"实中有囊",团块状实性成分中可见散在囊状影; 3例以实性成分为主,病灶中央见囊性液化坏死影。CT平扫囊性成分CT值18～30 HU,实性成分35～56 HU,增强扫描囊性成分未见明显强化,实性成分呈持续明显强化; MRI表现囊性部分T_1WI呈稍高/高信号影6例,T_1WI呈低信号影10例,T_2WI均呈高信号影,实性成分T_1WI呈等低信号为主,T_2WI呈高信号为主,DWI以高信号为主,增强后持续明显强化。7例病灶边缘见增粗血管影,4例肿块内见丰富血管影。结论 OCCA的CT、MRI表现具有一定特异性,可以较为清晰显示肿块的囊实性改变、强化方式和供血血管,对术前诊断具有重要价值。     

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.     

胸膜孤立性纤维瘤的影像学诊断

目的 探讨胸膜孤立性纤维瘤的CT及MRI表现及其诊断价值.资料与方法 对11例经手术病理证实的胸膜孤立性纤维瘤患者的CT及MRI表现特征进行回顾性分析.结果 11例11个病灶,7例来源于右侧胸膜,其中斜裂胸膜2例,水平裂胸膜3例;左侧胸膜4例,其中斜裂胸膜2例,CT表现为边界清晰的混杂密度影,其内见不规则低密度区,2例可见结节状钙化,增强扫描实性部分不同程度强化,低密度区无强化,9例可显示肿瘤内血管;MRI表现为边界清晰的混杂信号实性部分T_1WI与肌肉相比呈高信号,T_2WI呈等或稍低信号,囊变部分表现为长T_1、长T_2信号,扩散加权成像(DWI)表现为等或稍高信号;增强扫描肿瘤实性部分不同程度强化.结论 胸膜孤立性纤维瘤的CT及MRI表现有一定的特征,分析其影像学特征,可做出较明确的诊断并能够与其他胸部肿瘤相鉴别.     

毛细胞型星形细胞瘤的CT、MRI表现及病理学基础

目的:探讨脑内毛细胞型星形细胞瘤(PA)的CT、MRI表现及病理学基础,以提高对此病的认识.材料和方法:回顾性分析经手术病理证实的脑内典型PA 13例的CT与MRI表现.结果:位于小脑半球4例、小脑蚓部7例、右侧大脑半球2例.病变大小2.3cm×2.0cm×2.7cm～4.5cm×4.8cm×5.6cm.实性病变3例,CT平扫呈等密度软组织肿块,T1WI呈等信号,T2WI呈长信号或长信号中见少量短信号的混杂信号,CT及MRI增强后均表现为均质或不均质明显增强,其中2例病灶中心见少量无增强的低信号区,1例CT平扫见钙化灶.囊实性10例,MRI平扫显示肿瘤囊性部分呈长T1、长T2信号,实性部分呈等T1长T2信号,增强扫描实性部分明显增强,囊性部分无增强,3例见明显增强壁结节,2例病变呈多房性,增强后分隔明显增强,其中1例见短T1、长T2出血灶 .结论:脑内PA的CT与MRI表现具有一定的特征性,结合临床资料有助于术前诊断.     

颅内畸胎类肿瘤的CT与MRI诊断

目的 总结颅内畸胎类肿瘤CT、与MRI的特征性表现，提高诊断水平。方法 与材料本组10例，男性5例，女性5例，年龄在11—45岁之间，平均年龄为25．5岁。10例中8例行CT检查(3例同时做增强扫描)；4例行MRI检查(2例同时行增强扫描)，其中2例同时行CT和MRI检查。结果 10例颅内畸胎类肿瘤中，皮样囊肿5例，畸胎瘤5例，病变位于松果体区4例，鞍区2例，前颅凹脑实质内1例，第三脑室及第四脑室各1例，小脑1例。3例脑畸胎瘤呈囊实性混杂密度块，大小不一，形态不规则，其内均见有斑点片状钙化影，2例含有脂肪密度，肿瘤占位效应明显，但瘤周水肿轻微，增强扫描肿瘤实性部分呈轻度不均匀强化，囊性部分不强化；5例皮样囊肿呈边界清楚的囊性低密度区，囊壁显示不清楚，其中1例增强扫描囊壁及囊内容物均未见明显强化。3例脑畸胎瘤行MRI检查，肿瘤呈短T1长T2混杂信号2例，短T1短T2混杂信号1例，其中钙化呈黑色低信号，脂肪呈白色高信号，经脂肪抑制后呈低信号。增强扫描肿瘤呈轻度不均匀强化；1例皮样囊肿呈长T1长12信号。结论 CT与MRI对颅内畸胎瘤的诊断均具有重要价值。CT对钙化与骨骼的显示优于MRI，而MRI多轴位成像对显示肿瘤大小范围、脂肪组织及周围邻界组织的解剖关系较CT有明显优势。两者结合术前正确诊断率90％(9／10)，能准确定位、定性，对临床拟定正确的手术方案提供可靠的依据。     

