放射学实践
放射學實踐
방사학실천
RADIOLOGIC PRACTICE
2014年
7期
808-813
,共6页
韩太林%赵慧萍%曾蒙苏%周康荣%周建军
韓太林%趙慧萍%曾矇囌%週康榮%週建軍
한태림%조혜평%증몽소%주강영%주건군
阑尾肿瘤%体层摄影术,X线计算机%磁共振成像%诊断,鉴别
闌尾腫瘤%體層攝影術,X線計算機%磁共振成像%診斷,鑒彆
란미종류%체층섭영술,X선계산궤%자공진성상%진단,감별
Appendiceal neoplasms%Tomography,X-ray computed%Magnetic resonance imaging%Diagnosis,differential
目的：探讨阑尾黏液性肿瘤的CT及 MRI特征，并分析其良、恶性鉴别要点。方法：回顾性分析67例经病理证实的阑尾黏液性肿瘤的临床资料，其中黏液腺癌27例，黏液性囊腺瘤22例，低级别黏液性肿瘤18例。分组对照分析CT及 MRI征象并行Logistic回归分析性别、年龄、部位、大小、形态、境界、根蒂和囊壁（厚度、均匀度、光滑度、完整度）、内容物（壁结节、分隔、钙化、囊液、气体）、强化（强度、均匀性、方式）、腹水、淋巴结等因素与良、恶性的相关性。结果：黏液腺癌多表现为长茄子形，最大径6．5 cm（2．9～11．2 cm），长径与短径比值平均2．5。27例均囊壁不光整，边界不清，强化不均匀，多伴附壁结节样（n＝11）或分隔条絮样强化（n＝13），钙化（n＝17）以囊内颗粒状多见（n＝14），部分可见囊壁破裂形成腹腔假性黏液瘤（n＝12）及腹腔种植转移（n＝8）。黏液性囊腺瘤多为球形，最大径3．5 cm（2．2～9．5 cm），长径与短径比值平均1．65，囊壁相对光整，边界相对较清，强化较均匀；钙化（n＝17）多为附壁蛋壳样钙化（n＝11），腹水少见。低级别黏液性肿瘤恶性度较低，影像表现介于黏液腺癌与囊腺瘤之间，1例穿孔但未见腹腔种植转移。Logistic回归分析提示良性组的根蒂和囊壁均匀度、光滑度及其强化均匀性与恶性组间差异有统计学意义（P＜0．05）。结论：阑尾黏液性肿瘤病理上分为上述三类，CT、MRI表现有一定特征性，但术前相互鉴别困难；根蒂和囊壁的均匀度、光滑度及强化均匀性等因素对判断良恶性有帮助，由于样本量有限，其他因素的鉴别价值有待进一步研究。
目的：探討闌尾黏液性腫瘤的CT及 MRI特徵，併分析其良、噁性鑒彆要點。方法：迴顧性分析67例經病理證實的闌尾黏液性腫瘤的臨床資料，其中黏液腺癌27例，黏液性囊腺瘤22例，低級彆黏液性腫瘤18例。分組對照分析CT及 MRI徵象併行Logistic迴歸分析性彆、年齡、部位、大小、形態、境界、根蒂和囊壁（厚度、均勻度、光滑度、完整度）、內容物（壁結節、分隔、鈣化、囊液、氣體）、彊化（彊度、均勻性、方式）、腹水、淋巴結等因素與良、噁性的相關性。結果：黏液腺癌多錶現為長茄子形，最大徑6．5 cm（2．9～11．2 cm），長徑與短徑比值平均2．5。27例均囊壁不光整，邊界不清，彊化不均勻，多伴附壁結節樣（n＝11）或分隔條絮樣彊化（n＝13），鈣化（n＝17）以囊內顆粒狀多見（n＝14），部分可見囊壁破裂形成腹腔假性黏液瘤（n＝12）及腹腔種植轉移（n＝8）。黏液性囊腺瘤多為毬形，最大徑3．5 cm（2．2～9．5 cm），長徑與短徑比值平均1．65，囊壁相對光整，邊界相對較清，彊化較均勻；鈣化（n＝17）多為附壁蛋殼樣鈣化（n＝11），腹水少見。低級彆黏液性腫瘤噁性度較低，影像錶現介于黏液腺癌與囊腺瘤之間，1例穿孔但未見腹腔種植轉移。Logistic迴歸分析提示良性組的根蒂和囊壁均勻度、光滑度及其彊化均勻性與噁性組間差異有統計學意義（P＜0．05）。結論：闌尾黏液性腫瘤病理上分為上述三類，CT、MRI錶現有一定特徵性，但術前相互鑒彆睏難；根蒂和囊壁的均勻度、光滑度及彊化均勻性等因素對判斷良噁性有幫助，由于樣本量有限，其他因素的鑒彆價值有待進一步研究。
목적：탐토란미점액성종류적CT급 MRI특정，병분석기량、악성감별요점。방법：회고성분석67례경병리증실적란미점액성종류적림상자료，기중점액선암27례，점액성낭선류22례，저급별점액성종류18례。분조대조분석CT급 MRI정상병행Logistic회귀분석성별、년령、부위、대소、형태、경계、근체화낭벽（후도、균균도、광활도、완정도）、내용물（벽결절、분격、개화、낭액、기체）、강화（강도、균균성、방식）、복수、림파결등인소여량、악성적상관성。결과：점액선암다표현위장가자형，최대경6．5 cm（2．9～11．2 cm），장경여단경비치평균2．5。27례균낭벽불광정，변계불청，강화불균균，다반부벽결절양（n＝11）혹분격조서양강화（n＝13），개화（n＝17）이낭내과립상다견（n＝14），부분가견낭벽파렬형성복강가성점액류（n＝12）급복강충식전이（n＝8）。점액성낭선류다위구형，최대경3．5 cm（2．2～9．5 cm），장경여단경비치평균1．65，낭벽상대광정，변계상대교청，강화교균균；개화（n＝17）다위부벽단각양개화（n＝11），복수소견。저급별점액성종류악성도교저，영상표현개우점액선암여낭선류지간，1례천공단미견복강충식전이。Logistic회귀분석제시량성조적근체화낭벽균균도、광활도급기강화균균성여악성조간차이유통계학의의（P＜0．05）。결론：란미점액성종류병리상분위상술삼류，CT、MRI표현유일정특정성，단술전상호감별곤난；근체화낭벽적균균도、광활도급강화균균성등인소대판단량악성유방조，유우양본량유한，기타인소적감별개치유대진일보연구。
