CT和磁共振成像在原发性卵巢癌分期中的应用

Preoperative staging of patients with primary ovarian carcinoma by CT and MRI

目的 探讨ＣＴ和磁共振成像（ＭＲＩ） 在原发性卵巢癌分期中的价值和限度。方法 收集４２ 例原发性卵巢癌患者的临床资料，对照手术和病理，获得ＣＴ、ＭＲＩ、ＣＴ加ＭＲＩ各自的准确性、敏感性、特异性（ 简称三特性） 及术前分期。结果 ＣＴ和ＭＲＩ对评价子宫受侵和子宫直肠窝病变均较满意（ 三特性均≥８０ ％ ） 。ＣＴ在判断单侧或双侧卵巢肿瘤和腹膜种植性病变方面优于ＭＲＩ，主要是敏感性较高；ＭＲＩ则在显示包膜受侵或破裂、侵犯除肠管以外的盆腔脏器、子宫直肠窝病变以及淋巴结转移方面优于ＣＴ，三特性多数较高。ＣＴ、ＭＲＩ及ＣＴ加ＭＲＩ的分期准确性分别为７３ ．７ ％ 、６８．４％ 及７０．６ ％ （ Ｐ＞０ ．０５） 。对于多数部位病变的诊断，两者均显示特异性较高而敏感性偏低。

Objective To investigate values and limitations of CT and MRI applied in staging of patients with primary ovarian carcinoma (POC). Methods Forty two patients with POC proven by radical surgery, laparotomy, and postoperative pathology were studied. In comparison to surgical and pathological findings, sensitivity, specificity, and accuracy of CT, MRI and CT plus MRI were calculated. Staging by the three imaging methods was obtained according to FIGO′s classification. Results CT and MRI showed higher accuracy in evaluation of invasion to uterus (89.5% and 94.7%) and disease of Douglas pouch (94.7% and 97.4%). CT was to some extent superior to MRI in assessing ipsilateral or bilateral tumor and lesions related to peritoneal seeding; MRI, however, had better capability of diagnosing invasion to ovarian capsule, pelvic organs excluding bowel, nodules in Douglas pouch, and metastasis to lymph nodes. The overall accuracy of staging by CT, MRI, and CT plus MRI was 73.7%, 68.4%, and 70.6%, respectively ( P >0.05). Conclusion CT and MRI are useful imaging modalities in staging of POC, but low sensitivity for detecting involvement in some anatomic regions needs to be improved.