良、恶性卵巢肿瘤在多层螺旋CT中的图像表现及其鉴别诊断价值分析

Analysis on Image Manifestations and Differential Diagnosis Value of Multislice Spiral CT(MSCT)for Benign and Malignant Ovarian Tumors

目的分析良、恶性卵巢肿瘤在多层螺旋CT(MSCT)中的影像表现及其鉴别诊断价值。方法收集2017年8月至2018年12月于我院就诊治疗的104例卵巢肿瘤患者的临床及影像学资料进行回顾性分析,分析不同卵巢肿瘤MSCT影像表现,以手术病理活检结果为标准,总结MSCT检查对卵巢肿瘤的检出率和诊断率。结果共104例卵巢肿瘤患者,其中良性卵巢肿瘤88例,恶性卵巢肿瘤16例;卵巢肿瘤的诊断正确率为90.38%,其中对良性肿瘤的诊断正确率(95.45%)显著高于对恶性肿瘤的诊断正确率(62.50%)(P<0.05)。卵巢囊腺瘤在MSCT扫描中表现为囊实性肿块,肿块内部呈水样密度,黏液性囊腺瘤内部密度稍高,增强扫描示轻度强化;卵巢囊肿表现为附件区均一圆形或卵圆形水样低密度肿块,病灶边界较清楚,增强后病灶囊壁未见强化;畸胎瘤多表现为密度不均的类圆形影,囊壁光滑,囊内可含有牙齿状或骨样高密度影,边缘不规则呈分叶状,增强囊壁轻度强化;卵巢癌中5例浆液性囊腺癌表现为囊实性肿块,且囊壁上可见乳头状突起,增强其病灶囊壁以及实质成分明显强化,3例粘液性囊腺癌多表现为单房肿瘤,增强后囊壁实质成分呈现明显强化;恶性畸胎瘤肿瘤内可见骨骼、脂肪密度影,增强可见少许强化;颗粒细胞癌肿块内可见密度不均的低密度坏死区,增强扫描肿块实性部分、囊壁结节状突起部可见有明显不规则增强、钙化。结论MSCT检查对卵巢肿瘤的诊断率较好、尤其是良性卵巢肿瘤,可清楚显示良、恶性卵巢肿瘤的病变特征,有助于良、恶性卵巢肿瘤的鉴别诊断。

Objective To analyze the image manifestations and differential diagnosis value of multi-slice spiral CT(MSCT)for benign and malignant ovarian tumors.Methods The clinical and imaging data of 104 patients with ovarian tumors who were treated in our hospital from August 2017 to December 2018 were analyzed retrospectively.The images of different ovarian tumors in MSCT were analyzed.The results of surgical pathological biopsy were used as criteria to summarize the detection rate and diagnostic accuracy of MSCT for ovarian tumors.Results A total of 104 patients with ovarian tumors,88 cases were benign ovarian tumors and 16 cases were malignant ovarian tumors,the diagnostic accuracy of ovarian tumors was 90.38%,and the diagnostic accuracy of benign tumors(95.45%)was significantly higher than that of malignant tumors(62.50%)(P<0.05).Ovarian cystadenoma showed a cystic and solid mass in the MSCT scan.The inside of the mass showed a water-like density.The internal density of the mucinous cystadenoma was slightly higher,and the enhanced scan showed mild enhancement.Ovarian cysts showed a uniform,round or oval and water-like low-density mass in the adnexa area.The edge of the lesion was relatively thin,and after enhancement,there was no obvious enhancement of the wall of the lesion.Teratoma often showed a circular shadow with uneven density.The cyst wall was smooth.The capsule may contain a tooth-like or bone-like shadow with high density,the edge was irregularly lobulated,and after enhancement,there was slight enhancement of cyst wall.In ovarian cancer,serous cystadenocarcinoma of 5 cases showed a solid and cystic mass,and papillary protrusions were observed on the cyst wall.After enhancement,the components of the cyst wall and parenchyma of capsule were obviously strengthened.The mucinous cystadenocarcinoma in 3 cases showed unilocular tumor,and the parenchymal component of the cyst wall was enhanced.The density shadow of bone and fat can be seen in the tumor of malignant teratoma,and after enhancement,some enhancement can be seen.A low-density and necrotic area with uneven density can be seen in the mass of granulosa cell carcinoma,and after enhancing the scanning for solid part of the mass and the nodular protrusion of the cyst wall,obvious and irregular enhancement and calcification were observed.Conclusion MSCT has a higher diagnostic rate for ovarian tumors,especially for benign ovarian tumors.It can clearly show the pathological features of benign and malignant ovarian tumors,and is helpful for the differential diagnosis of benign and malignant ovarian tumors.