18例卵巢纤维瘤的MRI表现与误诊分析

李 艳, 胡 宁, 郑 晔, 林 宇杰, 吴 伯林, 张 顺镇
厦门市海沧医院放射影像科

摘要

目的：通过分析18例卵巢纤维瘤的MRI表现及对误诊病例进行分析，提高对该病的诊断水平。方法：回顾性分析经手术病理证实的18例卵巢纤维瘤的 MRI 征象，拟按照瘤特征分成五种类型：均质型、变性型、出血型、“Meigs综合征”型及复杂型，具体观察各类纤维瘤的MRI特征，并对误诊病例原因进一步分析。结果：1、临床特点：好发年龄为35-60岁，占发病病例的77.8%；临床表现较轻，以腹部肿块为最主要症状占61.1%，阴道不规则出血、腹痛、月经紊乱等占33.3%，无症状者占33.3%。2、MRI表现：18例患者共19个肿瘤，除1例为双侧卵巢发病，余均为单发。五种类型卵巢纤维瘤MRI征象：①均质型：4例，肿瘤体积均较小，表现为边界清楚光滑、圆形或椭圆形实质肿块，T1WI及T2WI上为均匀的低信号，增强后早期病灶几乎不强化，延迟期出现轻到中度强化；②变性型：5例，肿瘤体积均较大，表现为边缘欠光滑、大小不一的囊实性混杂信号肿块，瘤体内可见不规则长T 1长T2信号区，增强后瘤体的囊、实质部分均强化不明显。③出血型：2例，表现为T 1WI和T 2WI上肿瘤内均可见略高信号，增强后瘤体轻度强化。④“Meigs综合征”型：5例，肿瘤体积较大，表现为实性、囊实性及囊性肿块，T1WI及T2WI肿瘤内信号不均匀，增强扫描呈不均匀延迟强化，4合并腹腔或盆腔积液，1例合并胸腔积液。⑤复杂型：2例，其中1例表现为囊性肿块，与周围分界清楚，增强扫描后囊壁轻度强化，另1例为双侧卵巢囊实性肿块，信号混杂。3、误诊病例：共计10例，误诊为浆膜下及阔韧带肌瘤、卵巢卵泡膜纤维瘤及颗粒细胞瘤、卵巢癌及浆液性囊腺瘤。分许原因多为观察MRI征象不仔细，过于依赖临床表现或对该病认识程度不够深刻。结论：不同类型的卵巢纤维瘤MRI表现有一定的差异性，综合应用对卵巢肿瘤的定性诊断有重要的临床价值。

关键词

卵巢肿瘤；纤维瘤；Meigs综合征；磁共振成像

参考

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