女性盆腔肿块的CT和TVS诊断探讨

目的 探讨CT和TVS对女性盆腔肿块的诊断价值。方法 收集33例先后作CT和TVS检查的女性盆腔肿块病例，均经手术和病理证实。结果 CT对肌瘤囊变、钙化、假包膜及肌瘤内部强化后出现的不规则低密度区较为敏感，而对粘膜下肌瘤所致宫腔影变形容易忽略（确诊率71％，5／7）。TVS对肌瘤所表现出旋涡状低回声能准确判断，但对肌瘤囊变所致无回声及宫腔内异常光团容易误诊（确诊率71％，5／7）。3例子宫内膜癌，TVS均能准确测得内膜增厚且回声不规则（确诊率100％，3／3），CT表现为宫体中央规则或不规则低密度区，缺乏特异性（确诊率33％，1／3）。结合二种影像学检查方法，仔细观察单纯囊肿、巧克力囊肿及囊腺瘤的囊液性质、壁结构、分隔及存在的赘生物，确诊率可明显提高：单纯囊肿（100％，4／4），巧克力囊肿（67％，2／3），囊腺瘤（75％，3／4）。畸胎瘤因具有脂质及钙化成分，CT对此极为敏感，再结合薄层扫描技术，确诊率（100％，3／3）。恶性实性肿块边缘呈分叶状、结节状且强化明显，良性实性肿块边缘往往光整且强化不明显，CT对实性肿瘤良恶性鉴别确诊率（100％，4／4），TVS扫描只能显示实性肿物，不能提供良恶性鉴别。CT和TVS对盆腔脓肿的诊断，均应结合临床综合考虑。结论 对女性盆腔肿块的诊断，CT检查应该重视结合TVS图像，这样才能提高诊断的准确性。

CT and TVS diagnostic evaluation of female pelvic masses

Purpose To evaluate the diagnostic value of female pelvic masses with CT and TVS. Methods 33 eases of female pelvic masses confirmed by operation and pathology were retrospectively studied with CT and TVS. Results It is of sensitivity to detect cystic change, calcification and pseudcapsule of uterine leiomyomas and irregular low - density area inside leiomyomas having been enhanced by CT scanning, nevertheless it tend to neglect submucosal leiomyoma contributing to deforming uterine cavity (accuracy rate71% ,5/7) . TVS scanning can provide accurate diagnosis of leiomyoma presenting circinate hypoechoic mass, whereas it tend to diagnose wrong to cystic change of leiomyoma resulting in non -echo focus and abnormal echoic mass inside uterine cavity (accuracy rate71% ,5/7). For 3 cases of endomentrioid adenocarcinoma, TVS scanning can accurately measure thickening of endometrium and detect irregular echo (accuracy rate 100% ,3/3). Corresponding to regular or irregular low -density area in the center of uterine in CT pattern, it lack of differentia (accuracy rate33% , 1/3). We carefully observed the fluids, the wall and septa of cyst and endocystic vegetations of ovarian cyst, endometriosis and ovarian cystadenaraa in combination with two imaging methods, improving accuracy rate obviously: ovarian cyst(100% ,4/4) , endometriosis(67% ,2/3), ovarian cystadenama(75% ,3/4) . It is of sensitivity to detect ter-atoma by CT thin- slice scanning, because of its containing calcification and lipid(accuracy rate 100% ,3/3) . Accuracy rate is 100% to differential diagnosis between malignant solid mass and benign solid mass by CT scanning. Because malignant tumors are often solid with lobulated and nodular borders and enhanced obvious, whereas benign tumors are solid with margmated borders and enhanced faint. TVS scanning only presents solid mass rather than diagnosing that of malignant or benign. Whether CT or TVS scanning, which must be in combination with clinic information to diagnose pelvic abscess. Conclusions CT combined with TVS can improve diagnostic accuracy in female pelvic masses.