卵巢透明细胞癌的CT和MRI表现分析

CT and MRI Analysis of Ovarian Clear Cell Carcinoma

目的分析卵巢透明细胞癌(OCCC)的CT及MRI表现,以期提高诊断水平。方法回顾性分析2015年1月至2021年7月经手术病理确诊的31例OCCC患者的临床表现、实验室检查及CT、MRI影像表现,影像评估内容主要包括评估病灶的部位、分布(单发或多发)、大小、形态、边缘(光滑或分叶)、密度或信号(囊、实性组成)、有无合并子宫内膜异位、腹盆腔积液以及周围/远处器官受侵等表现。结果31例患者共34个病灶,左侧16例,右侧12例,3例双侧发生。病灶最大径3.3~24.8 cm,平均(10.72±4.75)cm。29个病灶形态呈圆形或类圆形,边缘光滑;5个病灶形态不规则,呈分叶状改变。34个病灶中,囊性21个,囊实性6个,实性7个;病灶内实性成分的形态及生长方式表现为附壁结节或乳头状突起24个、不规则团块状6个、弥漫片絮状3个,1例未见明显壁结节;合并子宫内膜异位13例;合并腹盆腔积液14例;侵犯邻近结构21例,侵犯盆腔外结构7例。病灶内囊性成分CT值或TWI信号多稍高于尿液,增强扫描实性部分呈中度至明显强化。结论OCCC临床上常有肿瘤指标升高及易合并子宫内膜异位,影像学多表现为单发大囊或囊实性肿块,壁结节呈乳头状及团块状突起,增强后囊壁及实性成分持续强化,有助于临床诊断。

Objective To analyze the CT and MRI imaging manifestations of ovarian clear cell carcinoma(OCCC).Methods The clinical features,laboratory tests,CT and MRI imaging manifestations of 31 patients confirmed as OCCC from January 2015 to July 2021 were retrospectively analyzed.The following imaging findings were evaluated:location,distribution(single or multiple),size,morphology,margin(smooth or lobulated),density or signal(cystic or solid composition),the presence of endometriosis,abdominal pelvic effusion,and peripheral/distant organ invasion.Results A total of 34 lesions were found in 31 patients.They were locateed on the left side(n=16),right side(n=12),and bilateral sides(n=3).The maximum diameter of the lesions ranged from 3.3 to 24.8 cm with a mean of(10.72±4.75)cm.29 lesions were round or round-like with smooth margins,5 lesions were irregular with lobar changes.The lesions showed as cystic(n=21),solid-cystic(n=6),and solid(n=7).The solid components in the lesions demonstrated as papillary nodules or papillae(n=24),irregular masses(n=6),diffuse patchy(n=3).13 cases combined with endometriosis.Abdomino-pelvic effusion were detected in 14 cases.The adjacent structures and external pelvic structures were invaded in 21 cases and 7 cases,respectively.The CT values or TWI signal intensities of the cystic component within the lesion were mostly slightly higher than that of urine.The solid part showed moderate to significant enhancement.Conclusion OCCC usually showed elevated tumor markers and prone to complicated with endometriosis clinically.Imaing examinations manifested as big cystic or solid-cystic masses with papillary or mass-like protrusions of the wall,and continuous enhancement of the solid components after enhancement.Those are helpful image findings in clinical diagnosis.