卵巢肿瘤蒂扭转与盆腔脓肿的螺旋CT鉴别诊断

Differential Diagnosis of Torsion of Ovarian Tumors and Pelvic Abscesses by Spiral CT

目的探讨卵巢肿瘤蒂扭转与盆腔脓肿的螺旋CT鉴别诊断。资料与方法回顾性分析经手术病理证实的8例卵巢囊性肿瘤蒂扭转和8例盆腔脓肿的CT表现。结果扭转的卵巢囊肿为圆形或椭圆形,5例为单房囊肿,3例为多房囊肿。位于右附件区5例,囊肿边缘光滑,大小4.5～14cm,囊壁均匀或偏心性增厚伴轻度增强或不增强。合并出血4例,输卵管增粗4例,盆腔积液2例。盆腔脓肿分布范围广,形态不规则,囊壁厚薄不均,内壁光滑,外缘模糊不清,增强典型出现"靶征"或呈环形、网格样。盆腔脂肪密度增高模糊5例,伴少量腹水4例,直肠、乙状结肠增厚3例,子宫骶骨韧带增厚2例。结论螺旋CT能很好显示肿瘤细微结构及周围病变特征,对卵巢肿瘤蒂扭转、盆腔脓肿鉴别诊断有价值。

Purpose To differentiate torsion of ovarian tumors from pelvic abscesses using multi-slice spiral CT（MSCT）.Materials and Methods The CT features of 8 cases with torsion of ovarian cystic lesions and 8 cases with pelvic abscesses proved by surgery and pathology were analyzed and compared retrospectively.Results The ovarian tumors appeared round or oval in shape,unilocular（5/8） or multilocular（3/8）.Five ovarian tumors were located at right adnexal area with diameter from 4.5cm to 14cm.All the ovarian tumors were presented as the symmetrical or eccentric wall thickening.The margins of the cystic lesions were smooth in 6 cases and ill defined in 2 cases.After injecting contrast agent,the cystic wall and solid portion of tumors were enhanced slightly in 4 cases and not enhanced in 2 cases.Hemorrhage in cystic mass（n=4）,the tube thickening（n=4） and pelvic cavity effusion（n=2） were also revealed in ovarian tumor patients.In contrast,pelvic abscesses（cystic or cystic-solid） were widely distributed with heterogeneous thickened walls and irregular forms（smooth inner walls and obscure boundaries）.Circular target sign,ring-like and reticular enhancement can be found on contrast-enhanced CT images.Additionally,haziness of pelvic fat（n=5）,ascites（n=4）,rectosigmoid bowel thickening（n=3）,thickening of uterosacral ligaments（n=2） were also observed in patients with pelvic abscesses.Conclusions The microscopic structures and the surrounding features of ovarian tumors can be clearly delineated by CT imaging,which is helpful for differentiating the torsion of ovarian tumors from pelvic abscesses