胃肠道来源卵巢转移瘤的CT诊断与鉴别

CT Diagnosis and Differentiation of Ovarian Metastasis from Gastrointestinal Tract

目的:探讨胃来源卵巢转移瘤与肠道来源卵巢转移瘤的CT表现特点及其鉴别诊断价值。方法:对我院28例经手术或穿刺病理证实的胃肠道卵巢转移性肿瘤进行回顾性分析,着重观察患者发病年龄、肿瘤部位、形态、大小、肿瘤质地、实性成分强化程度、腹膜转移、腹水及淋巴结转移。结果:胃来源的10例卵巢转移瘤CT共发现19个肿块,9例累及双侧卵巢,以Ⅱc(7个)、Ⅲ型(9个)肿块多见,体积较肠癌转移瘤小。结直肠、阑尾及十二指肠来源的18例卵巢转移瘤CT共发现22个肿块,14例累及单侧卵巢,以Ⅱa型肿块(13个)多见,且体积较大;两组病例在患者的发病年龄、肿瘤分布、肿瘤大小、肿瘤质地(囊/实性)等方面比较具有差异性(P<0.05),在肿瘤形态、边界、实性成分强化程度、腹水、腹膜转移及淋巴结转移方面无统计学差异(P>0.05)。结论:胃来源的卵巢转移瘤与肠道来源的卵巢转移瘤的CT表现有差异,深入认识该形态学、影像学的特征并结合病史可以提高胃肠道卵巢转移瘤的CT诊断水平。

Objective:To investigate the CT features and differential diagnosis value of gastric and intestinal ovarian metastases.Methods:28 cases of gastrointestinal ovarian metastatic tumors confirmed by surgery or biopsy pathology in our hospital were retrospectively analyzed, focusing on the age of onset, tumor location, morphology, size, texture, solid component strengthening degree, peritoneal metastasis, ascites and lymphatic metastasis.Results:There were 19 masses in 10 cases of ovarian metastasis from stomach, and 9 cases involved bilateral ovaries. Type ⅱ C(7 cases) and type ⅲ(9 cases) were more common, and their size was smaller than that of colorectal carcinoma.In 18 cases of ovarian metastasis from colorectal, appendix and duodenum, 22 masses were found on CT, 14 of which involved unilateral ovary. Type ⅱ A masses(13) were most common and large.There were differences between the two groups in age of onset, tumor distribution, tumor size and tumor texture(cystic/solid)(P<0.05), but there were no statistical differences in tumor morphology, boundary, enhancement of solid components, ascites, peritoneal metastasis and lymphatic metastasis(P>0.05).Conclusion:CT findings of ovarian metastasis from stomach are different from those of intestinal metastasis. In-depth understanding of morphological and imaging features combined with medical history can improve the CT diagnosis level of gastrointestinal ovarian metastasis.