Gd-DTPA在诊断卵巢肿块中的应用及评价

Evaluation of Gd DTPA in the diagnosis of ovarian masses

目的：正确评价Ｇｄ－ＤＴＰＡ在诊断卵巢病变中的作用。材料和方法：采用ＭＲ的Ｔ２加权成像（Ｔ２ＷＩ）和增强前后Ｔ１加权成像（Ｔ１ＷＩ）３种序列，对具有手术病理结果的７５例１１０个卵巢肿块进行回顾性分析。结果：静注Ｇｄ－ＤＴＰＡ后有以下变化特征：（１）恶性肿瘤特征显示正确率由８３．３％升至１００．０％。（２）良、恶性肿块的实质均有明显强化，其强化率之间无显著性差异（Ｐ＞０．０５）；不同强化时程，绝大多数病变的强化率也无明显差异（Ｐ＞０．０５）。（３）２２例手术病理明确分期的恶性肿瘤患者中，常规平扫Ｔ１ＷＩ及Ｔ２ＷＩ，分期正确率为５９．１％，运用造影剂后升至７７．３％，结合ＭＲＩ的３个序列可达８１．８％。结论：Ｇｄ－ＤＴＰＡ可改善对肿瘤的描述和对其内部结构的显示，提高对恶性肿瘤诊断及分期的正确率，但Ｇｄ－ＤＴＰＡ增强无特异性，尚不能依据信号的强化程度来判断病灶的性质，恰当的选择使用对临床具有重要的指导意义。

Purpose: To evaluate Gd DTPA in characterization of ovarian masses. Materials and methods: Using T 2 weighted, unenhanced and Gd DTPA enhanced T 1 weighted MR images, 110 lesions (79 were benign, 31 were malignant) in 75 patients with surgical pathologic findings were analysed retrospectively. Results: (1) With Gd DTPA enhanced MR, the accuracy of characterization of malignant tumors was improved from 83.3% to 100.0%; (2) The substantial tissue of benign and malignant ovarian masses were enhanced obviously, but the degree of enhancement and enhancement rate at different times had no statistical differences ( P >0.05); (3) In the 22 malignant cases with surgical pathologic staging, using only T 1 weighted and T 2 weighted MR images, the staging accuracy was 59.1%; using Gd DTPA enhanced T 1 weighted ones, it could go up to 77.3%; combining with T 2 weighted, unenhanced and enhanced T 1 weighted ones, it could reach 81.8%. Conclusion: The administration of Gd DTPA could improve tumor delineation, intratumoral architecture, and accuracy in diagnosis and staging, but contrast enhancement was nonspecific; therefore, determination of pathologic nature based on signal enhancement was not possible in the current study.