原发性输卵管癌的MRI诊断价值

目的探讨原发性输卵管癌（PFTC）的MRI诊断价值,以提高术前影像诊断的准确率。方法回顾性分析6例PFTC患者的术前MRI资料,并与术后病理结果对照。分析PFTC的3T MRI表现,尤其是T1WI、T2WI与DWI的信号特征,动态增强扫描（DCE-MRI）肿瘤的强化特点,并绘制肿瘤的时间-信号强度曲线（TIC）。结果 6例患者均表现为盆腔附件区肿块,5例为单侧,1例为双侧。表现为不规则囊实性肿块2例,输卵管迂曲扩张伴伞端实性结节2例,腊肠样或不规则实性肿块2例,实性肿块及壁结节T1WI多呈等或较低信号,T2WI多呈等或较高信号,DWI上多呈高信号;增强扫描实性肿块、壁结节及囊实性肿块的实性成分主要呈不均匀轻-中度强化,常伴囊变、坏死。TIC 3例为持续强化型,2例为平台型,1例为流出型。伴有盆腔内种植转移3例,盆腔外转移2例,腹水4例。结论 PFTC通常表现为附件区腊肠样或不规则囊实性或实性肿块,增强扫描轻-中度强化,输卵管积水伴壁结节是诊断PFTC的重要征象,不典型PFTC与卵巢癌影像表现相似,需结合临床症状及实验室检查综合诊断。

The Diagnostic Value of MRI in Primary Fallopian Tube Carcinoma

Objective To explore the MRI features of primary fallopian tube carcinoma（PFTC） and evaluate its diagnostic value,in order to improve the preoperative diagnostic accuracy. Methods MR images of 6 PFTC patients confirmed by surgical pathology were retrospectively reviewed. 3T MRI features-especially T1WI, T2WI and DWI signal intensity and homogeneousness, the enhancement degrees and patterns of dynamic contrast enhancement MRI （DCE-MRI） were analyzed and compared to surgical pathological findings. Time-signal intensity curve （TIC） of each solid lesion were obtained. Results Five patients with PFTC had unilateral adnexal masses and 1 patient had bilateral masses. The lesions appeared as irregular cystic and solid masses in 2 cases, tubular-shaped cystic masses with papillary nodes in the fimbriated end in 2 cases, irregular or discrete sausagelike solid masses in 2 cases. The solid masses and nodes usually presented iso- or hypointense on T1WI while iso-or slightly hyperintense on T2WI. The lesions were hyperintense on DWI. After injection of contrast medium, nodes and solid masses enhanced slightly to moderately, usually accompany with cystic or necrotic parts. As to TIC, 3 cases were type I, 2 cases were type II, and 1 case was type III. The metastasis of 3 patients was confined to the pelvic and 2 patients were out of the pelvic, 4 patients had ascites. Conclusions PFTC usually manifest adnexal irregular or sausagelike cystic and solid masses, with slightly to moderately enhancement. Hydrosalpinx along with tubal papillary nodes were important signs to diagnose PFTC. Atypical PFTC commonly present adnexal masses which mimics ovarian carcinoma, the diagnosis should combine with clinical manifestations and laboratory examinations.