通过磁共振成像鉴别卵巢良恶性肿瘤

Chen Min, Wang Wen-Chao, Zhou Cheng, Zhou Ni-Na, Cai Kui, Yang Zheng-Han, Zhao Wei-Feng, Li Sa-Ying, Li Guo-Zhen

Department of Radiology, Beijing Hospital, Beijing 100730.

Chin Med Sci J. 2006 Dec;21(4):270-5.

OBJECTIVE

To determine the magnetic resonance (MR) imaging findings of an ovarian mass which are most predictive of malignancy and assess the value of intravenous gadolinium administration in the characterization of an ovarian mass.

METHODS

Totally 74 consecutive patients with a clinically or sonographically indeterminate adnexal mass underwent MR imaging, of whom 59 had subsequent surgical resection of 70 adnexal masses. These 59 patients formed the study population. MR imaging studies were prospectively and independently reviewed by a senior and a junior radiologist. The senior radiologist also reevaluated the studies in a blind fashion after a minimum 6 months interval. The sensitivity, specificity, positive predictive value, and negative predictive value of contrast-enhanced and unenhanced MR imaging were evaluated.

RESULTS

The most predictive MR imaging findings for malignancy were presence of vegetations in a cystic lesion and presence of necrosis in a solid lesion. The odds ratio was even higher when the ancillary finding of peritoneal metastasis or ascites was present. Contrast media contributed significantly to lesion characterization. Total 70 ovarian masses were detected by contrast-enhanced MR imaging including 37 malignant ovarian masses and 33 benign ovarian masses with 87% (61/70) accuracy, 86% (32/37) sensitivity, 88% (29/33) specificity, 89% (32/36) positive predictive value, and 85% (29/34) negative predictive value, whereas 70 ovarian masses were detected by unenhanced MR imaging with 74% (52/70) accuracy, 73% (27/37) sensitivity, 76% (25/33) specificity, 77% (27/35) positive predictive value, and 71% (25/35) negative predictive value. There were significant differences in accuracy (P < 0.01), sensitivity (P < 0.01), specificity (P < 0.01) between contrast-enhanced and unenhanced MR imaging.

CONCLUSION

Contrast-enhanced MR imaging is highly accurate in detection and characterization of complex adnexal masses.

目的

确定对卵巢肿块恶性程度最具预测性的磁共振（MR）成像表现，并评估静脉注射钆剂在卵巢肿块特征性诊断中的价值。

方法

连续74例临床或超声检查无法明确诊断的附件肿块患者接受了MR成像检查，其中59例随后对70个附件肿块进行了手术切除。这59例患者构成了研究人群。MR成像研究由一位资深放射科医生和一位初级放射科医生进行前瞻性独立评估。资深放射科医生在至少间隔6个月后以盲法重新评估这些研究。评估了增强和未增强MR成像的敏感性、特异性、阳性预测值和阴性预测值。

结果

对恶性程度最具预测性的MR成像表现为囊性病变中有赘生物以及实性病变中有坏死。当存在腹膜转移或腹水等辅助表现时，优势比更高。造影剂对病变特征性诊断有显著贡献。增强MR成像共检测出70个卵巢肿块，其中37个为恶性卵巢肿块，33个为良性卵巢肿块，准确率为87%（61/70），敏感性为％（32/37），特异性为88%（29/33），阳性预测值为89%（32/36），阴性预测值为85%（29/34）；而未增强MR成像检测出70个卵巢肿块，准确率为74%（52/70），敏感性为73%（27/37），特异性为76%（25/33），阳性预测值为77%（27/35），阴性预测值为71%（25/35）。增强和未增强MR成像在准确率（P < 0.01）、敏感性（P < 0.01）、特异性（P < 0.01）方面存在显著差异。