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第四章 卵巢良性病变
第一节 囊腺瘤
囊腺瘤是来源于上皮的卵巢良性肿瘤,最常见,占卵巢良性肿瘤的50%,包括浆液性囊腺瘤和黏液性囊腺瘤。浆液性囊腺瘤占卵巢良性肿瘤的25%,好发于20~40岁妇女。多为单侧,可双侧发生,发生率约为15%。肿瘤呈圆形或卵圆形,大小不一,从数厘米到小儿头大,表面光滑。浆液性囊内充满淡黄色清澈浆液。黏液性囊腺瘤占卵巢良性肿瘤的20%,95%为单侧性,黏液性囊内密度稍高,囊液呈胶冻状,其内含黏蛋白或糖蛋白。两者均可发生恶变,浆液性囊腺瘤恶变率约35%,黏液性囊腺瘤恶变率约5%~10%。有时浆液性囊腺瘤和黏液性囊腺瘤可同时发生。
囊腺瘤的主要临床表现是盆腹部肿块,较大肿块可产生压迫症状,造成大小便障碍。因肿瘤的间质可分泌激素(黄体化),具有内分泌功能,可引起阴道出血。肿瘤发生扭转或破裂时出现腹痛。肿瘤巨大时,可压迫横膈,引起呼吸困难、心悸、腹腔积液。
【影像表现】
1.CT表现
(1)常见CT表现:①盆腔内较大囊性肿块,圆形或卵圆形,边界清晰,边缘光滑,呈水样低密度,黏液性囊腺瘤密度较高。②为单房或多房,如为多房,各房密度一致或略有差异。③囊壁和分隔多较薄且均匀一致,少数较厚或有乳突状软组织突起;④有时可见钙化或出血。⑤巨大者可占据大部分盆腹腔。增强扫描肿瘤囊壁或间隔强化,囊性部分无强化。(图4-1-1~图4-1-12)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1518.jpg?sign=1734418557-PqzPWbQ1pqRAwXBkXbSolW30ylM9QkfA-0-97dd877f2b2084c4e3e2145d4999346c)
图4-1-1 左侧卵巢浆液性囊腺瘤, 呈水样密度
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1520.jpg?sign=1734418557-6BYtCqsaxkT9NmrrmJ3t4nFCthh80rOa-0-df79894b49c07c6bf3cbf600789a6dce)
图4-1-2 左侧卵巢浆液性囊腺瘤, 呈水样密度。 同时见子宫增大, 左侧壁见等密度肌瘤凸向宫腔
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1519.jpg?sign=1734418557-7mhqOZ4wooICQFN3Ov30a7rZQ3zG6ITj-0-2276ca7f7f6c37515357e92f38635e10)
图4-1-3 右卵巢巨大黏液性囊腺瘤, 呈水样密度
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1521.jpg?sign=1734418557-P2jdSU6PcGtXJkXrF9Wcw3z5zoi9JbEW-0-46b9a4cb9e287cc2a2d3813e18cb4931)
图4-1-4 右侧卵巢混合性囊腺瘤, 多房, 各房密度相仿
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1522.jpg?sign=1734418557-NHsKudweJL0Xj70oVdDmfMegCte1qWmq-0-ec44609245eafcc602b2968526200dcd)
图4-1-5 左侧卵巢黏液性囊腺瘤, 多房, 各房密度相仿
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1528.jpg?sign=1734418557-LcStmlFLgmIl3PRRgoC6wtDJYZVztkiA-0-3bf87f9be7c13a4a2e7d06d4cd583b61)
图4-1-6 右侧卵巢黏液性囊腺瘤, 多房, 各房密度不均
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1525.jpg?sign=1734418557-d4kAqYnwWGiH9vTSK9qqTXHpNeq3Qsyy-0-568033afef58f5d46c385edc3f7d90bf)
图4-1-7 右卵巢黏液性囊腺瘤并囊壁钙化
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1523.jpg?sign=1734418557-dYgd5zjNy9HoBj6bMBZTSLDC2Bj5GR8c-0-13959dc7c8ddc5e2a66b3ddc8ca6040d)
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图4-1-8 双侧卵巢黏液性囊腺瘤
A:右侧卵巢黏液性囊腺瘤,伴囊壁局灶性钙化;右侧较大,蒂扭转;B:左侧卵巢小囊状黏液性囊腺瘤,囊壁钙化
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1524.jpg?sign=1734418557-BHDQE52xvweorPJkwoukDGOM90wqJADw-0-30f8e76a6b3f75bc80dca29e60e33159)
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图4-1-9 右卵巢黏液性囊腺瘤
A:右卵巢黏液性囊腺瘤,多房,各房密度不均一,内见小斑片状高密度出血,CT值约为66HU;B:增强动脉期囊壁及间隔强化不明显,囊性部分未见强化;C:增强延迟期囊壁轻度强化,囊性部分未见强化
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1529.jpg?sign=1734418557-XVoXnP3jIuY1t9bCwAq6sYe4I5DcU5xl-0-42e5bfe3cf48e933deb9f478a9b5480d)
