卵巢甲状腺肿的术前影像学诊断及鉴别  

Preoperative imaging diagnosis and differential diagnosis of struma ovarii

作　　者：王进进 肖美玲 周建军 计一丁 蔡宋琪 曾蒙苏 WANG Jin-jin;XIAO Mei-ling;ZHOU Jian-jun(Department of Radiology,Suzhou Ninth Hospital Affiliated to Soochow University,Jiangsu 215200,China)

机构地区：[1]苏州大学附属苏州九院影像科,江苏215200 [2]复旦大学附属金山医院放射科,上海200032 [3]复旦大学附属中山医院放射科上海市医学影像研究所,上海201508

出　　处：《放射学实践》2024年第1期90-96,共7页Radiologic Practice

基　　金：上海市卫生健康委员会科研项目计划《磁共振组学预测晚期间质表型卵巢癌初始手术完全切除的可行性研究》(编号:20214Y0298)。

摘　　要：目的:对照分析卵巢甲状腺肿(SO)与Ⅰ期上皮性卵巢癌(EOC)的临床及影像学资料,总结SO的临床特点及影像学特征。方法:回顾性分析经手术及病理确诊的42例SO与40例Ⅰ期EOC患者的临床及影像学资料,临床资料包括症状、年龄、肿瘤指标(CA125、HE4和CA19-9),影像学资料包括病变部位、数目、大小、形态、质地、囊壁及分隔厚度、CT密度、MRI信号特征、强化方式及程度等。比较两组患者的临床指标及影像学特征是否有统计学差异;通过多因素回归分析明确独立预测因素,并计算诊断效能。结果:Ⅰ期EOC组CA125(P<0.001)及HE4(P<0.001)异常升高、绝经后阴道流血症状(P=0.005)的发生率均高于SO组。两组肿瘤的质地、蜂房、壁结节、囊液密度、实性信号、肿块强化方式及程度差异均有统计学意义(P<0.05);其中CA125及肿瘤实性部分强化程度是鉴别SO与I期EOC的独立预测因素(P=0.022,OR=0.128;P=0.002,OR=11.148),两者联合诊断SO的ROC曲线下面积为0.857,敏感度为66.7%,特异度为90.0%。结论:SO与Ⅰ期EOC在临床症状、肿瘤标志物及影像学特征上均有差异,其中CA125及肿瘤实性成分强化程度是两者鉴别诊断的独立预测因素。Objective:This study aims to compare the clinical and imaging characteristics of struma ovarii(SO)and stageⅠepithelial ovarian cancer(EOC)to improve preoperative imaging diagnosis and differential diagnosis.Methods:A retrospective study was conducted on 42 patients with SO and 40 patients with stageⅠEOC who underwent clinicopathological analysis.The clinical data,including symptoms,age,tumor biomarkers(CA125,HE4 and CA19-9)and imaging data,including location,number,size,shape,texture,the thickness of septic and cyst walls,CT density,MRI signal intensities,the degree,and pattern of enhancement were compared between the two groups.Multivariate logistic regression and ROC curve analysis were used to assess the association between clinical data and imaging features and to evaluate diagnostic performance.Results:Elevation of CA125(P<0.001)and HE4(P<0.001),postmenopausal vaginal bleeding(P=0.005)were significantly different between the two groups.The differences in tumor texture,honeycomb loculi,wall nodule,cystic fluid density,solid components signal intensity,and enhancement degree were also statistically significant(P<0.05).Elevation of CA125 and the degree of enhancement are independent predictors(P=0.022,OR=0.128;P=0.002,OR=11.148),with a combined diagnosis specificity of 90.0%.Conclusions:SO and stageⅠEOC have different clinical symptoms,tumor biomarkers and imaging characteristics.The elevation of serum CA125 and the enhancement degree of solid components are independent predictors in the differential diagnosis of the two diseases.

关 键 词：卵巢甲状腺肿 上皮性卵巢癌 体层摄影术 X线计算机 磁共振成像 

分 类 号：R737.31[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R814.42