卵巢甲状腺肿的影像学特征及误诊分析

The Analysis of Imaging Features and Misdiagnosis of Strumaovarii

目的:探讨卵巢甲状腺肿的影像学表现特点并分析误诊原因。方法:回顾性分析经手术病理证实的9例卵巢甲状腺肿的临床和影像学资料,重点分析其影像学特征及误诊原因。结果:9例患者年龄26～47岁,中位年龄36岁,均为卵巢单发多房囊实性肿块,左侧3例,右侧6例,呈不规则形或卵圆形,边界清晰,直径5.0～13.5cm,平均8.4cm;CT平扫2例患者均可见高密度囊腔,CT值55-90Hu;9例患者MRI平扫T2WI和脂肪抑制T2WI肿块各囊腔信号多样,均可见极低信号灶为其特征表现;增强扫描肿块囊壁和分隔强化,分隔厚薄不均,实性成分呈甲状腺样明显强化,囊性成分未见强化。1例伴左侧卵巢成熟型畸胎瘤,1例伴肿瘤蒂扭转。术前考虑为卵巢囊肿1例,巧克力囊肿1例,卵巢囊腺瘤1例。结论:卵巢甲状腺肿的影像学表现具有一定的特征,即附件区边界清晰、体积较大,CT病灶内含高密度囊腔,MRIT2WI序列见极低信号病灶的多房囊实性肿块。误诊主要原因是对卵巢甲状腺肿的影像学表现认识不足。

Objective: To investigate the imaging features of strumaovarii and analyze the causes of misdiagnosis. Methods: The clinical and imaging data of nine cases of strumaovarii confirmed by operation and pathology were retrospectively analyzed, focusing on the imaging features and the causes of misdiagnosis. Results: Nine patients, aged from 26 to 47 years with a median age of 36 years, They were all ovarian single multilocular cystic and solid masses, Three on the left and six on the right, with irregular or oval shape, clear boundary, diameter 5.0-13.5 cm, the mean 8.4 cm. High density cysts with CT value of 55-90 Hu were found in two cases on plain CT scan.Nine cases MRI plain scan of T2WI and fat-suppressed T2WI showed Signal diversity in the cysts, and extremely low signal foci on T2WI could be seen as their characteristic manifestations. Enhanced scanning showed enhancement of cystic wall and septum, uneven thickness of septum, thyroid-like enhancement of solid components, and no enhancement of cystic components. One case had mature teratoma of the left ovary and one case had torsion of the tumor pedicle. Preoperative considerations included ovarian cyst one case, chocolate cyst one case and ovarian cystadenoma one case. Conclusion: The imaging manifestations of strumaovarii have certain characteristics, that is, the boundary of the adnexal area is clear, the volume is large, the CT focus contains high density cystic cavity, and the multi-locular cystic and solid mass of extremely low signal focus can be seen on the T2WI sequence of MRI. The main reason for misdiagnosis is lack of understanding of imaging manifestations of strumaovarii.