儿童卵巢扭转的影像学征象及卵巢坏死评估

The analysis of imaging features of ovarian torsion in children and evaluation of ovarian necrosis

目的:探讨影像学征象在儿童卵巢扭转的诊断及卵巢坏死评估中的价值。方法:回顾性分析经手术病理证实的33例儿童卵巢扭转的临床及影像学资料。所有患者行CT和/或MRI检查,统计各影像征象的发生率。按手术病理结果将病例分为坏死组和为非坏死组,比较两组间各影像征象发生率的差异。结果:33例卵巢扭转各征象发生率由高到低分别为增强扫描无强化征(85.7%)、附件出血征(60.6%)、附件最大径≥5cm(57.6%)、蒂样突起征(39.4%)、偏心性壁增厚征(36.4%)、果盘征(27.3%)、子宫患侧移位征(24.2%)、包膜下积液征(9.1%)。附件出血征的发生率在坏死组与非坏死组间具有统计学差异(χ~2=22.074,P<0.001);其余征象在两组间均无统计学差异(P均>0.05)。结论:增强扫描无强化征是儿童卵巢扭转最常见的影像学征象,但不能提示卵巢坏死;附件出血征可提示卵巢坏死,为临床治疗方案的选择提供依据。

Objective：To investigate the value of imaging findings in the diagnosis of ovarian tor- sion and the evaluation of ovarian necrosis in children. Methods：The clinical and imaging data of 33 pediatric patients with ovarian torsion confirmed by surgery and pathology, were retrospectively analyzed. All patients underwent pre- and post-contrast CT and/or MRI study. The incidence of various imaging features was calculated and statistically analyzed. All cases were divided into the necrosis group and the non-necrotic group according to the pathological results, and the difference of the inci- dence of image features between these two groups was compared. Results：Ranking from high to low in- cidence,imaging features in all 33 patients were as follows： lack of contrast enhancement （85. 7%）, hemorrhage within adnexa （60.6%）, ovarian enlargement ≥5cm （57.6%）, twisted vascular pedicle （39.4%） ,eccentric wall thickening （36.4%）,edematous ovary with peripheral follicles （27.3%）,uterine deviation toward torsion （24, 2%） and ovary subcapsular effusion （9.1%）. There was statistically significant difference between necrotic group and non-necrotic group in the incidence of hemor- rhage within adnexa （χ^2= 22. 074,P〈0. 001）, but there was no significant difference in other signs between the two groups （P〉0.05）. Conclusion： Lack of contrast enhancement is the most common im- aging features of ovarian torsion in children, but this does not indicate ovarian necrosis. Hemorrhage within adnexa can suggest ovarian necrosis, this provides valuable information for clinical treatment and decision making.