卵巢囊腺瘤与囊腺癌的CT征象及鉴别诊断价值

Value of CT manifestations in diagnosis of ovarial cystadenoma and cystadenocarcinoma

目的分析卵巢囊腺瘤与囊腺癌的CT征象及其鉴别诊断价值。方法回顾分析经术后病理证实、有完整CT资料的卵巢囊腺瘤31例(囊腺瘤组)及囊腺癌17例(囊腺瘤组),通过ROC法评估肿瘤大小、成分、钙化、密度、囊变、分隔、乳头状突起、强化情况、周围脏器受侵及转移等,评价上述各项诊断良恶性卵巢囊腺肿瘤的价值。结果肿瘤成分以混合型的囊实性或实性成分更多、囊壁或分隔最大厚度大于0.6cm、密度不均匀、囊壁或分隔明显强化、有乳头状突起、乳头状突起明显强化、周围脏器受侵、腹膜或大网膜转移、腹腔积液9个CT征象对诊断卵巢囊腺癌有一定价值。出现3个及以上上述征象时,诊断卵巢囊腺癌的敏感度为100%(17/17),特异度为80.65%(25/31),阳性预测值为73.90%(17/23),阴性预测值为100%(25/25)。结论卵巢囊腺肿瘤的CT表现对鉴别其良恶性有较高价值。

Objective To explore the differential diagnostic value of CT features for ovarial cystadenoma and cystadenocarcinoma. Methods Clinical and CT data of 31 ovarial cystadenoma and 17 cystadenocarcinoma patients proved with histology were retrospectively analyzed. ROC was used to assess the value of CT features, including tumor size, solid portion of tumor, calcification, unilocular or multilocular, cyst in cyst, homogeneity of tumor, tumor enhancement levels, calcification, septa, thickness of septa or wall and their enhancement, papillary protrusion of tumor and enhancement, surrounding invasion, peritoneum or omental implantation, as well as ascites and pelvic metastastic lymphadenopathy. Results CT finding of more solid portion, more than 0.6 cm of irregular thickened septa or capsule, inhomogeneity in tumors, obvious enhancement of septa or wall, papillary protrusion of tumor and obvious enhancement, accompany with surrounding organ invasion, metastastic or omental implantation and ascites were useful in differentiating ovarial cystadenocarcinoma from cystadenoma. When 3 or more above features were showed in the same patient, the sensitivity of diagnosing ovarial cystadenocarcinoma was 100% （17/17）, the specificity was 80.65% （25/31）, the positive predictive value was 73.90% （17/23） and the negative predictive value was 100% （25/25）. Conclusion Some CT features are useful in differentiating ovarial cystadenocarcinoma from cystadenoma.