卵巢Brenner瘤CT及MRI影像学征象分析

目的 探讨卵巢Brenner瘤CT及MRI影像学表现.方法 收集经病理证实的卵巢Brenner瘤10例,病例有完整的临床及影像学资料,分析典型的CT及MRI影像学特征.结果 10例卵巢Brenner瘤均发生于老年女性,单侧发病,肿瘤体积较大,平均直径为10.3 cm,类圆形,浅分叶样改变,病灶内部多出现颗粒样钙化灶;良性9例,交界性1例;6例单纯性卵巢Brenner瘤表现为实性肿块或实性肿块部分囊变;4例合并囊腺瘤表现为囊实性病变,增强后9例病灶实性部分表现为轻度增强;7例CT检查实性部分为软组织密度;3例MRI检查实性部分呈T1等低信号,T2为低信号为主,内散在高信号影;1例交界性肿瘤内部可见多发分隔样改变,间隔较粗大,信号较混杂,少量腹水.结论 卵巢Brenner瘤具有一定的特征性,CT及MRI检查有助于诊断.     

儿童松果体区肿瘤的影像诊断

目的：评价儿童松果体区肿瘤的影像诊断价值。方法：回顾性分析本院经手术病理证实的31例儿童松果体区肿瘤的CT和MRI资料。结果：生殖细胞瘤12例,CT上呈等、高密度,MRI扫描T1WI上呈等低信号,T2WI上呈等、高信号,增强扫描明显强化;畸胎瘤8例（3例成熟型和5例非成熟型）,成熟型畸胎瘤囊性为主,CT平扫均呈混杂密度,可见钙化和脂肪密度,MRI上呈混杂信号,可见短T1、长T2的脂肪信号,增强扫描实质部分强化,非成熟型畸胎瘤实性部分较多,可看不到脂肪;松果体母细胞瘤4例,毛细胞型星形细胞瘤2例,混合性生殖细胞瘤1例;精原细胞瘤1例;原基细胞瘤1例,松果体中分化松果体实质瘤1例,脂肪瘤1例。结论：儿童松果体区肿瘤的类型较多,影像表现复杂多样,CT和MRI能基本反映松果体区肿瘤的特点,结合临床病史、性别、年龄等资料综合分析,大部分病例可作出定性诊断。     

Ovarian teratomas: tumor types and imaging characteristics.

Ovarian teratomas include mature cystic teratomas (dermoid cysts), immature teratomas, and monodermal teratomas (eg, struma ovarii, carcinoid tumors, neural tumors). Most mature cystic teratomas can be diagnosed at ultrasonography (US) but may have a variety of appearances, characterized by echogenic sebaceous material and calcification. At computed tomography (CT), fat attenuation within a cyst is diagnostic. At magnetic resonance (MR) imaging, the sebaceous component is specifically identified with fat-saturation techniques. The US appearances of immature teratoma are nonspecific, although the tumors are typically heterogeneous, partially solid lesions, usually with scattered calcifications. At CT and MR imaging, immature teratomas characteristically have a large, irregular solid component containing coarse calcifications. Small foci of fat help identify these tumors. The US features of struma ovarii are also nonspecific, but a heterogeneous, predominantly solid mass may be seen. On T1- and T2-weighted images, the cystic spaces demonstrate both high and low signal intensity. Familiarity with the US, CT, and MR imaging features of ovarian teratomas can aid in differentiation and diagnosis.     

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     

MR findings of ovarian tumours with cystic components

This article depicts the MR findings of ovarian tumours with cystic components. MRI can predict the cyst contents and evaluate the potential for malignancy when an irregular solid portion or a papillary nodule is observed within the cystic tumour. Post-contrast T1 weighted MRI is helpful for the identification of solid areas that enhance. Fat suppression imaging is useful for differentiation between mature cystic teratoma and other pathology. Fat suppressed post-contrast T1 weighted MRI may demonstrate contrast enhancement, reflecting inflammatory or neoplastic processes in the pelvis.     

