影像诊断与介入放射学

目的探讨卵巢癌及误诊为卵巢癌病变的CT征象,提高卵巢癌诊断及鉴别诊断的水平。方法病理证实47例盆腔肿块,其中卵巢癌42例,8例误诊;5例其他病变误诊为卵巢癌。所有病例均做平扫加增强扫描,回顾性分析其CT征象。结果①本组卵巢癌92.4%表现为盆腔或盆腹腔肿块,肿块呈囊实性、囊性、实性;增强扫描后,肿块间隔及实性成分明显强化;7.6%盆腹腔未见肿块,仅表现为腹水、网膜增厚。约57.2%有腹水。约19.0%肿块出现钙化。②盆腔脓肿或结核CT表现与囊性卵巢癌相似,但囊壁和间隔规则,未见壁结节;囊内积气为较特征的征象。③巧克力囊肿出血较新鲜以及浆膜下子宫肌瘤坏死囊变,平扫均呈囊实性肿块,增强扫描后,前者实性成分无强化,后者实性成分强化不明显。结论CT增强扫描,能清楚地显示肿块内部及其与周围器官的情况,不同病变强化形式不同对于不典型卵巢癌的CT诊断与鉴别诊断很有帮助,从而提高卵巢癌的诊断水平。

Objective To study the CT manifestations of carcinoma of ovary and the CT findings that mimic the carcinoma of ovary.Methods CT findings were retrospectively studied in 47 cases of pelvic masses including 42 cases of carcinoma of ovary and 5 misdiagnosed as carcinoma of ovary.Misdiagnosis was made in 8 of the 42 cases ofcarcinoma of ovary.Non-contrast and enhanced CT scan were performed in all cases.Results Pelvic or abdominal-pelvic masses were demonstrated in 92.4% cases.The lesions were parenchymatous,cystic,or cystic-parenchymatous masses,in which the parenchyma and septum were remarkably enhanced after the contrast agent was given intravenously.No mass was found in 7.6% cases,in which the ascites and thickening of the omentum were noted on CT images.Ascites was shown in 57.2% cases.Calicification was manifested in 19.0% cases.Abscess or tuberculosis located in pelvis could have the similar CT findings with cystic carcinoma of ovary,while these infectious lesions presented with regular or smooth wall and septum,instead of mural nodule.Another characteristic sign of abscess or tuberculosis was air density identified within the cavity of the cysts.Chocolate cysts with recent hemorrhage or subserous leiomyoma uteri with cystic degeneration were cystic-parenchymatous mass during the non-contrast enhanced scan.No enhancement could be revealed in parenchyma of the former and slight enhancement could be identified in the parenchymatous component of the latter.Conclusion Contrast enhanced CT scan can demonstrate the structure of the mass and the adjacent organs,and reveal the enhancement of the lesions,which plays a valuable role in diagnosis or differential diagnosis of carcinoma of ovary with atypical CT findings.