卵巢囊性腺纤维瘤和卵巢腺纤维瘤的超声诊断效能及图像特征分析  

The ultrasonic features and diagnostic performance of ultrasound for ovarian cystadenofibroma and adenofibroma

作　　者：钱乐[1] 姜美娇[1] 杨伯文 陈慧[1] QIAN Le;JIANG Meijiao;YANG Bowen;CHEN Hui(Department of Obstetrics and Gynecology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院妇产科,上海200025

出　　处：《诊断学理论与实践》2021年第2期161-167,共7页Journal of Diagnostics Concepts & Practice

基　　金：上海市科委医学创新研究项目(20Y11914000)。

摘　　要：目的:探讨卵巢囊性腺纤维瘤(cystadenofibroma,CAF)和卵巢腺纤维瘤(adenofibroma,AF)的超声图像特征。方法:回顾性分析经术后病理检查证实的50例卵巢CAF和7例卵巢AF患者的超声声像图特征,并评估超声的诊断价值。结果:根据病理结果,50例CAF中,良性为46例,共47个肿块;交界性为4例,均为单发,7例AF均为良性单发病灶。卵巢CAF和AF的病理分型以浆液性为主(53/58,91.4%)。将交界性肿瘤归入恶性肿瘤,术前超声检查鉴别CAF及AF肿块良恶性的灵敏度为100.0%[95%置信区间(confidential interval,95%CI)为39.8%~100.0%],特异度为72.2%(95%CI为58.4%~83.5%),准确率为74.1%。超声图像上,良性CAF多表现为形态规则(43/47,91.5%)、边界清晰(46/47,97.9%)的单房囊实性肿块(25/47,53.2%),且多数肿块附壁有规则的乳头状突起(32/47,68.1%),突起内无或少量血流信号(31/32,96.9%)。交界性CAF的超声表现均有实性部分或乳头状突起,内部血供程度为少量至丰富不等。与良性CAF相比,交界性CAF实性部分或乳头状突起的最大径更大[最大径,19.5(18.8~26.3)mm比8.0(7.0~13.0)mm,P=0.002],实性部分或乳头状突起与肿块最大径比值更大(0.35比0.15,P=0.033),内有血供者更多(4/4比10/35,P=0.012)。AF超声图像多表现为形态规则(6/7)、边界清晰(5/7)且后方伴有回声衰减的实性肿块(4/7),其实性部分内呈乏血供表现(6/6)。结论:超声诊断CAF及AF的效能一般。良性CAF多表现为附壁有乏血供乳头状突起的囊实性肿块;交界性CAF多表现为有不同程度血供的实性或乳头状突起的肿块;而AF多表现为后方伴回声衰减、无血供的实性肿块。肿块在超声图像上表现为实性成分多和血供程度丰富,多提示交界性CAF。Objective:To investigate ultrasonic features of ovarian cystadenofibroma(CAF)and adenofibroma(AF).Methods:Ultrasonic features of 50 cases with ovarian CAF and 7 cases with AF were analyzed,and diagnostic performance of ultrasound was evaluated.Results:According to pathological findings of the CAF cases studied,46 were benign CAF with 47 tumors identified,and 4 cases were borderline AF.All the seven AF cases were benign with single lesion.Pathologically,most of lesions was serous(53/58,91.4%).With borderline CAF defined as malignant,the ultrasound differentiated benign from malignant masses of CAF and AF with a sensitivity of 100.0%(95%CI 39.8%-100.0%),specificity of 72.2%(95%CI 58.4%-83.5%),and accuracy of 74.1%.Most benign CAF masses were described as unilocular solid cysts(25/47,53.2%)with regular morphology(43/47,91.5%)and well-defined boundaries(46/47,97.9%).Regular papillary projections(32/47,68.1%)in CAF lesions manifested no or minimal color Doppler signals(31/32,96.9%).The borderline CAF masses were all identified with solid components or papillary projections,which manifested various degree of blood supply.Compared with benign CAF,borderline CAF showed more solid or papillary components[maximum diameter,borderline CAF was 19.5(18.8-26.3)mm versus benign 8.0(7.0-13)mm,P=0.002],with higher the maximum diameter ratio of the solid components or papillary projections to the mass[the borderline CAF was 0.35 versus benign CAF0.15,P=0.033],and there were more blood supply inside the borderline CAF(4/4)than benign CAF(10/35),(P=0.012).Most of the AF masses were described as regular(6/7),well-defined(5/7)solid masses with shadowing identified(4/7).Absent color Doppler signals were recorded in the solid components(6/6).Conclusions:The ultrasound has a sound diagnostic performance for CAF and AF.Benign CAF lesions are mostly described as solid cysts with papillary projection(s)mani-festing no or minimal color Doppler signals;borderline CAFs are mostly described as masses with papillary projection(s)and solid compone

关 键 词：卵巢肿瘤 超声 囊性腺纤维瘤 腺纤维瘤 

分 类 号：R445.1[医药卫生—影像医学与核医学]