Guerra A, Cunha T M, Félix A
Department of Radiology, Hospital Pulido Valente, Lisbon, Portugal.
Acta Radiol. 2008 Jul;49(6):700-9. doi: 10.1080/02841850802064995.
Accurate evaluation of adnexal masses allows correct surgical procedure, avoiding unnecessary surgery.
To evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of malignancy of adnexal lesions.
We retrospectively reviewed the pelvic MRI scans of 161 patients with 199 surgically confirmed adnexal masses, between November 1998 and June 2005. The criteria for adnexal malignancy were contrast-enhanced solid lesions, contrast-enhanced solid components in mixed lesions (except those with low-signal-intensity solid components on T2-weighted imaging [T2WI]), contrast-enhanced papillary projections in cystic lesions (except those with low-signal-intensity papillary projections on T2WI), or septal thickness >or=3 mm. Ascites, peritoneal metastasis, and pelvic adenopathy were also regarded as criteria for malignancy.
On MRI evaluation, 97 adnexal lesions were malignant and 102 were non-malignant. Thirty-two percent of patients with ascites had benign lesions. Histopathologic evaluation of the adnexal lesions showed that 83 were malignant (true positives), 100 were non-malignant (true negatives), and seven were uncertain malignant potential tumors; two were false negative and seven were false positive. The MRI sensitivity and specificity for malignancy were 98% and 93%, respectively. MRI reached an accuracy of 95%, with a positive predictive value of 0.92 and a negative predictive value of 0.98 for malignant adnexal lesions. The kappa coefficient was 0.906, indicating almost perfect agreement between MRI and histological results.
MRI is an accurate method for evaluating the malignancy of adnexal lesions.
准确评估附件肿块有助于选择正确的手术方式，避免不必要的手术。
评估磁共振成像（MRI）诊断附件病变恶性肿瘤的准确性。
回顾性分析1998年11月至2005年6月间161例经手术证实有199个附件肿块患者的盆腔MRI扫描资料。附件恶性肿瘤的诊断标准为：增强扫描呈实性的病变、混合性病变中的增强实性成分（T2加权成像[T2WI]上低信号实性成分者除外）、囊性病变中的增强乳头状突起（T2WI上低信号乳头状突起者除外）或分隔厚度≥3mm。腹水、腹膜转移及盆腔淋巴结肿大也作为恶性肿瘤的诊断标准。
MRI评估显示，97个附件病变为恶性，102个为非恶性。有腹水的患者中32%为良性病变。附件病变的组织病理学评估显示，83个为恶性（真阳性），100个为非恶性（真阴性），7个为恶性潜能不确定的肿瘤；2个为假阴性，7个为假阳性。MRI诊断恶性肿瘤的敏感性和特异性分别为98%和93%。MRI对附件恶性病变的诊断准确性达95%，阳性预测值为0.92，阴性预测值为0.98。kappa系数为0.906，表明MRI与组织学结果几乎完全一致。
MRI是评估附件病变恶性程度的准确方法。