CT and MRI findings of cystadenofibromas of the ovary

The aim of this study was to assess imaging findings on CT or MR images of histologically proven ovarian cystadenofibromas. In the period 1995–2001, 32 histologically proven ovarian cystadenofibromas were identified in 28 women. Of the 32 ovarian cystadenofibromas, 16 tumors were purely cystic and the remaining 16 were complex cystic on CT or MR images. Solid components of 16 complex cystic tumors were seen as nodular (n=8) or trabecular (n=9) solid areas. One tumor had both nodular and trabecular solid components. Among 16 complex cystic tumors, 14 had thick or irregular septa; thus, half of ovarian cystadenofibromas had morphological imaging features of malignancy on CT or MR images. On histology, solid components in the cystic tumors were correlated with fibrous stromas that occasionally made a false-positive result for malignancy on imaging.     

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。     

Computed tomography and magnetic resonance imaging of mediastinal tumors

We describe the clinical, pathological, and imaging findings of mediastinal tumors with focus on thymic hyperplasia, thymic epithelial tumors, and germ cell tumors, malignant lymphoma, and various cystic masses. Chemical shift magnetic resonance imaging (MRI) is useful in characterization of the normal thymus and differentiation of hyperplastic thymus and thymic tumors. In contrast to noninvasive thymomas, invasive thymomas and thymic carcinomas show a more aggressive growth pattern. Local invasion and pleural spread are characteristic of invasive thymoma and mediastinal lymphadenopathy and distant metastasis suggest thymic carcinomas. Mature teratoma typically shows various computed tomography (CT) attenuation, and MR signal intensity depending on its contents and fat tissue and bone within the lesions are its characteristic findings. Seminomas typically have homogenous internal CT attenuation and MR signal intensity with minimal contrast enhancement. Nonseminomatous malignant germ cell tumors characteristically show prominent internal degenerative changes and invasion to the adjacent structures. In mediastinal lymphomas, a residual mass is common after treatment and MRI provides important information in distinguishing viable tumors from residual benign masses. Some mediastinal cysts may reveal high attenuation similar to solid lesions on CT depending on their contents and MRI can be useful in the differentiation of cystic masses from solid lesions.     

Imaging of Ovarian Teratomas in Children: A 9-Year Review

Objective

Germ cell tumours are the most common ovarian neoplasms in childhood and, of these, teratomas, whether mature or immature, are the most frequently found. Mature teratoma is a benign tumour, whereas the immature type, although also benign, has a more aggressive course, with a propensity to recurrence. A review of the literature revealed that there are some imaging features that may help to differentiate between these 2 types of teratoma, although no systematic comparison has been made. The objective of this study was to review imaging features of ovarian teratomas in children and to assess differentiating imaging features between the mature and immature types of ovarian teratoma.

Methods

Retrospective analysis of all patients who presented to our institution during a 9-year period (September 1999 to August 2008) with ovarian teratoma as confirmed on histology.

Results

Forty-one patients with pathologically proven ovarian teratoma were found. The patient ages ranged from 4–18 years at presentation (mean [standard deviation] age, 12.4 ± 3.4 years; median age, 13 years). Thirty patients (73.2%) were found to have mature ovarian teratoma, and 11 (26.8%) had immature teratoma. A component of endodermal sinus tumour was found in one of the immature teratomas. On ultrasonography, the appearance of the immature teratomas was purely solid in 3 (27.3%), mixed solid and cystic in 6 (54.5%), and predominantly cystic in 2 (18%). The mature ovarian teratomas demonstrated a predominantly cystic appearance in 22 (73.3%) and a mixed solid and cystic appearance in 8 (26.6%); there were no cases with a pure solid appearance. The prevalence of the more cystic appearance of the mature type showed significant statistical difference when compared with its prevalence in the immature type (P = .0008, χ² test). Other imaging features, such as size, presence of fat, or calcifications, did not show a significant difference between the 2 types of teratoma.

Conclusions

The predominance of a cystic component and a pure solid component in ovarian teratoma are significant differentiating factors between the mature type and the more aggressive immature type of teratoma.     

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...