输卵管卵巢脓肿影像学表现及误诊分析

目的：总结输卵管卵巢脓肿的影像学表现,探讨该病影像学诊断价值并分析误诊原因。方法回顾性分析13例术后病理确诊或临床确诊输卵管卵巢脓肿影像学资料,4例行 CT 平扫,9例行 MRI 平扫及增强(其中5例同时行超声检查),并与病理结果对照。结果10例表现为附件区腊肠样病变(其中1例超声误诊为肠梗阻),CT 平扫呈均匀低密度影,MRI 平扫呈长/短 T1长T2信号、部分可见液-液平面形成,增强扫描脓肿壁轻度增厚并明显均匀强化,所有患者表现不同程度腹腔、盆腔积液及周围筋膜增厚；3例表现为单侧附件区厚壁多房囊实性包块(其中2例术前误诊为卵巢肿瘤性病变),增强扫描表现为厚壁及分隔明显强化。结论CT 及 MRI 对腊肠样表现的输卵管卵巢脓肿诊断的特异性及敏感性较高,多能做出定性诊断,对囊实性病灶能清楚显示,但定性诊断困难,误诊率较高。

Analysis of misdiagnosis and imaging features of tubo-ovarian abscess

Objective To summarize the imaging findings of tubo-ovarian abscess and to explore the imaging diagnostic value and analyze the causes of misdiagnosis.Methods The imaging data of 13 patients with pathologically confirmed or clinically diagnosed tubo-ovarian abscess were analyzed retrospectively,which 4 cases underwent CT plain scan,9 cases underwent MRI plain scan and contrast scan (5 cases were examined by ultrasound at the same time).Then the imaging results were compared with surgical-pathologic findings. Results 10 cases showed adnexal lesions like sausage (in which 1 case misdiagnosed as intestinal obstruction by ultrasound),which CT plain scan showed low density lesions.MRI plain scan showed long/short T1 long T2 signal,partially visible liquid-liquid plane,and MRI contrast scan showed obvious enhancement of the walls of abscesses.All patients showed different degree of abdominal and pelvic effusion and the surrounding fascia thickening.3 cases (in which 2 cases misdiagnosed as the adnexal tumor)were found the thick walled and cystic-solid mass with multilocula in annex by MRI,and the thick wall and separations were significant enhanced on contrast scan.Conclusion The specificity and sensitivity of CT and MRI in the diagnosis of tubo-ovarian abscess which show like sausage are high,and most can make qualitative diagnosis.Although the cystic-solid lesions can be clearly showed with CT and MRI,the qualitative diagnosis is difficult and the misdiagnosis rate is high.