成年女性盆腔内囊性为主占位病变误诊原因及3.0T DCE-MRI影像特征分析

Analysis of female pelvic cystic space-occupying lesions misdiagnosed by 3.0 DCE-MRI

目的探讨成年女性盆腔内囊性为主占位病变(main cystic occupying lesions,MCOLs)的3.0T DCE-MRI误诊原因及不同影像特征。方法连续收集我院成人女性盆腔内MCOLs中MRI影像诊断与手术病理诊断不符患者45例。磁共振检查采用德国西门子产3.0T MRI Verio,行磁共振平扫(T1WI横断位,T2WI及压脂T2WI横断位、T2WI冠状位,DWI)和多期动态增强扫描。与手术及病理检查对照,分析盆腔内MCOLs的MRI误诊原因及影像特征和可能的鉴别点。结果 45例DCE-MRI误诊病例中,因定位错误引起的误诊占15.6%(7/45);定位准确,但对病变MRI征象认识不足引起的MRI误诊占84.4%(38/45)。其中肿瘤性与非肿瘤性病变误诊26例(57.8%),良恶性定性误诊8例(17.8%)。本组误诊病例病变体积多较大,平均(8.3±3.3)cm,与卵巢及附件区关系密切。MRI误诊的主要影响的因素包括病变的大小、病变的信号变化、囊内分隔、囊壁及壁结节的形态及强化特点、病变周围组织结构的变化等。结论 DCE-MRI误诊女性盆腔内MCOLs受诸多因素的影响,正确认识MCOLs的MRI影像特征及周围结构变化有助于提高磁共振的诊断准确度。

Objective To analyze female pelvic main cystic occupying lesions(MCOLs) misdiagnosed by 3.0T DCE MRI.Methods Forty five female patients with misdiagnosed pelvic space-occupying lesions were enrolled in the study.All patients underwent scan with 3.0T DCE-MRI(Siemens Magnetom Verio 3.0T,Germany),including the plain scan(axial T1WI and T2WI,coronal T2WI and DWI) and multiphase DCE-MRI before surgical treatment.The pathological results of surgical specimens were obtained,and the consistency of MRI findings with pathological diagnosis was analyzed.Results Among 45 misdiagnosed cases,15.6%(7/45) cases were misdiagnosed by MRI due to error location,84.4%(38/45) cases due to lack of differentiating the distinctive characteristics of MRI finding.Twenty six cases(57.8%) were misdiagnosed for neoplasm or non-neoplasm lesions,and 8 cases(17.8%) were misdiagnosed for benign or malignant lesions.The size of pelvic lesions was(8.3 ± 3.3) cm in average.All lesions were located in pelvic and closed to the ovary or annex.The factors leading to MRI misdiagnosis included the lesion size,signal density of lesions,thickness of septa or envelope,DCE characteristics,and the changes of surrounding tissues.Conclusion MRI misdiagnosis of cystic space-occupying lesions in female pelvic may be affected by many factors.To recognize the distinctive MRI characteristics may increase the diagnostic accuracy of the lesions.