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卵巢T1高信号良性 病变信号分析

作者:骈文婷1 张得志1 贾福艳1 张爱丽2

所属单位:1.天津港口医院放射科 2.天津港口医院病理科 (天津 300456)

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摘要

目的 探讨卵巢T1高信号常见良 性病变信号特点及机制。方法 回顾手 术及病理证实的16例卵巢T1高信号良性 病变,分析术前T1WI/TSE、T2WI/TSE、 T2WI/SPAIR序列图像,观察T1WI高信号 强度和均质性、T2WI和SPAIR信号强度。 结果 16例患者发现31个T1高信号病灶。 子宫内膜异位囊肿8例17个病灶,T1WI显 著高信号16个、中等高信号1个,均匀12 个、不均5个,T2WI、SPAIR高信号15个、 低信号2个。浆液性囊腺瘤出血2例2个 病灶,T1WI中等高信号,均匀,T2WI、 SPAIR高信号。成熟性囊性畸胎瘤3例6 个病灶,T1WI显著高信号,不均,都有 T1WI、T2WI高信号且SPAIR信号减低灶。 甲状腺肿1例2个病灶,T1WI稍高信号,均 匀,T2WI、SPAIR高信号。粘液性囊腺瘤2 例4个病灶,T1WI中等高信号2个、稍高信 号2个,均匀,T2WI、SPAIR高信号3个、 低信号1个。结论 卵巢良性病变MRI中, 出血比蛋白质引起的T1高信号更强、更不 均质,但二者信号有重叠,还需要结合其 他影像学征象和临床信息加以鉴别。卵巢 含脂肪成分良性病变T1高信号在脂肪抑制 序列特异性减低,容易确诊。

Objective To investigate the characteristics and mechanisms of ovarian benign lesions with T1 hyperintense. Methods 16 cases of ovarian benign lesions with T1 hyperintense were reviewed. They were confirmed by surgery and pathology. The MRI sequences included T1WI/TSE, T2WI/TSE and T2WI/SPAIR. The signal intensity and homogeneity of T1WI and the signal intensity of T2WI and SPAIR were observed. Results 31 lesions with T1 hyperintense were found. 17 lesions were Endometriotic cysts (T1WI: significantly high signal 16, medium high signal 1, homogeneous 12, heterogeneity 5, T2WI and SPAIR: high signal 15, low signal 2). 2 lesions were serous cystadenoma hemorrhage (T1WI: medium high signal, homogeneous, T2WI and SPAIR: high signal). 6 lesions were mature cystic teratoma (T1WI: significantly high signal, heterogeneity, high signal reduced on SPAIR). 2 lesions were goiter (T1WI: slightly higher signal, homogeneous, T2WI and SPAIR: high signal). 4 lesions were mucinous cystadenoma (T1WI: medium high signal 2, slightly higher signal 2, homogeneous, T2WI and SPAIR: high signal 3, low signal 1). Conclusion Although the signal intensity of ovary benign lesions with hemorrhagic were stronger and more homogeneous than that of protein on T1WI, but the MR signals also had overlap. More imaging features and clinical informations can help diagnose. Fat composition of ovary benign lesions were easy to confirm because of the specific signal reduction on fat suppression sequence.

【关键词】卵巢;磁共振成像;子宫内膜 异位囊肿;成熟性囊性畸胎瘤; 囊腺瘤

【中图分类号】R737.3;R445.2

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.09.033

前言

近年来对于MRI颅内T1高信号已有较为深入的研究,认为能够提示 某些特定成分的存在,如高铁血红蛋白、脂肪、蛋白质、黑色素、矿 物质等[1]。临床妇科盆腔MRI中附件区T1高信号病灶常见,其中卵巢良 性病变占大多数,包括子宫内膜异位囊肿、成熟性囊性畸胎瘤、粘液 性囊腺瘤等[2]。不同卵巢病变产生T1高信号的物质基础不尽相同,这 使得病变MRI信号各具特点,掌握其规律并了解机制可以提高定性诊断 的准确性,进而选择合适的治疗方案。本文通过回顾病理证实的卵巢 T1高信号灶,分析T1高信号特点及产生机制,并结合T2WI、SPAIR信号 鉴别几种常见卵巢良性病变。