卵巢癌腹膜转移MRI表现分析

MRI Diagnosis and Analysis of Peritoneal Carcinomatosis of Ovarian Cancer

目的探讨卵巢癌腹膜转移(PC)的MRI表现。方法回顾性分析20例经手术及病理证实的卵巢癌腹膜转移患者的MRI资料,20例均行MRI平扫+增强扫描及DWI扫描。结果 20例卵巢原发恶性肿瘤中,18例为囊实性肿块,2例为实性。PC表现为腹膜线状增厚3例,不规则增厚15例,网膜粟粒状及结节增厚8例,饼状增厚5例,肠系膜污垢样增厚3例,腹腔多发斑块、结节、团块11例,囊性肿块2例。增强原发癌灶及PC灶实性成分扫描呈不均匀强化,囊性成分不强化。PC灶位于膀胱周围间隙7例,子宫直肠窝8例,结肠旁沟5例,网膜6例,肠系膜根部2例,膈下(肝周或脾周)2例,卵巢癌侵犯双侧输卵管12例,子宫9例,直肠1例,输尿管1例。腹水19例,腹部淋巴结肿大8例。20例卵巢原发恶性肿瘤及腹膜转移灶DWI上均呈高信号。结论卵巢癌腹膜转移MRI表现有一定特点,结合DWI,有助于准确诊断,特别是提高病灶较小不典型原发癌灶的检出率。

Objective To explore the MRI findings of ovarian cancer peritoneal carcinomatosis (PC).Methods MRI findings of 20 cases with davanced ovarian cancer and PC confirmed by operation and pathology were reviewed retrospectively.All of the patients underwent plain and enhanced scan of MRI,and diffusion-weighted imaging (DWI) examination.Results Among 20 cases of the ovarian tumor,18 cases showed mixed cystic solid masses,2 cases showed solid masses.The MR manifestations of PC were described as follow: linear thickening of the peritoneum (n =3),irregular linear thickening of the peritoneum (n =15); thickening of the omentum with miliary and nodular (n =8),cake-like thickening of the omentum (n =5); fouling-appearance of the mesentery (n =3); plaque,nodule and mass in the abdominal cavity (n =11),cystic mass (n =2).PC lesions were detected in the paravesical interspace in 7 cases,the douglas' space in 8 cases,paracolic gutter in 5 cases,omentum in 6 cases,subdiaphragmatic (parahepatic space or parasplenic space) in 2 cases,the primary invaded the fallopian tube in 12 cases,uterus in 9 cases,rectum 1 case,ureter 1 case.Ascites were seen in 19 cases,lymphadenectasis in the abdomen were seen in 8 cases.20 cases of the ovarian tumors and PC lesions were high signal intensity in DWI.Conclusion Ovarian cancer PC have certain MRI features,which are very helpful to diagnose accurately the disease by combing DWI,especially to find the small and atypic cases.