卵巢肿瘤蒂扭转的MR特征（附13例病理）.DOC

卵巢肿瘤蒂扭转的MR影像表现（附8例报告） 方如旗， 曹代荣 * ，翁淑萍， 施跃全 作者单位：350001 福建省妇幼保健院影像科 *通讯作者：350005 福建医科大学附属第一医院影像科 【摘要】目的 探讨卵巢肿瘤蒂扭转的MRI表现，评价MRI对卵巢肿瘤蒂扭转的诊断价值。 资料和方法 对8例经手术证实的卵巢肿瘤蒂扭转MRI资料进行回顾性分析。 结果 本组8例中良性肿瘤7例，恶性肿瘤1例，MRI上8例均可显示肿瘤扭转蒂，表现为肿瘤旁模糊实性小肿块样结构影，其中3例呈漩涡状改变。肿瘤囊壁或分隔不规则增厚5例，囊壁线状出血2例，盆腔积血1例。术中见5例肿瘤蒂扭转360o，3例肿瘤蒂扭转720o，病理见5例肿瘤囊壁淤血、坏死。 结论 卵巢肿瘤蒂扭转有较特征的MRI表现，结合临床病史，MRI可对多数卵巢肿瘤蒂扭转作出正确诊断。 【关键词】 卵巢肿瘤 蒂扭转 磁共振成像 MR Imaging Features of Pedicle Torsion of Ovarian Tumours （8 cases reported）Department of Radiology，Fujian Province Female and Children Hospital，Fuzhou，Fujian province 350000，P.R.China 【Abstract】　Objective To investigate the M manifestation of pedicle torsion of ovarian tumours and evaluate the diagnostic value of MR imaging for it . Materials and Methods The MR imaging data of ovarian tumours with pedicle torsion in 8 cases confirmed by surgery were analyzed retrospectively. Results 7 of 8 patients were benign tumors ，1 was malignant. Small solid amorphous masslike structures located adjacent to adnexal masses were observed in all of 8 cases on MR imaging，in which 3 cases showed whirlpool siccentric thickened wall or septa were observed in 5 cases ，linear hemorrage of cyst wall2 cases，hemoperitoneum case. The torsion of pedicle were 360o in 5 cases，720o in 3 cases ，ongestion and necrosis of cyst wall were noted in 5 cases on pathology. Conclusion The MR imaging of ovarian tumours with pedicle torsion demonstrates some characteristic features ，and is helpful for correct diagnosis combining with clinical presentation in most cases . 【key words】Ovarian tumour Pedicle Torsion Magnetic Resonance Imaging 卵巢肿瘤蒂扭转系由输卵管系膜部分或完全扭转所造成，常见临床表现为腹痛、附件肿块、腹膜炎三联征[1]，严重者可危及患者生命，部分病例临床表现不典型，早期诊断、及时解除扭转对保存卵巢和输卵管功能有重要意义，尤其对于有生育要求的育龄妇女或幼女更为重要[7]。其实验室检查并无特异性，B超对于卵巢肿瘤蒂扭转征象显示率仍较低，文献报道仅为24%[8]，多普勒超声可以探测肿块的血流，但并不能诊断或者排除肿瘤蒂扭转。CT检查[3、4、5]对于显示囊壁增厚，肿瘤出血以及扭转蒂的显示率较高，但软组织分辨率较低，MRI以其高软组织分辨率以及任意平面成像的优势，其价值逐渐被认可。 3.1 病理生理及临床表现 卵巢肿瘤的蒂是由骨盆漏斗韧带、输卵管和卵巢固有韧带组成,韧带中有卵巢动静脉及由此分出的子宫血管走行