标题：卵巢上皮性肿瘤的MRI影像表现与病理学的对照研究

      作者：沈月红 1，刘小红 2    1.南通市肿瘤医院放射科，江苏 南通 226361；2.上海中医药大学附属岳阳中西医结合医院，上海 200437

      卷次： 2019年30卷13期

      【摘要】 目的 探讨MRI检查在卵巢上皮性肿瘤诊断与鉴别诊断中的应用价值。方法 选取南通市肿瘤医院2013年1月至2018年6月期间经过手术证实的37例56个卵巢癌及14例单发卵巢囊腺瘤患者，收集所有患者的临床、病理及影像资料，观察卵巢癌及卵巢囊腺瘤的MRI影像特征，并与病理检查结果进行对照，分析MRI诊断卵巢癌和卵巢囊腺瘤的准确率。结果 70个病变中有20个浆液性癌，4个黏液性癌，28个低分化腺癌，3个子宫内膜样癌，1个透明细胞腺癌，5个浆液性囊腺瘤，9个黏液性囊腺瘤；与病理结果对照，MRI诊断卵巢癌的准确率为92.9%，黏液性囊腺瘤准确率为100%，5例浆液性囊腺瘤有3例诊断正确，2例误诊为巧克力囊肿；MRI图像显示卵巢癌囊性部分T1WI低信号，T2WI高信号，实性部分T1WI低或等信号，T2WI稍高或高信号，实性部分DWI高信号，ADC低信号，囊性部分ADC均值为 2.70×10-3 mm2/s，实性部分ADC均值为 1.06×10-3 mm2/s，增强实性成分、囊壁、分隔明显强化，大部分卵巢癌边界不清；囊腺瘤体积较大，T1WI低信号，T2WI高信号，DWI低信号，ADC高信号，增强后不强化，边界清晰，其中黏液性囊腺瘤多房囊性或囊内多发分隔，增强后分隔及边缘可见线样强化。14例囊腺瘤的ADC均值为2.81×10-3 mm2/s；卵巢癌囊性部分与囊腺瘤的ADC值比较差异无统计学意义(P>0.05)，卵巢癌实性部分与囊腺瘤的ADC值比较差异有统计学意义(P<0.05)。结论 MRI在卵巢上皮性良恶性肿瘤的诊断与鉴别诊断中价值很高，值得临床推广应用。
      【关键词】 磁共振成像；上皮性；卵巢癌；囊腺瘤；病理学；鉴别诊断
      【中图分类号】 R737.31 【文献标识码】 A 【文章编号】 1003—6350（2019）13—1715—05

A comparative study of MRI findings and pathology of epithelial ovarian tumor.
SHEN Yue-hong 1, LIU Xiao-hong 2.1. Department of Radiology, Nantong Tumor Hospital, Nantong 226361, Jiangsu, CHINA; 2. Department of Radiology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of TCM, Shanghai 200437,CHINA
【Abstract】 Objective To explore the value of MRI in the diagnosis and differential diagnosis of epithelial ovar-ian tumor. Methods We selected 37 cases of ovarian cancer (56 tumors) and 14 cases of single ovarian cystadenomaconfirmed by surgery during the period from January 2013 to June 2018 in Nantong Tumor Hospital. The clinical, patho-logical and imaging data of all patients were collected. The imaging features of ovarian cancer and ovarian cystadenomawere observed and compared with the pathological findings to analyze the accuracy of MRI in the diagnosis of the twodiseases. Results Among the 70 lesions, there were 20 serous carcinomas, 4 mucinous carcinomas, 28 poorly differenti-ated adenocarcinomas, 3 endometrioid carcinomas, 1 clear cell adenocarcinoma, 5 serous cystic adenomas, and 9 muci-nous cystadenoma. Compared with pathological findings, the accuracy of MRI in diagnosis of ovarian cancer was92.9%, and 100% in diagnosis of mucinous cystadenoma. Of the 5 serous cystadenomas, 3 were correctly diagnosedand 2 were misdiagnosed as chocolate cysts. MRI images showed low signal on T1WI in cystic part, high signal onT2WI, low or equal signal on T1WI in solid part, slightly high or high signal on T2WI, high signal on DWI in solidpart and low signal on ADC in ovarian cancer. The ADC mean value of cystic part was 2.70×10-3 mm2/s and solid partwas 1.06×10-3 mm2/s. After injection of contrast medium, the solid components, cystic wall and septa of the tumors wereobviously enhanced. Most ovarian cancers had unclear borders. Cystadenoma had large volume, low signal on T1WI,high signal on T2WI, low signal on DWI and high signal on ADC. It was not enhanced after enhancement, and its bound-ary was clear. Among them, mucinous cystadenoma was multi-sac cystic or intracapsular multiple separation. Linear en-hancement had been seen in the separation and margins after enhancement. The ADC mean value of 14 cases of cystade-noma was 2.81×10-3 mm2/s. The ADC values of cystic part and cystadenoma of ovarian cancer showed no statisticallysignificant difference (P>0.05), while the ADC values of solid part of ovarian cancer and cystadenoma had significantdifference (P<0.05). Conclusion MRI is of high value in the diagnosis and differential diagnosis of ovarian epithelialbenign and malignant tumors, which is worthy of clinical application.
      【Key words】 Magnetic resonance imaging (MRI); Epithelial; Ovarian cancer; Cystadenoma; Pathological; Differ-ential diagnosis