MRI对软组织肿瘤的鉴别诊断价值  

Value of MRI in the differential diagnosis of soft tissue tumor

作　　者：金腾[1] 刘垚[1] 李婷[1] 李小明[1] 王仁法[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,武汉430030

出　　处：《放射学实践》2015年第3期269-274,共6页Radiologic Practice

基　　金：国家自然科学基金资助项目(81320108013;31170899;81071133)

摘　　要：目的:探讨软组织肿瘤的MRI表现及其组间鉴别诊断。方法:回顾性分析本院经手术病理证实的50例软组织肿瘤的病例资料,其中外周神经鞘瘤13例,侵蚀性纤维瘤10例,纤维肉瘤14例,恶性纤维组织细胞瘤7例,腺泡状软组织肉瘤6例。所有患者均行MR平扫,18例行MR增强扫描,其中2例行MR血管成像,2例行MR波谱成像。结果:50例软组织肿瘤中45例发生于四肢。纤维肉瘤与侵蚀性纤维瘤长径最长,约112.73mm与112.98mm,外周神经鞘瘤长径最短,约37.75mm。50例肿瘤边界均较清楚,T1WI呈等信号或稍高信号,T2WI呈高信号夹杂多发线样或片状低信号分隔。外周神经鞘瘤为类圆形软组织肿块,MRI特异征象为"靶征"、"神经出入征"及"脂肪彗星尾征"。侵蚀性纤维瘤T2WI呈高信号且有多发粗条状低信号分隔。纤维肉瘤主要表现为多发囊变坏死、出血及邻近组织受侵犯。恶性纤维组织细胞瘤多呈边界不清的分叶状,可见囊变坏死与出血灶,T2WI背景呈高信号。腺泡状软组织肉瘤多呈类圆形,病灶内可见血液流空信号及线样低信号分隔。结论:好发于四肢的T1WI呈等信号或稍高信号的软组织肿瘤极易混淆,但各种肿瘤的MRI表现有差异,再结合各自的临床特征,鉴别五种肿瘤并不困难。Objective：To investigate the MR appearances of soft tissue tumor and the value in the differential diagnosis.Methods：The clinical materials of 50 cases with surgery and pathology proved soft tissue tumors including peripheral nerve sheath tumors（NST,13cases）,aggressive fibromatosis（AF,10cases）,fibrosarcoma（MFH,14cases）,malignant fibrous histiocytoma（MFH,7cases）and alveolar soft part sarcoma（ASPS,6cases）were retrospectively analyzed.All patients underwent MRI and 18 patients underwent contrast enhanced MRI,2of the 18 patients underwent magnetic resonance angiography（MRA）and 2patients had MR spectroscopy（MRS）.Results：45of the 50 soft tissue tumors located at the extremities.The average long dimension of AF,FS and NST was 112.73 mm,12.98 mm and 37.75 mm respectively.All of the tumors showed well defined margin,isointensity or slight hyperintensity on T1 WI,hyperintensity on T2 WI with hypointensity linear or patchy septa.The NSTs were round masses with the characteristic features as target sign、 ＂entering and exiting nerve＂ sign and comet tail sign.The AFs showed hyperintensity on T2 WI with multiple hypointensity coarse septa.The FSs showed multiple necrosis,cystic degeneation,hemorrhage and invasion of adjacent tissues.The MFHs were mostly illdefined and lobulated in shape,hyperintensity on T2 WI with cystic necrosis and hemorrhagic foci.The ASPSs were round in shape,with intra-tumoral vascular flow void signal and hypointensity linear septa.Conclusion：Soft tissue tumors located at extremities mostly,presents as isointensity or slightly hyperintensity on T1 WI,which could easily be confused.Yet their MRI findings have their own characteristics.Differential diagnosis is not so difficult when MRI findings in combination with clinical features were applied.

关 键 词：软组织肿瘤 磁共振成像 诊断 鉴别 

分 类 号：R445.2[医药卫生—影像医学与核医学] R738.6[医药卫生—诊断学]