卵巢成熟囊性畸胎瘤误诊或漏诊CT表现研究

Study the CT Manifestations in the Erroneous or Missed Diagnosis of Mature Cystic Teratoma

目的探究卵巢成熟囊性畸胎瘤误诊或漏诊CT表现。方法回顾性分析2013年3月—2018年3月经手术病例证实的57例卵巢成熟囊性畸胎瘤患者的CT图片,其中有16例发生误诊或漏诊,对此16例漏诊、误诊的CT图像进行分析,探讨卵巢成熟囊性畸胎瘤误诊或漏诊CT表现。结果 57例卵巢成熟囊性畸胎瘤患者中有16例发生误诊或漏诊,其中有2例为卵巢甲状腺肿,误诊为囊腺癌;4例卵巢成熟性囊性畸胎瘤漏诊并发蒂扭转;1例囊性畸胎瘤蒂扭转误诊为囊腺癌;1例畸胎瘤蒂扭转并感染漏诊。3例误诊为内膜异位囊肿;2例囊性成熟性畸胎瘤误诊为囊肿,2例误诊为囊腺瘤。1例双侧卵巢畸胎瘤,因对侧病灶较小漏诊。结论 CT诊断在卵巢畸胎瘤的诊断中具有重要的临床价值,但也会存在误诊、漏诊的情况,应结合临床症状、化验检查及病史,通过仔细观察、薄层扫描和多方位重建,熟悉不典型囊性畸胎瘤及其并发症CT表现,对于不典型囊性畸胎瘤患者亦可加做磁共振检查,明确囊内无脂质信号,减少误诊、漏诊的产生。

Objective To study the CT (computed tomography) manifestations in the erroneous or missed diagnosis of mature cystic teratoma. Methods According to the clinical CT images, 57 mature cystic teratoma patients were surgically proved with 16 erroneous or missed diagnosis cases from March 2013 to March 2018. The CT manifestations were analyzed and discussed. Results Among 57 mature cystic teratoma cases, 16 erroneous or missed diagnosis cases were occurred including two struma ovary cases as cystadenocarcinoma, 4 missed cases with mature cystic teratoma and pedicle torsion, one cystic teratoma as cystadenocarcinoma, one missed case with pedicle torsion and infection, three cases as endometrial cysts, two mature cystic teratoma as cyst, two cases as cystadenocarcinoma and one bilateral teratoma case. The missed diagnosis rate on the contralateral side was lower. Conclusion The CT examination plays a key role in the diagnosis of ovarian teratoma, but there are some erroneous and missed diagnosis cases. In order to reduce the erroneous or missed diagnosis rate, it is necessary to think about the clinical symptoms, laboratory examination and medical history, take the thin-layer chromatographic scanning and multi-dimensional reconstruction and know well about the CT manifestations of atypical cystic teratoma and complications. In particular, the atypical cystic teratoma patients shall receive the magnetic resonance imaging examination to define whether the lipid signaling is appeared.