卵巢非上皮源性肿瘤的MRI特征与临床特点

MRI and Clinical Features of Non-epithelial Ovarian Tumors

目的:分析卵巢非上皮源性肿瘤的磁共振成像(MRI)特征与临床表现,以提高对卵巢非上皮源性肿瘤术前的诊断水平。方法:回顾性分析40例经手术及病理证实的卵巢非上皮源性肿瘤的MRI图像及临床资料。结果:15例成熟畸胎瘤均呈囊性,余25例呈囊实性或实性,其中未成熟畸胎瘤4例,卵泡膜-纤维瘤8例,纤维瘤3例,卵黄囊瘤5例,类固醇细胞瘤1例,转移瘤3例,淋巴瘤1例。畸胎瘤均可见脂肪成分,增强扫描未成熟畸胎瘤明显强化,成熟型畸胎瘤轻度强化;卵泡膜-纤维瘤、纤维瘤T2WI可见低信号纤维成分,延迟期呈轻度强化;卵黄囊瘤呈“蜂窝状”改变,呈明显持续性强化,并见扭曲血管。肿瘤含实性成分、盆腔积液与肿瘤恶性相关性高(r=0.599,P=0.002;r=0.553,P=0.004),而病灶最大径线、弥散受限与肿瘤良恶性无相关性(r=0.145,P=0.488;r=0.230,P=0.268)。根据MRI图像特征及病理结果,MRI对畸胎瘤、卵泡膜-纤维瘤、纤维瘤诊断率为84.21%(13/15)、100.00%(8/8)、100.00%(3/3)。MRI结合甲胎蛋白(AFP),对卵黄囊瘤诊断率达100.00%。结论:卵巢非上皮源性肿瘤在MRI上有一定的特征性改变,结合肿瘤标志物可提高术前诊断率。

Objective To analyze the magnetic resonance imaging(MRI)features and clinical manifestations of nonepithelial ovarian tumors,and to improve the preoperative diagnosis level of non-epithelial ovarian tumors.Methods The MRI images and clinical data of 40 patients with non-epithelial ovarian tumors confirmed by surgery and pathology were retrospectively analyzed.Results All 15 cases of mature teratoma were cystic,and the remaining 25 cases were cystic or solid,including 4 cases of immature teratoma,8 cases of theca fibroma,3 cases of fibroma,5 cases of yolk sac tumor,1 case of steroidocytoma,3 cases of metastatic tumor,and 1 case of lymphoma.Fatty components were found in all teratomas.The immature teratoma was significantly enhanced,and the mature teratoma was slightly enhanced.Theca fibroma and fibroma showed hypointense fibers on T2WI and mild enhancement in delayed phase.The yolk sac tumor showed"honeycomb-like"changes,obvious continuous enhancement,and tortuous blood vessels.Tumor with solid component and pelvic effusion were highly correlated with malignancy(r=0.599,P=0.002;r=0.553,P=0.004),while the maximum diameter and limited diffusion of the lesions were not correlated with benign and malignant tumors(r=0.145,P=0.488;r=0.230,P=0.268).According to MRI image features and pathological results,the diagnostic rates of MRI for teratoma,theca fibroma and fibroma were 84.21%(13/15),100.00%(8/8)and 100.00%(3/3),respectively.The diagnostic rate of MRI combined with alpha-fetoprotein(AFP)for yolk sac tumor was 100.00%.Conclusion Non-epithelial ovarian tumors have certain characteristic changes on MRI,and combine with tumor markers can improve the preoperative diagnosis rate.