良性卵巢甲状腺肿的临床和CT征象分析

Clinical and CT features of benign ovarian goiter

目的探讨良性卵巢甲状腺肿(struma ovarii, SO)的临床和CT影像特征。方法选取32例经手术病理证实的良性卵巢甲状腺肿的临床资料,分析其图像特征。结果临床伴有腹痛及腹部坠胀感12例,月经不规律8例,甲亢症状2例,无症状10例;血清CA-125升高3例,T3、T4或TSH异常者3例,白细胞升高6例,无异常20例。影像表现为大小不等的盆腔内包块,平均直径(5.3±2.8) cm;单侧发病23例,双侧发病9例。伴有脂肪密度15例,钙化18例,对侧卵巢囊肿12例,腹水8例。呈现均匀高密度为主的肿块8例,均匀等密度为主的肿块4例,多结节囊实性肿块18例,不规则肿块伴腹水2例。CT诊断为SO者占43.75%,平扫和增强诊断准确率差异无统计学意义(χ2=0.200,P=0.66)。结论良性SO临床症状不典型, CT表现为子宫附件区包块,可呈均匀高密度为主结节、均匀等密度为主结节、多结节囊实性占位和不规则结节伴腹水等表现,病灶内常伴钙化和脂肪,CT增强扫描与平扫诊断准确性差异无统计学意义。

Objective To analyze the clinical and CT imaging features of benign Struma ovarii(SO), in order to improve the accuracy of diagnosis. Methods The clinical and CT image data of 32 cases of benign SO proved by pathology were retrospectively analyzed. The clinical symptoms, laboratory tests and CT image characteristics were analyzed. Results Twelve cases were clinically accompanied by abdominal pain and abdominal bloating, 8 cases were irregular menstruation, 2 cases were hyperthyroidism, 10 cases were asymptomatic;There were 3 cases with high serum CA-125 levers, 3 cases with abnormal T3, T4 or TSH, 6 cases with elevated white blood cells, and 20 cases without abnormalities. The images showed pelvic masses of various sizes, with an average diameter of(5.3±2.8) cm;23 cases were unilateral, and 9 cases were bilateral. There were 15 cases with fat density, 18 cases with calcification, 12 cases with contralateral ovarian cysts, and 8 cases with ascites. 8 cases were predominantly homogeneous and high-density masses, 4 cases were predominantly homogeneous and uniform-density masses, 18 cases were solid masses with multiple nodules and 2 were irregular masses with ascites. There are 43.75% cases were diagnosed as SO accurately before surgery, and no significant difference in the diagnosis accuracy was found in plain CT scan and enhanced scan(χ^2=0.200, P=0.660). Conclusion The clinical symptoms of benign SO are atypical, and most of them are non-specific symptoms such as abdominal pain, bloating, asymptomatic pelvic mass, and occasionally hyperthyroidism and ascites. The CT image has certain characteristics, appearing as a mass in the appendix of the uterus, which can show uniform high density or uniform equal density as the main nodule, multiple nodule sac solid space, and irregular nodules with ascites. Lesions are often associated with calcification and fat. There are no statistically significant difference in the diagnosis accuracy of plain and contrast CT scans. The CT images characteristics above can improve the accuracy of diagnosis.