卵巢病变蒂扭转的MRI表现特征及与病理对照分析

Comparative study of MRI and pathological manifestations of ovarian diseases with pedicle torsion

目的探讨卵巢病变蒂扭转的MRI表现,旨在提高对其MRI征象的认识及诊断水平。方法回顾性分析2012年3月~2017年3月东莞市妇幼保健院经手术病理证实的12例卵巢病变蒂扭转患者的MRI资料,观察扭转蒂、扭转后病变及其周围结构的MRI表现。对蒂扭转部位和扭转程度的MRI表现进行探讨。结果 12例均为卵巢良性病变。扭转蒂为实性结构,6例条索样、4例环样、2例结节样,10例内见流空血管。患侧病变为囊实性或囊性结构,呈偏心性增厚,病变内及边缘见出血灶。10例扭转蒂由卵巢韧带及输卵管组成,6例上下方向扭转,4例内外方向扭转,呈条索样、环样;2例扭转蒂是卵巢与病灶之间的蒂,呈结节样。依据含流空血管的条索样、环样结构联合病变偏心性增厚诊断蒂扭转符合率为92%。扭转半圈囊壁轻度增厚,扭转2~5圈,囊壁偏心性增厚,扭转5圈囊壁最厚。2例扭转5圈合并供血动脉增粗。结论卵巢病变扭转蒂及扭转后肿块有特征性的MRI表现,能初步认识扭转发生的部位及辨别病变蒂扭转严重程度(扭转圈数)。

Objective To evaluate MRI manifestations of ovarian diseases with pedicle torsion and promote the knowledge and diagnostic level. Methods The MRI manifestations of 12 patients with pedicle torsion of ovarian diseases which were confirmed by surgery and pathology from March 2012 to March 2017 in Dongguan Maternal and Child Health Care Hospital were retrospectively analyzed. The twisted pedicles, signal characteristic of the diseases and vascular changes near by the torsion were studied. The MRI manifestations of torsional positio and torsional degrees of pedicle were investigated. Results Twelve patients were benign ovarian lesions. The torsion pedicle which was solid mass-like structures showed irregular long soft tissue（n = 6）, with round and circle shape（n = 4）, and nodular shape（n = 2）, 10 with vascular signal. The lesions were cystic or cystic-solid, which proved eccentric wall thickening, and with hemorrhage. The pedicle torsion was composed of the ovarian ligament and the oviduct（n = 10）; the lesion turned in up and down direction（n = 6）; the lesion turned in inside and outside direction（n = 4）. The pedicle torsion was composed of the ovary between the lesion（n = 2）. MRI show cord-like structure, ring like structure with vascular signal diagnosis torsion with diagnostic coincidence was 92% in the combined of eccentric thickening. The wall of the torsional which was twisted half circle was slightly thickened, and 2-5 circles was eccentric wall thickening, 5 circles was most thicken. The artery was enlarged which was twisted 5 circles. Conclusion Ovarian diseases pedicle torsion have some MRI characteristic manifestations, understanding the location of the torsion, distinguishing the severity of torsion（different twisted turns）.