卵巢癌肉瘤和高级别浆液性卵巢癌的MR鉴别要点  

Key Points Of MRI Imaging Differentiation between Ovarian Carcinosarcoma and High-grade Serous Ovarian Carcinoma

作　　者：石健 冯峰[1] 杨彦松 傅爱燕[1] 邢金丽 李君 朱政錡 毛咪咪 SHI Jian;FENG Feng;YANG Yan-song;FU Ai-yan;XING Jin-li;LI Jun;ZHU Zheng-qi;MAO Mi-mi(Department of Imaging,Nantong Tumor Hospital Affiliated to Nantong University,Nantong 226000,Jiangsu Province,China)

机构地区：[1]南通大学附属肿瘤医院影像科,江苏南通226000

出　　处：《中国CT和MRI杂志》2025年第3期153-156,共4页Chinese Journal of CT and MRI

基　　金：南通市卫生健康委指令性面上项目(MS2022050);南通市卫生健康委指令性面上项目(MS2022051)。

摘　　要：目的探讨磁共振成像(MRI)对卵巢癌肉瘤(CS)和高级别浆液性卵巢癌(HGSC)的鉴别诊断的价值。方法回顾性分析了经病理证实的10例CS和20例HGSC患者的一般临床资料(包括年龄、绝经状态和基线治疗前的肿瘤标志物)和MRI影像表现(包括肿瘤的分布、大小、形状、肿块类型、各囊性分房信号、实性成分类型、有无出血、有无坏死、有无子宫内膜异位症、平均ADC值、增强强化程度和MRI上的影像学FIGO分期)。使用独立样本t检验、Mann-Whitney U检验、卡方检验和Fisher精确检验比较CS和HGSC两组间的一般临床资料和MRI影像学表现。结果一般临床资料方面,CS组绝经后状态比例显著高于HGSC组(P=0.029),肿瘤标志物CA125(P=0.043)、CEA(P=0.024)低于HGSC组,CA199(P=0.009)高于HGSC组;两组间年龄、HE4无统计学差异。MRI影像表现方面,CS组的肿块最大径高于HGSC组(P=0.030),囊性成分信号不均匀比例(P=0.026)、出血比例(P=0.001)、影像学FIGO分期(P=0.049)高于HGSC组,平均ADC值低于HGSC组(P=0.020)。两组间肿块分布、形状、肿块类型、实性成分类型、有无坏死、有无子宫内膜异位、强化程度均无统计学差异。结论患者的绝经状态、肿瘤标志物CA125、CA199、CEA和MR影像表现中的肿块最大径、囊性成分信号特征、出血、FIGO分期、平均ADC值是CS和HGSC的鉴别要点。Objective To investigate the value of MRI in differential diagnosis of ovarian carcinosarcoma(CS)and high grade serous ovarian carcinoma(HGSC).Methods General clinical data(including age,menopausal status,and baseline tumor markers)and MRI findings(including tumor distribution,size,shape,appearance,nature of cystic and solid components,presence or absence of hemorrhage,presence or absence of necrosis,presence or absence of endometriosis,and imaging FIGO stage on MRI)of 10 pathologically confirmed CS and 20 HGSC patients were retrospectively analyzed.General clinical data and MRI findings were compared between CS and HGSC using independent sample t test,Mann-Whitney U test,chi-square test,and Fisher's exact test.Results In general clinical data,the proportion of postmenopausal status in CS group was significantly higher than that in HGSC group(P=0.029),the tumor markers CA 125(P=0.043),and CEA(P=0.024)were significantly lower than those in HGSC group,CA199(P=0.009)is higher than that in the HGSC group.There was no significant difference in age and HE4 between the two groups.In terms of MRI imaging features,the maximum diameter of the mass in CS group was higher than that in HGSC group(P=0.030),the proportion of cystic component inhomogeneous signal(P=0.026),the proportion of hemorrhage(P=0.001),imaging FIGO stage(P=0.049)were higher than that in HGSC group,and the average ADC value was lower than that in HGSC group(P=0.020).There was no significant difference in the distribution,shape,type,component,necrosis,endometriosis and enhancement between the two groups.Conclusion Menopause status,tumor markers CA125,CA199,CEA,maximum diameter of tumor,cystic component signal characteristics,hemorrhage,FIGO stage and average ADC value are the main points for distinguishing CS from HGSC.

关 键 词：上皮性卵巢癌 癌肉瘤 磁共振成像 上皮和间质混合肿瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学]