卵巢子宫内膜样癌与高级别浆液性癌的MRI鉴别诊断

MRI differential diagnosis of Ovarian Endometrioid Carcinoma and High-grade serous cystadenocarcinoma

目的:比较卵巢子宫内膜样癌(OEC)与高级别浆液性癌(HGSC)的MRI特征,为两者的术前鉴别诊断提供依据。方法:回顾性选取2017年1月—2023年11月来宾市人民医院收治的24例OEC和49例HGSC患者,术前已行MRI影像检查并经临床手术病理证实,比较其临床特征及MRI特征并总结分析。结果:2种癌症的肿瘤标志物水平、有无贫血、肿瘤最大径差异均无统计学意义(P>0.05);而2种癌症的患者发病年龄、FIGO分期、单双侧发病、边界、实性部分最大径、肿瘤囊实性分布特点、囊性T_(1)WI信号、实性部分强化特点、实性成分DWI高b值信号特点、大量腹水发生率、淋巴结转移及腹膜种植转移、合并子宫内膜病变,差异均有统计学意义(P<0.05)。结论:OEC典型表现为大单囊伴“梳妆”乳头样偏心附壁肿块为主、囊内伴或不伴纤维分隔;HGSC表现以实性占比为主的多房囊实性肿块伴多发纤维分隔并可能双侧癌。

Objective To compare MRI features of ovarian endometrioid carcinoma(OEC) and High-grade serous carcinoma(HGSC),and to provide evidence for preoperative differential diagnosis.Methods A total of 24 patients with OEC and 49 patients with HGSC admitted to Laibin People's Hospital from January 2017 to November 2023 were retrospectively selected.MRI examinations were performed before surgery and confirmed by clinical operation and pathology.Their clinical and MRI features were compared and summarized.Results There were no significant differences in the level of tumor markers,anemia and maximum tumor diameter between the two cancers(P > 0.05);The age of onset,FIGO stage,unilateral and bilateral disease,boundary,maximum diameter of solid part,characteristics of tumor cyst solid distribution,cystic T_(1)WI signal,solid part enhancement feature,high b-value signal of solid component diffusion weighted imaging(DWI),incidence of massive ascites,lymph node metastasis and peritoneal implantation metastasis,and endometrial disease.There were significant differences(P < 0.05).Conclusion The typical manifestations of OEC were large single capsule with a "dressing" papillary eccentric mastic mass,intracapsular with or without fibrous separation.HGSC presents as a multilocular solid mass with multiple fibrous compartments and possibly bilateral carcinoma.