孔伟 林文聪 陈文坚 余裕珍 周志娟 谭丽珊

【摘要】 目的：探讨常规MRI及DWI对囊性卵巢上皮性肿瘤（EOT）的鉴别诊断价值。方法：回顾性分析81例囊性卵巢EOT患者的MRI资料。将肿瘤分为良性、交界性和恶性三组，记录肿瘤的定性指标及表观弥散系数（ADC）值并比较各项指标在三组肿瘤间的差别。绘制ROC曲线评价定性及定量指标的鉴别诊断效能，比较ROC曲线下面积（AUC）。结果：三组囊内赘生物、实性成分/分隔弥散情况比较，差异均有统计学意义（P<0.05）;良性组与交界性组、恶性组的纯囊性结构、实性成分/分隔强化程度比较，差异均有统计学意义（P<0.05）;恶性组与良性组、交界性组的病灶形态比较，差异均有统计学意义（P<0.05）;交界性组与良、恶性组的蜂房结构比较，差异均有统计学意义（P<0.05）;良性组与恶性组的腹膜转移情况比较，差异有统计学意义（P<0.05）。良性、交界性及恶性EOT含实性/分隔区域的ADC值（ADCmeanS）分别为（2.674±0.211）×10-3、（1.962±0.262）×10-3、（1.165±0.190）×10-3 mm2/s，

三组间两两比较差异均有统计学意义（P<0.05）。良性组、交界性组、恶性组的纯囊性区ADC值（ADCmeanC）分别为（2.714±0.157）×10-3、（2.624±0.189）×10-3、（2.622±0.152）×10-3 mm2/s，良性组与交界性组、恶性组比较，差异均有统计学意义（P<0.05）。良性及交界性EOT的定性特征联合、ADCmeanS与ADCmeanC的AUC比较，差异均有统计学意义（P<0.05）。交界性及恶性EOT的定性特征联合与ADCmeanS的AUC比较，差异无统计学意义（P>0.05）。结论：联合多個定性MRI指标能较好区分良性、交界性及恶性EOT，结合ADC定量值能进一步确定肿瘤性质。

【关键词】 卵巢上皮性肿瘤 囊性卵巢肿瘤 磁共振成像 弥散加权成像

The Value of DWI and Conventional MRI in Differential Diagnosis of Cystic Epithelial Ovarian Tumors/KONG Wei， LIN Wencong， CHEN Wenjian， YU Yuzhen， ZHOU Zhijuan， TAN Lishan. //Medical Innovation of China， 2021， 18（14）： -151

[Abstract] Objective： To explore the value of conventional MRI and DWI in the differential diagnosis of cystic ovarian epithelial tumors （EOT）. Method： The MRI data of 81 patients with cystic epithelial ovarian tumors were analyzed retrospectively. The tumors were divided into benign， borderline and malignant groups. The qualitative indexes and the apparent diffusion coefficient （ADC） of the tumors were recorded， and the differences of each index among the three groups were compared. ROC curves were drawn to evaluate the differential diagnosis efficiency of qualitative and quantitative indexes， and the areas under ROC curve （AUC） were compared. Result： Comparison of neoplasms and solid components/separations diffusion among the three groups， the differences were statistically significant （P<0.05）. Comparison of pure cystic structure and solid component/separation enhancement degree between the benign group and the borderline group， malignant group， the differences were statistically significant （P<0.05）. Comparison of lesions morphology between the malignant group and the benign or borderline group， the differences were statistically significant （P<0.05）. Comparing the hive structure between the borderline group and the benign group， malignant group， the differences were statistically significant （P<0.05）. Comparison of peritoneal metastasis between the benign group and the malignant group， the difference was statistically significant （P<0.05）. The ADCMeanC values in the pure cystic areas of the benign group， the borderline group and the malignant group were （2.674±0.211）×10-3，

（1.962±0.262）×10-3 and （1.165±0.190）×10-3 mm2/s， respectively and pairwise comparison of the three groups， the differences were statistically significant （P<0.05）. The ADCMeanC values in the pure cystic areas of the benign group， the borderline group and the malignant group were （2.714±0.157）×10-3， （2.624±0.189）×10-3，

and （2.622±0.152）×10-3 mm2/s， respectively， the differences between benign group and borderline group， malignant group were statistically significant （P<0.05）. Comparing the AUC between the combination of the qualitative characteristics of benign and borderline EOT， ADCmeanS and ADCmeanC， the differences were statistically significant （P<0.05）. Comparing the AUC between the combination of the qualitative characteristics of borderline and malignant EOT and ADCmeanS， the difference was not statistically significant （P>0.05）. Conclusion： Benign， borderline and malignant EOT can be well distinguished by integrating multiple qualitative MRI indexes， combined with quantitative ADC values can further determine the nature of the tumor.

[Key words] Epithelial ovarian tumor Cystic ovarian tumor Magnetic resonance imaging Diffusion weighted imaging

First-authors address： Shaoguan First Peoples Hospital， Shaoguan 512000， China

doi：10.3969/j.issn.1674-4985.2021.14.035

卵巢上皮性肿瘤（epithelial ovarian tumor，EOT）是女性生殖系统的常见肿瘤，病理上分为良性、交界性和恶性三类。EOT发病隐匿，临床症状不典型，手术是主要治疗手段，而术前对肿瘤性质的准确判断，对预后评估有重要影响。三种类型EOT常表现为附件区囊性或以囊性为主的包块，发现时体积均较大，鉴别诊断困难，明确诊断通常需要依靠病理。常规MRI具有高软组织分辨率，能很好地显示肿瘤的来源、形态、结构及累及范围[1-3]，而弥散加权成像（diffusion-weighted imaging，DWI）作为常规成像的补充，不仅能检测活体内水分子扩散情况、提供额外的视觉信息，还能将扩散改变进行量化，对肿瘤的鉴别诊断有重要意义。本研究旨在分析常规MRI及DWI对囊性EOT的鉴别诊断价值，为临床决策提供参考依据，现报道如下。……