卵巢甲状腺肿的MR诊断与病理对照

MRI diagnosis and pathology correlation of struma ovarii

目的探讨卵巢甲状腺肿(SO)的MRI表现和病理学特征。方法回顾性分析7例手术病理证实为SO的临床资料及MRI表现,与病理学所见进行对照分析。结果 7例均为单侧卵巢发病,肿块3.2～13.3 cm,平均7.8cm。囊实性5例,囊性2例,有分隔,分隔及囊壁增厚,不同囊腔信号可不均等。实性部分呈等T_1、等或稍高T_2信号;囊性部分呈长T_1、长T_2信号,或稍短T_1、长T_2信号,其中5例囊内见非压脂T_2WI极低信号、T_1WI等信号区;囊壁及分隔呈等T_1、等T_2信号。增强扫描实性部分明显强化,囊壁及分隔中度强化,囊性部分无强化。镜下肿瘤实质大部分由甲状腺组织组成,其中3例合并有皮脂腺、钙化等成分。肿瘤内衬单层柱状或扁平上皮,见成熟甲状腺滤泡,大小不一,腔内可见红染的胶冻样物质,无异形性。结论卵巢甲状腺肿MRI表现有一定的特征性(囊内出现非压脂T_2WI极低信号、T_1WI等信号改变),MRI平扫加增强扫描是诊断卵巢甲状腺肿有价值的方法。

Objective To study the MR imaging and pathological features of struma ovarii （SO）. Methods The clinical features and MRI of 7 patients with pathologically confirmed SO were analyzed retrospectively and compared with pathological findings. Results SO was unilateral in all patients （right： 5, left： 2） with ovarian size varying from 3.2 to 13.3 cm and average diameter of 7.8 cm. The ovaries were mixed solid and cystic in 5 and cystic in 2 patients with thick septa and walls. The solid components were T1 isointense, T2 iso- to slightly hyperintense whereas the cystic components had long T1 and T2 signals, or short T1 and long T2 signals. In 5 patients, there were intracystic areas of intermediate T1 and very low T2 signals with T1 and T2 isointense cyst walls. The solid components enhanced markedly; the cyst walls and septa enhanced moderately; the cystic portions did not enhance. On light microscopy,the solid components were ectopic thyroid tissues associated with sebaceous glands and calcification in 3 patients. The SO was lined with simple columnar or squamous cells with variable sized thyroid follicles containing jelly-like substance and no atypia. Conclusion SO has characteristic MRI findings of intermediate T1 and very low T2 signals combined with contrast enhancement.