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图4-1-10 右卵巢巨大黏液性囊腺瘤
A:冠状位显示腹盆腔内巨大单房囊性病灶,边界清,其内密度均匀;B:矢状位显示病灶
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1530.jpg?sign=1734418557-4RK0KbOagDXAT39k1AO1YJJNjg0VWaOV-0-fe3436e375db723c57a307abaac55794)
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图4-1-11 左卵巢黏液性囊腺瘤
A:盆腔见多房囊性病灶,边界清,各房密度相仿,囊壁及分隔薄且均匀一致,无强化;B:冠状位显示病灶
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1535.jpg?sign=1734418557-FQrKWnFNbcdSEiTPu5B0CU2kbDB7EEMm-0-71e59fe8d8fd9ddc4aecb108f9a538c0)
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图4-1-12 右卵巢巨大黏液性囊腺瘤
A:平扫腹盆腔见巨大多房囊性病灶,囊壁见等或稍高密度壁结节,CT值约为53HU;B:增强囊壁及壁结节均匀强化,囊内未见强化;C:冠状位增强显示病灶
(2)少见CT表现
1)肿瘤扭转:蒂较长、中等大小的囊腺瘤可以发生扭转,扭转后肿瘤静脉回流受阻,肿瘤淤血,进一步发展为血管破裂,血液充盈瘤腔甚至腹腔。后期肿瘤动脉阻塞,肿瘤缺血坏死。临床上患者常有突然下腹痛。CT见圆形的囊性肿块,边缘有凹陷或出现切迹,此处为扭转部位(图4-1-13)。
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1534.jpg?sign=1734418557-k40KnSf61a4awNXq9MlIpnRRjifyNdxz-0-78ede14d37629289b3314b96fa2937ee)
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图4-1-13 右侧卵巢黏液性囊腺瘤, 伴蒂扭转
右侧卵巢黏液性囊腺瘤, 伴囊壁局灶性钙化、 蒂扭转, 见条索征
2)囊肿肿瘤破裂:蒂扭转或肿瘤生长可以导致囊壁破裂,也可以由周围组织器官挤压、穿刺等引起破裂。破裂后瘤内容物流入腹腔出现相应的症状。CT见肿瘤由类圆形变为形态不规则,由于肿瘤内容物流到肿瘤周围,导致肿瘤边界不清,并见盆腔或腹腔积液,易误诊为恶性肿瘤。增强扫描后囊肿周围组织未见强化。
3)腹膜假黏液瘤:卵巢黏液性囊腺瘤患者有2%~5%伴发腹膜假黏液瘤,多继发于囊肿破裂后,瘤细胞种植于腹膜,并形成肿瘤结节,产生大量黏液,在腹膜表面形成许多胶冻样黏液团,外观极像卵巢癌转移。一般不发生脏器实质浸润。手术不易完全切除,术后容易复发,肿瘤上皮高度分化,对放疗或化疗不敏感。CT见盆腔或盆腔及下腹部低密度肿块,密度均匀,CT值与水接近,但不同于腹腔积液的是,它有明显的分隔及厚度不均的囊壁。此外,还可表现为上腹部肝外缘有分隔的囊性病变,肝脏表面见弧形压迹(图4-1-14)。
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1539.jpg?sign=1734418557-NGk5bzw4wxSixBSUqOFuvMK794N0Mfml-0-640f39f7ab1867574d34b33bf33fa641)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1541.jpg?sign=1734418557-yPkrmWbFGvXeUntrRUgUXNcppAQkCNUv-0-21c0c3ab12eecd33638fa1ba9f9b5bc2)
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图4-1-14 腹膜假黏液瘤术后复发
A:腹膜假黏液瘤术后复发,腹腔多发囊性病变;B:增强囊壁及分隔见强化;C:肝周、胃大弯侧多房囊性病变;D:增强扫描分隔及囊壁见强化
2.常见MRI表现
①囊腺瘤边界清晰、锐利,大小不等,可为单房或多房。②囊壁及间隔在T 2WI表现为线状较低信号。③囊内液体成分的信号与水的信号基本相同,为T 1WI低信号、T 2WI高信号,但若含蛋白或血液时,液体信号很复杂。④肿瘤内有或无壁结节,结节表现为乳头状突起。⑤增强扫描,肿瘤壁可呈中等强化,细小的壁结节显示得更清晰。⑥浆液性囊腺瘤单房多见,信号与水的相仿。⑦黏液性囊腺瘤由于囊液中黏蛋白的缘故,信号常高于水的信号,且由于蛋白含量不同,信号强度也不同。⑧在多房性肿瘤中,各小房内的信号强度可以有很大差别。⑨有些黏液性囊腺瘤在T 1WI表现为明显高信号,这时需与血液相鉴别,多数情况下黏液性囊腺瘤在T 1WI上的信号要低于皮下脂肪。⑩可伴发巧克力囊肿。(图4-1-15~图4-1-23)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1544.jpg?sign=1734418557-CDsjacD2TnDYJsZgu8WMueDvutq4T5vn-0-a8ec46ea79d772212d670a481a7a6bad)
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图4-1-15 右卵巢巨大浆液性囊腺瘤
A:T 2WI压脂序列腹盆腔见巨大单房囊性病灶,T 2WI压脂序列呈高信号;B:增强冠状位示囊壁线样均匀强化,囊内容物无强化;C:增强矢状位示病灶
