Lee Jong Hwa, Park Seong Bin, Shin Sang Hoon, Jang Jong Chang, Lee Won Chan, Jeong Ae Kyoung, Yang Myeon Jun
Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
J Comput Assist Tomogr. 2009 Nov-Dec;33(6):872-6. doi: 10.1097/RCT.0b013e31819e41f3.
The objective of this study was to evaluate the usefulness of the intra-adnexal and extra-adnexal computed tomographic (CT) features in identifying adnexal torsion.
We retrospectively analyzed CT examinations of 38 adnexal masses with torsion and 270 without torsion, which has been surgicopathologically confirmed. The CT features were evaluated according to 2 categorized groups. The first group included the intra-adnexal features dealing with the ovary and uterine tube, whereas the other included the extra-adnexal features dealing with changes of adjacent anatomical structures such as the uterus, gonadal vein, and peritumoral zone. We acquired statistical proportions for the frequencies of these 2 groups of CT features in ovarian tumors with adnexal torsion versus those without adnexal torsion.
When there were intra-adnexal CT features of adnexal torsion, peculiar uterine tube thickening was identified in 74% of the lesions, eccentric or concentric wall thickening in 54% (of only cystic lesions), eccentric septal thickening in 50% (of only cystic lesions except mature cystic teratoma), and eccentric or diffuse decreased or poor contrast enhancement of the internal solid component or thickened wall in 50%. In extra-adnexal CT features of adnexal torsion, uterine deviation to the twisted side was identified in 61% of the lesions, peritumoral infiltration in 40%, nonvisualized anatomic continuity of the ipsilateral gonadal vein with the twisted adnexal mass in 71%, and ascites in 13%. There were significant differences in all of the intra-adnexal and extra-adnexal CT findings, except for ascites, between twisted and nontwisted adnexal tumors.
The intra-adnexal and extra-adnexal groups of CT features are valuable in identifying torsion of adnexal mass.
本研究的目的是评估附件内和附件外计算机断层扫描（CT）特征在识别附件扭转中的作用。
我们回顾性分析了38例经手术病理证实为附件扭转的附件肿块及270例无扭转的附件肿块的CT检查结果。根据2个分类组对CT特征进行评估。第一组包括涉及卵巢和输卵管的附件内特征，而另一组包括涉及相邻解剖结构（如子宫、性腺静脉和肿瘤周围区域）变化的附件外特征。我们获取了这两组CT特征在有附件扭转与无附件扭转的卵巢肿瘤中的出现频率的统计比例。
当存在附件扭转的附件内CT特征时，74%的病变中可见特殊的输卵管增厚，54%（仅囊性病变）可见偏心或同心壁增厚，50%（仅除成熟囊性畸胎瘤外的囊性病变）可见偏心性间隔增厚，50%可见内部实性成分或增厚壁的偏心或弥漫性强化减低或强化不佳。在附件扭转的附件外CT特征中，61%的病变中可见子宫向扭转侧偏移，40%可见肿瘤周围浸润，71%可见同侧性腺静脉与扭转的附件肿块之间的解剖连续性消失，13%可见腹水。除腹水外，扭转与未扭转的附件肿瘤在所有附件内和附件外CT表现上均存在显著差异。
附件内和附件外CT特征组在识别附件肿块扭转方面具有重要价值。
