多层螺旋CT对输卵管卵巢脓肿及输卵管积水的诊断价值

Multi-slice Spiral CT in the Diagnosis of Tubo-ovarian Abscess and Hydrosalpinx

目的探讨输卵管卵巢脓肿及输卵管积水的多层螺旋CT表现,为提高临床医师对该类疾病的认识提供依据。资料与方法回顾性分析经手术病理证实的19例输卵管卵巢脓肿及17例输卵管积水患者的多层螺旋CT特征。结果 36例患者共53侧输卵管病变,CT多平面重组可以很好地显示附件区肿块,管状型39侧,多囊型7侧,单囊型7侧,腔内不全分隔及肿块边缘呈"3"字形切迹为其特征性征象。输卵管卵巢脓肿肿块壁常增厚[(4.5±1.7)mm],增强后明显强化,并可见分层;继发征象包括脓肿周围脂肪密度增高及条索影、与子宫体分界不清,7例子宫圆韧带受压前移,11例骶子宫韧带增厚,5例累及直肠系膜,8例邻近乙状结肠、小肠壁受累增厚,13例子宫直肠陷凹积水。输卵管积水肿块壁薄[(1.4±0.2)mm],增强后强化不明显,1例合并输尿管扩张。结论输卵管卵巢脓肿及输卵管积水具有特征性的CT表现,多层螺旋CT是输卵管卵巢脓肿及输卵管积水较好的检查方法。

Purpose To explore the value of multi-slice spiral CT （MSCT） in thediagnosis of tubo-ovarian abscess and hydrosalpinx, so as to provide basis for improvingthe knowledge of the disease. Material and Methods The MSCT findings of 19 patientswith tubo-ovarian abscess and 17 patients with hydrosalpinx who were all confirmedsurgically and pathologically were retrospectively studied. Results Fifty-three fallopiantube lesions were detected in all 36 cases and MPR showed the masses were well locatedin adnexa. Thirty nine lesions were tube-type as sausage, with C or S style; 7 lesions weremulti-cyst mass with incomplete septa and 3-shaped outer margin; and 7 were cystal mass.As to 19 cases of tubo-ovarian abscess, lesion walls were likely to be thick [（4.5±1.7）mm] with obvious enrichment and stratification after enhancement; the secondary signsincluded peri-ovarian fat stranding, adhesions with uterus （7 cases with anterior movementof round ligament of uterus; 11 cases with thickening of the uterosacral ligament; 5 casesinvolving the thickening of mesorectum; 8 cases with thickening of small intestine wallsadjacent to rectosigmoid colon and 13 cases with dropsy in rectouterine fossa）. The other 17 cases of hydrosalpinx showed thin wall [（1.4±0.2） mm] with slight enrichment afterenhancement （among which one case was combined with dilatation of ureter. ConclusionAlong with typical CT presentations, MSCT can be used in the diagnosis of tubo-ovarianabscess and hydrosalpinx.