| Objectives To investigate the characteristic imaging features of different types of ovarian cord-stromal tumors(SCST),and to compare the clinical and pathological data.At the same time,the diagnostic value of various imaging methods(ultrasound,CT,MRI)for SCST was analyzed.Methods From July 2015 to June 2019,121 patients who were first diagnosed as SCST in the Department of gynaecology in Tang Shan Maternal and Child Health Hospital were collected.All patients underwent pelvic ultrasound before operation and at least one examination of CT and MRI.Through the retrospective analysis of clinical and imaging data,the general data of different types of SCST were compared;Comparison of the clinical manifestations and laboratory results(reproductive series,tumor series)of different types of SCST;To compare the CT value of solid components of different types of SCST tumors before and after enhancement;To compare the ADC values SCST solid components of different types of tumors;The diagnostic value of different imaging methods(ultrasound,CT,MRI)for SCST was compared with the gold standard of postoperative pathology;Based on the gold standard of postoperative pathology,the combined application of ultrasound+MRI and ultrasound+CT was compared in the diagnosis of SCST;To summarize the imaging findings of different types of SCST.Results 1 Among 121 cases of SCST,the ovarian thecoma-fibroma had the most tumors,accounting for 62.0%,including 32 cases of ovarian thecoma,33 cases of fibrotheca cell tumor,10 cases of fibroma,28 cases of granulosa cell tumor,accounting for 23.1%,9 cases of sclerosing stromal tumor,accounting for 7.4%,8 cases of steroid cell tumor,accounting for 6.6%,1 case of amphoteric blastoma,accounting for 0.8%.2 There was a significant difference in the age of different types of SCST(ovarian thecoma-fibroma,granulosa cell tumor,sclerosing stromal tumor,steroid cell tumor)patients(P<0.001).The patients in the ovarian thecoma-fibroma and granulosa cell tumor group were older,while the patients in steroid cell tumor and sclerosing stromal tumor group were mostly young women;There was no significant difference in length of tumor(P=0.262),there was no significant difference in tumor location(left/right ovary)(P=0.909).3 In ovarian thecomafibroma group,there were abnormal menstruation in 15 cases,elevated estrogen in 6 cases,and abnormal tumor series in 34 cases(elevated CA125 and CEA),in the granulosa cell tumor group,there were abnormal menstruation in 13 cases,elevated estrogen in 9 cases,and abnormal tumor series in 1 case(elevated CEA),in the sclerosing stromal tumor group,there were abnormal menstruation in 2 cases,masculine signs in 2 cases,elevated testosterone in 2 cases,in the steroid cell tumor group,there were elevated testosterone in 3 cases.4 There was no significant difference in CT value of solid components between different types of SCST(ovarian thecoma-fibroma,granulosa cell tumor,sclerosing stromal tumor,steroid cell tumor)(P=0.589);There was a significant differencethe in △CT(P<0.001): In the follicular cell tumor fibroma group,there was no or slight enhancement,in the ovarian thecoma-fibroma,there was moderate or more enhancement,in the sclerosing stromal tumor and steroid cell tumor,there was no significant difference in the enhancement degree between the two groups(P=0.518).5 The ADC values of solid components in different types of SCST(ovarian thecoma-fibroma,granulosa cell tumor,sclerosing stromal tumor,steroid cell tumor)were significantly different(P<0.001).There was no significant difference between the ADC values of ovarian thecoma-fibroma and sclerosing stromal tumor(P=0.108).The difference between the other two groups was statistically significant(P<0.05).6 According to the gold standard of surgical pathology,the detection rate of SCST by different imaging methods(ultrasound,CT,MRI): MRI(98.0%)> CT(84.3%)> ultrasound(83.7%).There was statistically significant difference between the three(P=0.029);Compared with CT and ultrasound,the difference was statistically significant(P=0.012 and P=0.008),but there was no significant difference between CT and ultrasound(P=0.909);The diagnostic coincidence rate of SCST: MRI(90.2%)> CT(75.9%)> ultrasound(61.0%).The difference between MRI and CT and ultrasound is statistically significant(P<0.001).Compared with CT and ultrasound,the difference was statistically significant(P=0.039 and P<0.001).Compared with CT and ultrasound,the difference was statistically significant(P=0.025).7 The diagnostic value of ultrasound+MR and ultrasound+CT in SCST was compared.The results showed that the detection rate and diagnostic coincidence rate of ultrasound+MR in SCST were higher than that of ultrasound+CT.The difference between them was statistically significant(P=0.013 and P=0.030).8 Imaging findings: in 123 SCST of 121 cases,119 masses are round and 4 irregular,The boundary of 119 masses was clear and 4 cases were accompanied by calcification.In the group of 77 ovarian thecoma-fibroma,the tumor was solid or cystic,ultrasound is mainly hypoechoic,T2 WI showed low signal in varying degrees,with enhancement of 97.4%(75/77)showing no or slight progressive enhancement,96.4%(27/28)of granulosa cell tumor showed cystic solid alternate distribution,the ultrasound was mixed echo,with moderate enhancement of 82.1%(23/28),9 cases of sclerosing stromal tumor showed cystic solid,the ultrasound showed mixed echo,no echo in the center of the mass,with obvious enhancement around the large cystic focus in the early stage.Among the 8 steroid cell tumors,the ultrasound was hypoechoic,7 were solid with enhanced scanning,and 1 amphoteric mother cell tumor was solid with enhanced light enhancement,the ultrasound was hypoechoic.There were 67 cases with a small amount of fluid in the pelvic cavity,11 cases with fluid in the abdominal cavity at the same time,including 9 cases of ovarian thecoma-fibroma and 2 cases of granulosa cell tumor.Conclusions 1 Different types of SCST have certain characteristics on images,combined with the age of patients,clinical manifestations and laboratory examination(reproductive series,tumor series),we can make a more accurate preoperative diagnosis.2 Different imaging examination methods(ultrasound,CT,MRI)have certain diagnostic value for SCST,MRI is the most valuable in the diagnosis of SCST when the three methods are used alone,The combined application of ultrasound and MRI is more valuable in the diagnosis of SCST than the combination of ultrasound and CT.Figure 2;Table 14;Reference 48... |
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