卵巢无性细胞瘤影像诊断与临床治疗

Imaging diagnosis and clinical treatment of ovarian dysgerminoma

目的探讨卵巢无性细胞瘤的CT、MRI特征及临床治疗。方法回顾性分析13例病理证实的卵巢无性细胞瘤的CT、MRI及临床资料。结果 12例单发,1例双侧多发。单纯型11例,混合型2例。肿瘤体积大,边界清晰。CT表现：6例实性肿块,1例囊实性。增强动脉期6例不均匀轻-中度强化,4例见明显强化肿瘤血管;1例不均匀明显强化;静脉期持续强化。MRI表现：9例实性肿块,T1WI等或稍低信号,T2WI等或稍高信号;增强动脉期不均匀轻-中度强化,4例见迂曲肿瘤血管,静脉期持续强化。1例多房囊性肿块,增强动脉期分隔及囊壁明显强化,静脉期持续强化呈高信号。随访时间3-90个月,11例未复发,1例术后3年复发,1例术后2年死亡。结论卵巢无性细胞瘤具有一定的影像学特征,综合分析其影像特征,可以在术前做出初步诊断,结合术后3-6个疗程方案化疗可实现良好预后,手术的目的是尽可能切除病灶,使化疗发挥最大的疗效。

【Objective】 To investigate the computerized tomography（CT） and magnetic resonance imaging（MRI） features and clinical treatment of ovarian dysgerminoma. 【Methods】 The CT, MRI and clinical data of13 cases with ovarian dysgerminoma proved by pathology were retrospectively analyzed. 【Results】 Among the13 cases, 12 had single ovarian dysgerminoma, 1 had bilateral multiple ovarian dysgerminomas. The tumors were of simply type in 11 cases and mixed type in 2 cases. The tumors were large with clear boundaries. CT manifestations showed solid mass in 6 cases and cyst in 1 case; uneven light-moderate enhancement in 6cases, tumor blood vessels with significant enhancement in 4 cases and unevenly significant enhancement in 1case at arterial phase; all cases had sustained enhancement at venous phase. MRI manifestations showed that9 cases of solid mass displayed equal or slight low signal on T1 WI and equal or slight high signal on T2 WI,all the cases showed uneven light-moderate enhancement and 4 cases showed tortuous tumor vessels at arterial phase, all cases showed sustained enhancement at venous phase. In 1 case of multilocular cystic mass,the tumor septa and cyst wall significantly enhanced at arterial phase, and continued to enhance with high signal at venous phase. During the follow-up of 3-90 months, 11 cases had no recurrence, 1 case had recurrence 3 years after operation and 1 case died 2 years after surgery.【Conclusions】 Ovarian dysgerminoma has certain imaging features. Primary diagnosis could be made before surgery by comprehensive analysis of its imaging features. Combined with chemotherapy of 3 -6 cycles good prognosis could be achieved. The goal of surgery is to remove the lesion as much as possible so as to maximize the efficacy of chemotherapy.