卵巢低级别浆液性癌与浆液性交界性肿瘤的MRI表现及鉴别

MRI findings and differential diagnosis of low-grade serous carcinoma of the ovary:comparison with serous borderline tumor

目的探讨卵巢低级别浆液性癌(low-grade serous carcinoma,LGSC)与浆液性交界性肿瘤(serous borderline tumor,SBT)的核磁共振成像(magnetic resonance imaging,MRI)的表现与鉴别。方法回顾性分析2013年3月-2020年3月在安徽医科大学第四附属医院妇产科就诊并经病理学检查明确的LGSC和SBT患者资料,与术前MRI表现进行分析和比较。结果16例LGSC患者共22个病灶,24例SBT患者共32个病灶。LGSC病灶实性为主的发生率(40.9%)高于SBT(12.5%),差异有统计学意义(P<0.05)。囊性为主的LGSC病灶均表现为多房性囊性病变伴有附壁结节。实性为主的LGSC病灶中6个(66.7%)表现为纯实性肿块,3个(33.3%)表现为实性肿块伴瘤内囊肿。SBT病灶中21个可观察到内生性乳头状生长模式,伴有纤细分支,发生率明显高于LGSC(P<0.01)。LGSC病灶的T2W信号强度比和实性成分的表观扩散系数(ADC值)明显低于SBT(P均<0.01)。结论与SBT病灶相比,LGSC病灶实性成分的T2W信号强度和ADC值均较低,且瘤体内少见分叶状乳头状结构,二者MRI的影像表现存在差异性,MRI对LGSC与SBT病灶术前鉴别诊断具有重要价值。

Objective To investigate the magnetic resonance imaging(MRI)features and differential diagnosis of low grade serous carcinoma(LGSC)and serous borderline tumor(SBT)of ovary.Methods The retrospective analysis involved the data of LGSC and SBT patients,who went to the Department of Obstetrics and Gynecology of our hospital and were confirmed by pathological examination from March 2013 to March 2020.Their preoperative MRI findings were analyzed and compared.Results There were 22 lesions in 16 LGSC patients and 32 lesions in 24 SBT patients.The incidence of solid lesions in LGSC(40.9%)was higher than that in SBT(12.5%),and the difference was statistically significant(P<0.05).Most of the cystic LGSC lesions were multilocular cystic lesions with mural nodules.6(66.7%)of solid LGSC lesions showed pure solid mass,and 3(33.3%)showed solid mass with intratumoral cyst.In 21 lesions of SBT,papillary growth pattern with fine branches was observed,which was significantly higher than that of LGSC(P<0.01).The T2W signal intensity ratio and ADC value of solid components in LGSC lesions were significantly lower than those in SBT lesions(P<0.01).Conclusion Compared with SBT lesions,the T2W signal intensity and ADC value of solid components of LGSC lesions are lower,and lobulated papillary structures are rare in the tumor.There are differences in MRI findings between LGSC lesions and SBT lesions.MRI has important value in preoperative differential diagnosis of LGSC and SBT lesions.