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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=1739556311-bqzoOKxngWnAWUBvxR2JYuDDjmOS3d3j-0-f3d120cf517a2ecd97a9788f72cd9d06)
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=1739556311-wYMo3lxQsLO5RHuuC7h8sGrgT1BuL9lp-0-bf6213532d5d92155aa954d05b37464c)
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=1739556311-KGc8kUdUD6u8TghRdp3f77HQV7JLyWdF-0-07af6a637bce276113abb07704d8ca86)
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=1739556311-Dnzfa2p3Pzdr3Cogctm8fFWofyErRiqI-0-afd68cdb70b802eecc8e49af0815e730)
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=1739556311-hlGvlhvMMGv0SKrCRRS8P5n6F71iG1AG-0-f7dfbf0b8c85d4c6a10544bfca406c9f)
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=1739556311-JPJdpH6WY4X1Xuurkck2xbC95MG26uxw-0-ae60f20cfbf8e798dac6495a64228bdd)
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=1739556311-BJ2yRAZDh7Ubs9bc99PHqlKq9v5SB9CK-0-f5f86299c4777d3ed4185eea770c6d4d)
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=1739556311-vkZwuF32v9xb7wo49OJRvivpD5yqy3Cq-0-ee32951e550f34073dc92f55693baf20)
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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=1739556311-4do2dvE1Gm9oMYPiKDtJ56xbNRLdxgBD-0-9b451c2065ae87d5526bd30873dcbf84)
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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=1739556311-PMhbxiAuEPVkpKQNc81pLYAqBk8fYdWd-0-fbd3c18c4e14284eaaf7428ce0b2b918)
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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=1739556311-3RpPkfbqDMHr73l83SPwMW83W2cKHa6R-0-e25f42d7f24e8f01552782e4d2d83f75)
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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=1739556311-3LwakdmAnPW5RL45Smt90qZf3dH82Jdj-0-e295750b5ad94f2fa91ff28ff392695d)
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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=1739556311-Dwn10ORzqNmiMAavChQmR3YfKayZXzqp-0-ccc31619cf9bab8fd157bb4e9269f91f)
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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=1739556311-hU63VUERhomaNoC4C9Nqhv9S79acPwXE-0-bb26058e8ede9d7b1abc8437db4d430b)
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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=1739556311-agFAqaRvOtzm0xClmAIJVptvmxwKKQOG-0-cacf0cdedaf1c3a927119aadceb9f6f3)
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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=1739556311-EPydGIXLVm1k38D9lEkzfAiGd9KpcJdu-0-7fd4b4a364b412c7e4b2b1e85afa10a3)
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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=1739556311-sZD5UIhdHfcsWPWXW6eotsQB4EPIcXha-0-f71e814d4053fa55c3585d217bc6a098)
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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
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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=1739556311-nblH7DByKNYpvHw4sR3O6KN50VudBgXt-0-606e609aca412823bffb82b310a31c60)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_11.jpg?sign=1739556311-ehOLUTclHS0E5nVgoXQ78hHYrywwJo24-0-ee103545707b43ef44136a01ed141dce)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_9.jpg?sign=1739556311-VVPssSL5Rx7tdubGvduhyd1UceQht6B5-0-c036d60f72059767747d28ef9acb01e6)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_12.jpg?sign=1739556311-UJd1viBm8SPxu7KMdvMtAw41Il8eLDlA-0-e28ecf7b1729499b1455619e83cef0b9)
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=1739556311-s1C5061Vk9Y7jznIemZ9dJqiXiDYLh8F-0-9df4a108f21e104c89eae35314f46e44)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_17.jpg?sign=1739556311-Ur7sJI4ZzRODvQ0zlNIOBarxyHlWx8a6-0-0fea7fbbb0fe2636301baae8380a1bcd)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_15.jpg?sign=1739556311-S3zi5ZcxRTFBkjJBr2KMgarygzlGh6mg-0-5424967ed2a2cb17004cb9a72dd98823)
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=1739556311-0aAsakBo3OUcIZ5CmS5w3H16hkXJikHN-0-8204aaa550b95108f850f554f4d4c11f)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_16.jpg?sign=1739556311-Wp7UldCHYajwTiDPbhiRfjBqb6I1Vd8N-0-24325092973b29fd8f8fa9deda7e3009)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_19.jpg?sign=1739556311-zGyiyH051eoC7raZZ17VhnaXdwl4udW5-0-c0f2ff9fcb2292275fef47f9ed1bc55f)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_23.jpg?sign=1739556311-Pl21YPtZznxDhqI5SpcBU6dOtWvXyERL-0-970c559797f0371dce51df7948d9f7e0)