Objective:To investigate the CT、MRI manifestations and differential diagnosis of benignity and malignan-cy of appendiceal mucinous tumors.Methods:The clinical,CT and MRI materials of 48 cases with pathology proved appen-diceal mucinous tumor were analyzed retrospectively.There were mucinous adenocarcinoma (27 patients),mucinous cystad-enoma (22 patients)and low-grade mucinous tumors (18 patients).The CT and MRI manifestations were analyzed and cor-related with gender,age,location,size,shape,border,peduncle and cyst wall (thickness,evenness,smoothness,integrity),in-tra-cystic content (mural nodule,septa,calcification,intra-cystic fluid and gas),enhancement (intensity,homogeneity,pat-tern),ascites,lymph nodes with Logistic regression.Results:Mucinous adenocarcinoma (n= 27)usually presented as long eggplant shape with the longest dimension as 6.5cm (2.9~11.2cm),the ratio of length and width was 2.5 on average.All of the 27 patients had irregular cystic wall,ill-defined boundary,heterogeneous enhancement accompanied with mural nodu-lar enhancement (n= 11)or strip-like enhancement (n= 13).Calcifications were observed in 17 cases (17/27),most of them were intra-capsular granular calcification (n= 14).Occasionally part of the capsule wall ruptured with intra-abdominal pseu-do myxoma (n= 12)and implantation metastasis (n= 8).Of the 22 patients with mucinous cystadenoma,spherical shape was often encountered,with biggest diameter as 3.5cm (2.2~9.5cm),the ratio of length and width was 1.65 on average, with relatively smooth capsule wall,well defined boundary,homogeneous enhancement and calcification (n= 17),most of them presenting egg-shell pattern (n= 11).Ascites were rarely assessed.Low-grade mucinous neoplasm (n= 18)had low potential malignancy,the imaging features were between those of cystadenoma and cystadenocarcinoma.Perforation was seen in one case and without implantation metastasis.Logistic regression analysis suggested that the findings including even-ness of peduncle and cyst wall,smoothness,homogeneity of enhancement prompted to be benignity,showing statistically sig-nificant difference between the groups (P<0.05).Conclusion:Appendiceal mucinous tumors had the above mentioned three subtypes on pathology,characteristic CT and MRI manifestations could be displayed,but still had difficulty in differentiation of benignity and malignancy before surgery.Factors included evenness and smoothness of peduncle and cyst wall,homogene-ity of enhancement were helpful for differential diagnosis.Further evaluation is necessary due to limitation of sample size in this study.
