供血动脉及引流静脉的MSCT研究对卵巢肿瘤的诊断价值

Value of feeding artery and draining vein displayed on multi-slice CT angiography in the diagnosis of ovarian tumors

目的:通过对卵巢肿瘤供血动脉及引流静脉的MSCT研究,探讨卵巢血管对卵巢肿瘤的定位和定性诊断价值。方法:回顾性分析经病理确诊的48例56个卵巢肿瘤,单发40例,多发8例,其中囊性为主肿瘤9例9个,囊实混合性23例24个,实性为主的16例23个。采用MSCTA重组卵巢血管,通过子宫动脉卵巢支和/或卵巢动脉及卵巢静脉丛的显示,明确肿瘤起源,并通过观察肿瘤供血动脉的来源、数量、形态、起止、走行和分布等初步判断肿瘤的良恶性,并与病理结果进行对照分析。结果:MSCTA显示卵巢肿瘤的供血动脉43例,敏感度为89.6%(43/48),其中显示单侧子宫动脉卵巢支35支、双侧6对,单侧卵巢动脉10支、双侧3对,肠系膜上动脉分支1支,根据供血动脉判断卵巢来源肿瘤的符合率为97.7%(42/43)。CTA显示引流卵巢静脉丛45例,敏感度为93.8%(45/48),根据卵巢静脉丛显示并进入肿块来定位诊断卵巢肿瘤的符合率为97.8%(44/45)。术前根据重组血管特点定性诊断卵巢良性肿瘤20例22处、恶性肿瘤28例34处,诊断符合率达87.5%。结论:通过对卵巢肿瘤供血动脉及引流静脉丛的MSCT研究,能明显提高卵巢肿瘤定位和定性诊断准确性。

Objective： To study the value of feeding arteries and draining veins displayed on multi-slice CT angiogra- phy （MSCTA） in the diagnosis and localization of ovarian tumors. Methods..48 patients with 56 pathology proven ovarian neoplasms were analyzed retrospectively. There were solitary tumor （40 patients） and multiple tumors （8 patients）. The component of tumors were mainly cystic （9 patients, 9 masses）, mixed cystic/solid （23 patients, 24 masses） and mainly solid （16 patients, 23 masses）. The ovarian vessel was reconstructed on MSCTA and the uterine-ovarian artery branches and/or ovarian artery and ovarian venous plexus were displayed,tumors origin was proved. The nature of tumor （benignancy/ma- lignancy） was preliminarily judged according to the origin, number, morphology, pathway, distribution and approaches of the feeding arteries and draining veins, and correlated with pathology. Results：Ovarian feeding arteries were showed on MSCTA in 43 patients with the sensitivity as 89.6% （43/48）,including unilateral （n=35） and bilateral （n=6 pairs） branches of uterine-ovarian arteries, unilateral （n= 10） and bilateral （n= 3 pairs） ovarian artery and branch of superior mesenteric artery （n= 1）. The accuracy of diagnosing tumor originated from ovary based on feeding artery was 97.7 % （42/43）. Draining ovarian veinous plexus was showed on MSCTA in 45 patients,with the sensitivity as 93.8% （45/48） and the accuracy of localization was 97.8% （44/45）. The accuracy of localization and diagnosis of ovarian neoplasms based on ovarian vascular characteristics before surgery were benign tumor （20 patients, 22 masses） and malignant tumor （28 patients, 34 masses）, with the coincidence rate as 87.5%. Conclusion：The diagnosis and localization of ovarian tumors could be improved based on the demonstration of feeding arteries and draining veins on MSCTA.