卵巢卵泡膜-纤维瘤与卵巢实性恶性肿瘤的MRI鉴别诊断

Differential diagnosis of ovarian thecoma-fibroma tumors and malignant solid ovarian tumors by MR imaging

目的:探讨MRI在卵巢卵泡膜-纤维瘤和卵巢实性恶性肿瘤鉴别诊断中的应用价值,提高在临床工作中诊断的准确率。方法:回顾性分析2011年1月-2018年6月经手术和病理证实的59例OTFT和40例MSOT(共49个病灶)患者的临床及MRI特征。临床资料包括年龄、绝经状态、偏侧性、临床症状及子宫内膜情况。MRI特征包括病变的位置、最大径、包膜、边界、实性成分T_(2)WI信号、变性成分形态、流空血管、腹水、实性成分DWI信号和ADC值。采用t检验及Pearson卡方检验比较两组肿瘤间临床及MRI特征的差异,通过受试者操作特征曲线(ROC)分析和二元Logistic回归分析评价各参数的诊断效能。结果:OTFT与MSOT在偏侧性、子宫内膜情况、最大径、包膜、边界、实性成分T_(2)WI信号、变性成分形态、流空血管、实性成分DWI信号及ADC值方面的差异具有统计学意义(P<0.05)。相对于MSOT,OTFT最大径更大(8.4±4.0 vs.5.5±3.1;P=0.014),有包膜(56/59,94.9%vs.35/49,71.4%;P=0.001),边界清晰(59/59,100%vs.30/49,61.2%;P<0.001),实性成分T_(2)WI信号类似于子宫肌层(28/59,47.5%vs.16/49,32.6%;P<0.001),大片状变性区域(36/59,61.0%vs.12/49,24.5%;P<0.001),无流空血管(51/59,86.4%vs.30/49,61.2%;P=0.003),实性成分DWI信号低于子宫肌层(25/59,42.4%vs.1/49,4.1%;P<0.001),ADC值>1.27×10^(-3) mm^(2)/s(P=0.007)。二元logistic回归分析结果显示大片状变性区域(OR=6.961)、实性成分DWI信号低于子宫肌层(OR=99.072)及ADC>1.15×10^(-3) mm/s(OR=9.440)可作为独立预测因子,三者联合诊断的敏感度、特异度、准确度和AUC分别为86.4%、95.9%、90.7%和0.949。结论:OTFT与MSOT的MR表现各具一定特征性,MRI有助于鉴别两者。

Objective:To investigate the value of MR in distinguishing ovarian thecoma-fibroma tumors(OTFT)from malignant solid ovarian tumors(MSOT).Methods:The clinical data and MRI characteristics of 59 patients with OTFTs and 40 patients(49 tumors)with MSOTs confirmed by surgery and pathology were retrospectively analyzed between January 2011 and June 2018.Clinical data included age,menopausal status,tumor laterality,clinical symptoms and endometrial status.MRI features included location,maximum diameter,shape,capsule,boundary,T_(2)WI signal intensity of solid components,morphology of degeneration area,flow void,ascites,DWI signal intensity of solid components and ADC values.The differences of clinical and MRI features were analyzed using independent sample t test and Pearson chi-square test.The diagnostic performance of MRI wasdetermined by receiver operating characteristic(ROC)curve and binary logistic regression analysis.Results:The tumor laterality,endometrial status,diameter,capsule,boundary,T_(2)WI signal intensity of solid components,morphology of degeneration area,flow void,ascites,DWI signal intensity of solid components and ADC values were significantly different between OTFT and MSOT(P<0.05).Compared with MSOT,OTFT had larger diameter(8.4±4.0 vs.5.5±3.1;P=0.014),capsule(56/59,94.9%vs.35/49,71.4%;P=0.001),clear boundary(59/59,100%vs.30/49,61.2%;P<0.001),similar T_(2)WI signal of solid components to myometrium(28/59,47.5%vs.16/49,32.6%;P<0.001),larger patchy degeneration(36/59,61.0%vs.12/49,24.5%;P<0.001),no flow void(51/59,86.4%vs.30/49,61.2%;P=0.003),more lower DWI signal of solid component than myometrium(25/59,42.4%vs.1/49,4.1%;P<0.001)and had ADC values larger than 1.27×10^(-3) mm^(2)/s(P=0.007).The binary logistic regression analysis showed that larger patchy degeneration(OR=6.961),DWI signal of solid component lower than myometrium(OR=99.072)and ADC>1.15×10^(-3) mm/s(OR=9.440)could be used as independent predictors.The sensitivity,specificity,accuracy and AUC of the combined viables were 86.4%,95.9%,90.7% and 0.949,respectively.Conclusion:OTFT and MSOT had different MRI features,and MRI could be helpful for distinguishing OTFT from MSOT.