磁共振动态增强扫描、ADC及3D减影技术对卵巢囊腺瘤和囊腺癌的诊断价值

摘要

Objective To explore the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (MRI),multiple b-value diffusion-weighted imaging (DWI) combined with apparent diffusion coefficient (ADC) and three-dimensional (3D) subtraction technique for ovarian cystadenoma and cystadenocancinoma.Methods Thirty-nine cases of cystadenoma and 12 cases of cystadenocarcinoma confirmed by surgery and pathology received conventional MRI.multiple b-value DWI with ADC measurement of solid and cystic components,dynamic contrast-enhaneed MRI,3D subtraction multimodal scanning.The obtained data were retrospectively analyzed.Results Among 55 lesions,40 of them were benign eystadenoma and the other 15 were cystadenocarcinoma.The conventional MRI revealed that among 51 selected cases,9 cases had "stained-glass" sign and 6 cases of cystadenoma had isointensity wall nodules on Trweighted image (T2WI).The b-value DWI was 100,500,1 000 mm2/s,respectively.The ADC values of solid and cystic components of ovarian cystadenocarcinoma were lower than those of ovarian cystadenoma,with significant differences (P＜0.05).The ADC values of cystadenoma were 0.03±0.23)× 103,(2.92±0.20)× 10-3 and (2.88±0.21)× 103 mm2/s,respectively,while those of cystic components of cystadenocarcinoma were (2.71±0.31)×10-3,(2.63±0.27)× 10-3 and (2.47±0.41)× 10-3 mm2/s,respectively.The ADC values of solid compenents of cystadenonoma were (l.80±0.50)× 10-3,(1.47t0.48)× 10-3 and (l.30±0.39)× 10-3 mm2/s,respectively.The dynamic contrast-enhanced MRI demonstrated that no enhancement or slightly enhancement on isointensity wall nodules on T2WI of cystadenoma,and the time-intensity curve (TIC) was type Ⅰ.Moreover,the isointensity wall nodules and solid components in 13 cases of cystadenocarcinoma were significantly enhanced on T2WI,and the TIC was type Ⅱ.The TIC of 2 borderline cystadenocarcinoma was type Ⅰ.3D subtraction scanning image showed enhancement characteristics at the arterial phase of wall nodules.No enhancement was found at thrombus and cell fragments.The nipple structure of cystadenoma was slightly enhanced but the wall nodules and solid component of cystadenocarcinoma were significantly enhanced.Conclusion The combined use of dynamic contrast-enhanced MRI,multiple b-value DWI and 3D subtraction technique is more valuable for the diagnosis of ovarian cystadenoma and cystadenocarcinoma.%目的:探讨磁共振动态增强扫描、多b值扩散加权成像(DWI)结合表现扩散系数(ADC)值及3D减影技术对卵巢囊腺瘤和囊腺癌的诊断价值.方法:对经手术病理证实的39例囊腺瘤和12例囊腺癌进行常规MRI、多b值DWI及肿瘤囊实性成分ADC测量、动态增强、3D减影多模态扫描资料进行回顾性分析.结果:55个病灶中,40个为良性囊腺瘤,15个为囊腺癌.常规MRI,51例中9例见彩色玻璃征,6例囊腺瘤在T2WI见等信号壁结节.DWI在b值100、500、l 000 mm2/s,卵巢囊腺癌的囊、实性部分ADC低于囊腺瘤瘤体,囊腺瘤ADC分别为(3.03±0.23)×103、(2.92±0.20)×10-2、(2.88±0.21)×10-3 mm2/s,囊腺癌囊性ADC分别为(2.71±0.31)× 103、(2.63±0.27)×l0-3、(2.47±0.41)×10-3 mm2/s,囊腺癌实性ADC分别为(1.80±0.50)×10-3、(1.47±0.48)× 10-3、(1.30±0.39)× 10-3 mm2/s,囊腺瘤的瘤体与囊腺癌的囊、实性ADC值差异均有统计学意义(P＜0.05).动态增强扫描示囊腺瘤在T2WI等信号壁结节无强化或轻度强化,TIC曲线呈Ⅰ型,13个囊腺癌在T2WI等信号壁结节、实性成分呈明显强化,TIC曲线呈Ⅱ型,2个交界性囊腺癌TIC曲线呈Ⅰ型.3D减影清楚显示壁结节动脉期强化特点,囊腺瘤乳头结构轻度强化,血栓及细胞碎片无强化,囊腺癌壁结节及肿块明显强化.结论:磁共振动态增强扫描、多b值DWI所表现ADC值、3D减影技术三者联合运用对评估卵巢囊腺瘤和囊腺癌价值更大.