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1543.jpg?sign=1734418557-HKswbKzNdo3sCzMLAf5prKBKmCLdPfxs-0-c5756b5f984d9fab9425ca1b0dac9b4b)
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图4-1-16 右卵巢浆液性囊腺瘤
A:右卵巢浆液性囊腺瘤,多房囊状,囊内呈水样信号,T 1WI呈低信号;B:T 2WI示囊内呈高信号
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_4.jpg?sign=1734418557-iO3WzwC6jCHHdyTtPO4AWHHEDuYsDWxU-0-0e6b0ebd706c0ceb4644de3f59530f0e)
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图4-1-17 右卵巢黏液性囊腺瘤
A:右卵巢黏液性囊腺瘤,多房囊状,T 1WI囊内为低信号,分隔显示不清;B~C:T 2WI示囊内呈高信号,线状低信号分隔显示清晰
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1.jpg?sign=1734418557-kF1IGutK6UMZ50GV6EdJlSgHBTueGKFj-0-890f04394dc1e850828a84d25b49993d)
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图4-1-18 左卵巢黏液性囊腺瘤
A:左卵巢黏液性囊腺瘤,多房囊性,各房信号相仿,T 1WI呈低信号;B、C:T 2WI示各房内为高信号;D、E:增强扫描,囊壁及分隔均匀线状强化
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_8.jpg?sign=1734418557-JjaO43boak1zuvTTa9gL1GUg3W139FAH-0-a1f342165e61961549730287c6ec73d1)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_11.jpg?sign=1734418557-BTG6FSYa7fitTMSyE2gB3fr5yCCqgh45-0-48b504835fda9557909a04741a6a3ba3)
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![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_12.jpg?sign=1734418557-Mjz3MxIxWjaQjkNA4fIGqQeRiOX65oud-0-f26b9318245076d9592e4b9429be0d89)
图4-1-19 右卵巢黏液性囊腺瘤
A:右卵巢黏液性囊腺瘤,多房囊性,各房信号相仿,T 1WI为低信号;B、C:T 2WI压脂序列示各房内呈高信号;D:T 1WI压脂增强扫描囊壁及分隔线样强化,囊内未见强化
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_13.jpg?sign=1734418557-MYKWTeZMaiRWSHW7VuuwfMz22D1kHzK4-0-d148e0d8f0d483283ce90a9c2787e802)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_17.jpg?sign=1734418557-hh85Xp1eNdCmXD8Q9aEbC2njbq9KrkOu-0-3c9230ebb3b6e7a76499da26acbac8e1)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_15.jpg?sign=1734418557-8ALK9vlgIJhiTIsdzD4oC5QCsYeYpodS-0-ef668a907ed53490a6e375426a7af001)
图4-1-20 左卵巢黏液性囊腺瘤
A:左卵巢黏液性囊腺瘤,多房囊性,各房信号不一,T 1WI为稍低、低信号;B、C:T 2WI压脂序列示各房内呈高信号且信号强度不同
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_14.jpg?sign=1734418557-UAe5AytHIrGoEnEvaAjnkMfy6CvjDa1E-0-cf371dc040c0cbe3dda6281ae9e049b3)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_16.jpg?sign=1734418557-kbKOTicmn0ZXovw8w0N0Xcm990tdxeh9-0-581e50afc5a0d22fb88bfb88a9ab0058)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_19.jpg?sign=1734418557-4BgHr9yMVed5RcBO0ysCrSGEgttIN9YP-0-eaab62638a5edca51d227ae1a3408a16)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_23.jpg?sign=1734418557-IAJ09BqBs8JNdqwoZiyu4NQreC46PqlA-0-8b55d82bc77f644449882bd0a84dbf3f)
图4-1-21 左卵巢黏液性囊腺瘤
A:左卵巢黏液性囊腺瘤,多房囊性,各房信号不均一,T 1WI部分囊腔呈低信号,部分囊腔呈等或稍高信号;B、C:T 2WI非压脂序列示各房信号强度不同,呈稍高或高信号;D:增强扫描示囊壁及分隔线样强化,囊腔内未见强化