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=1739556311-Ua6exPM8GyQYlo5ovmg30rwQZSy6yc9z-0-48dd0b61497a07591e83bb09b6d3397e)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_21.jpg?sign=1739556311-d7FicYOX3mV0S3UsJOfj3AKc1gr8C2TD-0-66db0df496f0350dece68feb05251d33)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_18.jpg?sign=1739556311-1cAVrBnHXO3TAAfwjyioAnWrK741cUrG-0-4af401daa31a63d4766ce78795f87dac)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_22.jpg?sign=1739556311-VuujcQx6aYu331wJzOfCpttSYw8h3VB0-0-49bdb56f8f0aa474903c8418db00a577)
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=1739556311-gAgB6ehEPdY1p1HfEn1DsgWcI74wv5kH-0-6522b1dbf8599ad54d3a1c0f6200be27)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_29.jpg?sign=1739556311-SyoR7AtEAFbxcK0T4Ger0Z2nnUjrjYaN-0-168d5f932c5047f174c71d6c500b9e7d)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_26.jpg?sign=1739556311-d9TUWy3Vw022VlV7Q935fulzYvbHn80G-0-373487b3dc1f8dfaa79df2126966ae22)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_30.jpg?sign=1739556311-0dv3ZpXMnIaJbXpO9pupykKWTJLoZVNy-0-4ed67dee7c986280ac0b1a2123435fe5)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_24.jpg?sign=1739556311-zx6ESKQDxaMFA184KtE59ZfVzwrKKImb-0-eaa9cc6e18db60b3fbbd731f9caa455b)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_28.jpg?sign=1739556311-4yn7c22lXOutfGLvvrwZLBah8DmLkJQk-0-0ab0f59fd2f0089ba153939ac82f2fd6)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_27.jpg?sign=1739556311-C22YDOI2SoCzhb9YccNxlilXP8ekiswj-0-679330ef73b0fed61be81e6ac75b9d7b)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_31.jpg?sign=1739556311-4diD85H6X0VIHwZlTbhB5utI8HZexA36-0-0be228bb9fbe5f30e6db519e50f49bd4)
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=1739556311-hsUJnwMXEMA2TXPC8DuFlNl1Tj09mD8I-0-2f46d46aca843fed9a5b4cd640e0e200)
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=1739556311-rVeJgvwzCDi5mHEPGAAY5n3Cu7tOU6bx-0-0ec3657af0e5a303e9cda9a35efcf973)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_35.jpg?sign=1739556311-yyEglLTeo9KevrBq3Mc3FjQh35L3ezDQ-0-8eca04a90a7ebb22f8c14a66b31aba68)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_33.jpg?sign=1739556311-IUtwsKm39H0CRnfYksSRKGz6UHhkz1Ek-0-0bfcabcb3d12638d279c7d69af766dab)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_36.jpg?sign=1739556311-eG2OM1ZawGXONMXLDvfTwfNbtABM9KJF-0-9e7bf7ac44fb790c388d41735669adcb)
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=1739556311-YT7tRcsnb4Lm9p92KvVjukn0m30QV27B-0-78cc804f0e6b6bad6dcda6b7373c918f)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_41.jpg?sign=1739556311-RL1ketf9PiMYoGLjUvfdFFkEZCCCs3B0-0-43025f4429e3f6a7d9e028110382b6d3)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_39.jpg?sign=1739556311-1JSDiVIxp98DrTpLWwG9kg6MXWx2AfPb-0-0afb8fbab4ac8eef7312024d0996cc05)
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=1739556311-MxT8Q6X0JH8VNjFAlfIqMxTNrK7y0nAz-0-4f5cc7073c2015b3ff095ec72967d02a)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_40.jpg?sign=1739556311-nsZkQkj106lOPflYJGKPrMuBgJgU813N-0-cb2aea905e77a1d0df3c845acd5f2422)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_44.jpg?sign=1739556311-pd60SvVhl9pnJnPXg4AVa1e7SDcNlcHe-0-2c3be8d788ddf4158748743a58e35718)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_45.jpg?sign=1739556311-UzPxkeLH3NcbO0rldKUEX7UXnMKKaAM7-0-ba2e73dd3cf433a4ecd9ab883a54a47f)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_42.jpg?sign=1739556311-sQRLsKdUWVG09QNmIA4mBW6Rtqja7S8R-0-059590c76822df7e9ee37390c176e4c8)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_46.jpg?sign=1739556311-4yzucvBPajbBIMDrNnija5vIpQ8s905X-0-2bdf674d9588bca56d41c8aaa0271bd6)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_43.jpg?sign=1739556311-Orxa0N02qa7BmxCHZRPmIdKbPz7Srmg8-0-b1b38c4ceed5fe096b8b64bd17bebcfe)
![](https://epubservercos.yuewen.com/5F541E/14504128505009206/epubprivate/OEBPS/Images/Chapter_1303.jpg?sign=1739556311-vh1gah5HXY07zPIzy4smOlqXSvPvyqpF-0-b1a4800a6072f43e051229fa3289ccc4)
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