卵巢子宫内膜样腺癌PET/CT影像表现

PET/CT features of ovarian endometrioid carcinoma

目的:分析卵巢子宫内膜样腺癌(ovarian endometrioid carcinoma,OEC)的PET/CT影像表现,探讨PET/CT在诊断OEC中的价值。方法:回顾性分析颈手术病例证实的27例OEC患者的PET/CT影像特征,包括位置、大小、密度等解剖学特点及^(18)F-FDG代谢水平特征,两组或多组病灶SUV_(max)值有无差异采用t检验或单因素方差分析。结果:27例患者中有7例同时合并子宫内膜癌; 17例为单侧发生(其中左侧7例,右侧10例),10为双侧发生,共有病灶37个;肿瘤最大径1. 5～24 cm,平均(10. 92±5. 73) cm。31个为囊实性肿物,6个为实性肿物,实性部分均表现为不同程度^(18)F-FDG高摄取,平均SUV_(max)值为14. 30±5. 83(5. 93～28. 33)。肿瘤临床分期,分化程度,雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)表达量及合并子宫内膜癌与否之间的SUV_(max)差异均无统计学意义(P均> 0. 05)。结论:OEC在PET/CT上多为单侧或双侧明显高代谢的较大囊实性肿块,可伴有腹盆腔种植转移和淋巴结转移,与其他卵巢恶性肿瘤鉴别较困难。如果患者同时合并子宫内膜癌,可对诊断有一定的提示作用。PET/CT全身显像有助于OEC的分期。

Objective： To evaluate and summarize the imaging features of ovarian endometrioid carcinoma（ OEC）in order to evaluate the value of PET/CT in diagnosing OEC. Methods： The PET/CT imaging features of 27 patients confirmed by surgery and pathology were analyzed retrospectively. The imaging features were evaluated including the location,size,mass characteristic,18F-FDG uptake（ SUVmax） of cystic and solid portions,SUVmax values being analyzed with t tests and ANOVA analysis. Results： 7 out of the 27 patients had endometrial cancer simultaneously. 17 patients had unilateral tumor,7 tumors in the left and the other 10 in the right. 10 patients had masses in the both ovaries. The total number of masses was 37. The diameters of the tumors ranged from 1. 5 to 24 cm,with the average size of（ 10. 92 ± 5. 73） cm. The PET/CT scans showed that 31 tumors were cystic-solid and the other 6 were solid with heterogeneous. There was high 18F-FDG uptake in solid component,the average SUVmax value of the solid portions was 14. 30 ± 5. 83（ ranging from 5. 93 to 28. 33）. The SUV_（max）value of the main focus was not associated with surgical stages,degrees of pathological differentiation,expression of estrogen receptor（ ER） and progesterone receptor（ PR）（ P〉0. 05）,There was no significant difference of SUVmax between focus with endometrial cancer or not（ 13. 35 ±5. 60 vs 17. 00 ± 6. 03,P〉0. 05）. Conclusion： On PET/CT imaging the OEC is mainly shown as unilateral or bilateral large cystic solid portion mass,and high 18F-FDG uptake of solid portions,OEC can be accompanied by seeding metastasis and lymph node metastasis. SUV_（max）values have no correlation with clinical stage or pathological differentiation. It is often difficult to differenciate OEC from other ovarian malignant tumor,but it is suggested to diagnose OEC in the patients with endometrial cancer,PET/CT imaging is helpful to find metastasis for clinical staging.