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_20.jpg?sign=1734418557-VKtPyzMvNL930qE8vjdnX9nT2a9SCJC8-0-424598cc4743956d6a2b5a711de39881)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_21.jpg?sign=1734418557-Mzvg0HB6mZbzkcYM8EEQ6XfUdXv5ArIy-0-8b54175bc512a04c456c5a92554446a7)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_18.jpg?sign=1734418557-zCX17BWPG2LpbvmqjuTnZRh4c91mh74M-0-4720b5ed64f7f8052491f19f6b0e476f)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_22.jpg?sign=1734418557-9arNhveRVBSRaWRv80k1Ay1pnRlw1nZR-0-eef3d41b6becf9912ed687e24ef519a8)
图4-1-22 左卵巢黏液性囊腺瘤伴瘤内出血
A:左卵巢黏液性囊腺瘤伴瘤内出血,多房囊性,各房信号不一,T 1WI呈高、低信号;B:T 2WI示各房为高信号,但信号强度不同;C:T 2压脂序列矢状位显示病灶,各房为高信号且信号强度不同;D:增强扫描囊壁线样强化,囊内未见强化
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_25.jpg?sign=1734418557-v9jZHbERYVS4SNqTqaGhUk91w4WQEV1k-0-8ef790b05ee38c877e46a03e20e4b9b5)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_29.jpg?sign=1734418557-CUv9bkl5Uhge8uXZ0NMMZaWdOVAjNAZL-0-f1b3d32a6eee6df094adc9486c175d63)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_26.jpg?sign=1734418557-YpEW6laBJMJZXZlxcDdjLUQfB2qdKpAq-0-98c9289fb102866141f78ebef855f890)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_30.jpg?sign=1734418557-fO4KXZtrkCew13Qd2Q0K97geu11FQ189-0-45acda091cfbc89f35ac4b71f38d788c)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_24.jpg?sign=1734418557-VxGlyWzwNuAjqucptsKxrSilfVW5i1Vu-0-7a5c83621e4fccb23832dc5c67f74194)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_28.jpg?sign=1734418557-ddg6byN2dDkgV6e3b4lBHMlYLm8X7M6h-0-085ce066272640105c499cfb1c1cc2af)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_27.jpg?sign=1734418557-34s0HOw2n6UVISbrMtk88OX2Awu9ZczX-0-19a46e482efe6b3c96c29642b2f044c9)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_31.jpg?sign=1734418557-qtQBf4TuCmuqFjWYcPYXtBDblfWhSei1-0-0f64378f644e76f70e79f492d2b9ffdb)
图4-1-23 左卵巢黏液性囊腺瘤并巧克力囊肿
A、B:盆腔左侧见多房囊性病灶,各房信号不均一。T 1WI显示右前上方呈低信号,左后下方呈高信号。C:T 1WI较大囊呈低信号。D~F:T 2WI非压脂序列,前上方病灶呈高信号,左后病灶呈低信号。手术证实囊腺瘤合并巧克力囊肿。前上方为囊腺瘤,呈高信号;巧克力囊肿位于左后下方,呈稍低信号。G:T 2WI压脂序列病灶显示更清。前上囊性病灶信号更高。左后下病灶呈等低信号。H:增强扫描,囊腺瘤位于前上方,囊壁均匀强化,未见壁结节;巧克力囊肿信号较高,囊壁均匀强化,呈相对低信号
【鉴别诊断】
1.卵巢功能性或潴留性囊肿
一般体积<5cm,壁薄,无间隔,或多数小囊肿堆积在一起,无实质成分。如果肿块>5cm或巨大时,首先考虑囊腺瘤,反之亦然。如果肿块中等大小,则CT无法鉴别(图4-1-24)。
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_34.jpg?sign=1734418557-h5aum7uJXPkNPdn2GZidoEgHq0SmxQrm-0-46675312072371ae8ab4f9649ee3d481)
图4-1-24 右卵巢囊肿, 单房, 水样密度
2.卵巢冠囊肿
卵巢冠囊肿是位于卵巢系膜或阔韧带与卵巢之间的囊肿。多发生在育龄妇女,大多无症状,多在体检时发现。一般为单纯性浆液性囊肿。影像表现为单发囊性,呈水样密度或水样信号(图4-1-25)。
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_32.jpg?sign=1734418557-WxmRpOM9Iob2cPopYoyTjnn13swloNVT-0-bb1b40dddbb8020989c68dc7d82695aa)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_35.jpg?sign=1734418557-hbQ3H1LDzRXw85h2EnxpykXE6aT5t1hn-0-ec28a167e1c5cc7cdfa37cbb15751aaa)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_33.jpg?sign=1734418557-JdHgVlzk9sO3fzr7WUayR5f2K4bKjO6k-0-bbe803e5ca44fdd294056dbdf5a3c7eb)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_36.jpg?sign=1734418557-Tv0gIk1q4K8SChb84ll6brRuRH3emRMs-0-d715045dda15d2ce7a8c65b1d4e63552)
图4-1-25 左卵巢冠囊肿
A:左侧附件区单囊病灶,呈水样信号,T 1WI呈低信号;B:T 2WI呈高信号;C:T 2WI压脂序列示囊内呈高信号;D:增强扫描囊壁及囊内容物未见强化
3.巧克力囊肿
巧克力囊肿多为双侧,由于肿块与邻近组织易发生粘连,其边界不清,且常有痛经史。如果巧克力囊肿边界清楚,囊内呈水样密度或信号,囊壁薄且规则,影像无法鉴别(图4-1-26)。
4.囊腺癌
为囊实性肿块,壁较厚、不规则,常有壁结节(见第五章第一节)。
5.子宫肌瘤囊样变性
子宫非典型性肌瘤伴局部囊变时,如囊变较彻底,影像难以鉴别(图4-1-27)。
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_38.jpg?sign=1734418557-Zbvpr8GsNqvu4N1BZzptbRjvZw3Lp54c-0-32dde1e341aa9e7c4c3edefce08b87a2)
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![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_39.jpg?sign=1734418557-RaAhReiFKW6LocG9XvYyI6DsiA5G5c7e-0-345a4b279c8de97ef1fd27eff6ea49e4)
图4-1-26 左卵巢巧克力囊肿
A:盆腔左侧见单房,水样密度病灶;B:增强扫描囊壁及内容物均未见强化;C:冠状位增强显示病灶
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_37.jpg?sign=1734418557-RhivK14WDCQ23VJy3LKB7XkCc87NBxfI-0-418b6ffa78aff8c5959aff1e18cd6492)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_40.jpg?sign=1734418557-cWzC71RwAZdaDU6FSpEqmMnYFUlMPWuq-0-49367825902f776127d13eeb7f915f4e)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_44.jpg?sign=1734418557-6COo7y5H2ysIQQ9NuJffNvQRkKvN41cs-0-ec7ba6b5cda42774b3d345ad38d6280f)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_45.jpg?sign=1734418557-Es9pZXjfxs7974SyQTCGkpwPXk11zp5g-0-94c1418fbfebb29c795d8c29e141ccd2)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_42.jpg?sign=1734418557-AnAUXv4LTEKc7BXeKeaoOJJYtN7In1LT-0-01830664637d44687912c4399d64a73c)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_46.jpg?sign=1734418557-hqno2QGFYhgz4ZRJfmVTNaoetROw5bZv-0-c59e24333260cbdd97cab020dd6c26ba)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_43.jpg?sign=1734418557-tpiXvmQnqdgMxRfnkBVR2VUKlXVNh9T3-0-ad0daf28373d5881a5ddd212ca865639)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1303.jpg?sign=1734418557-3lON3G8apSMsUmr7dbdDjiYBqnIu7Hld-0-97ed1550866d46e5b48e52b5c212a1fb)
图4-1-27 子宫非典型性肌瘤伴局部囊变(病理显示囊内容物为黄褐色液体)
A:T 1压脂序列见盆腔巨大囊性病灶,多房,囊内为不均匀高信号,囊壁较厚,分隔显示欠清晰;B~D:T 2WI非压脂序列示囊内呈不均匀高信号,见线条状低信号分隔;E:DWI序列示囊壁为稍高信号,囊内容物为不均匀高信号,见线条状低信号分隔;F~H:T 1WI压脂增强扫描示实性部分及囊壁、分隔见强化,囊内容物无强化