四肢深部软组织血管瘤和血管畸形的X线及MRI表现  

Radiographic and MRI features of the hemangiomas and vascular malformation in the deep soft-tissue of the extremities

作　　者：马焕[1] 吕玲[1] 李振辉[1] 陶海波[1] 董兴祥[1] 飞勇[1] MA Huan LüLing LI Zhenhui TAO Haibo DONG Xingxiang FEI Yong(Department of Radiology ,the Third Affiliated Hospital of Kunming Medical University ,Kunming 650018 ,China)

机构地区：[1]昆明医科大学第三附属医院云南省肿瘤医院放射科,云南昆明650018

出　　处：《实用放射学杂志》2016年第10期1570-1573,1585,共5页Journal of Practical Radiology

摘　　要：目的：探讨四肢深部软组织血管瘤和血管畸形的 X 线及 MRI 表现。方法回顾性分析经手术病理及 DSA 证实的89例四肢深部软组织血管瘤和血管畸形患者的临床、影像资料,其中89例均行 X 线平片检查,33例行 MRI 检查。结果 X 线检查中,骨质及软组织影未见异常者54例（60.7%）,软组织异常者14例（15.7%）,可见静脉石者30例（33.7%）；骨质异常者32例（36.0%）,其中伴骨膜反应者13例,皮质破坏16例,髓腔受累者10例,三者均受累者为7例弥漫性病灶。MRI 图像上,病灶呈蜂窝状或海绵状,T1 WI 上呈等低信号者25例（75.8%）,低信号5例（15.2%）,不均匀稍高信号3例（9.0%）；T2 WI 上病灶为不均匀高信号伴低信号分隔,范围及边界显示清楚,其中9例内部可见低信号区伴血管流空影；检出静脉石10例（30.3%）,呈低信号；增强后病变不均匀明显强化。骨质异常者18例（54.5%）,均可见病灶紧邻骨质或呈半包绕、包绕改变,其中12例髓腔内可见异常信号影,3例为迂曲血管流空影。在15例（45.5%）骨质无改变患者中,3例病灶邻接骨质,余12例病灶与骨间隔以脂肪或肌肉组织。结论四肢深部软组织血管瘤和血管畸形可引起邻近骨质的异常,掌握其 X 线及 MRI 表现特征,有助于提高对本病的诊断与鉴别诊断能力。Objective To explore radiographic and MRI features of the hemangiomas and vascular malformation in the deep soft-tissue of the extremities.Methods 89 cases confirmed by surgical pathology and angiography were analyzed retrospectively with clinical data and radiological findings.Imaging exams included plain X-ray performed in all patients,and MRI scan in 33 patients.Results On X-ray plain film,there was normal bone and soft tissue in 54 cases（60.7%）,soft tissue abnormalities in 14 cases（1 5.7%）,and phleboliths in 30 cases（33.7%）.Also,plain X-ray film studies demonstrated bone changes adjacent to the deep soft tissue in 32 cases（36.0%）, including periosteal reactions（13 cases）,cortical erosion （1 6 cases）,involvement of the bone marrow （10 cases）and 7 diffuse lesions with all above changes.On MRI,lesions were similar to honeycomb or sponge,and T1 WI showed isohypointense signal in 25 cases （75.8%）,hypointense in 5 cases （1 5.2%）,inhomogeneous slightly hyperintense in 3 cases （9.0%）.On T2 WI,all lesions were well defined and showed hyperintense signals with hypointense septation,of which there were 9 cases with nodular hypointense areas and vascular flow effect.Hypointense phleboliths were showed in 10 cases（30.3%）.Following injection of the contrast medium,all lesions had heterogeneous enhancement patterns.Of the 33 patients studies with MRI,lesions of 18 cases（54.5%）had bone changes which were adjacent to or partially or fully wrapped by neighbouring soft tissue lesions,in which lesions of 12 cases showed abnormal signal within bone marrow and lesions of 3 cases with vascular flow void phenomenon.In 15 cases （45.5%）without osseous change,lesions of 3 cases were adjacent to bone,and lesions of 12 cases were with fat and muscle septum between the bone and lesions.Conclusion The hemangiomas and vascular malformation in the deep soft-tissue of the extremities may cause changes in adjacent bones.Familiarity with the performance of reactive bone changes on X-ray and MR

关 键 词：血管瘤 血管畸形 放射摄影术 磁共振成像 

分 类 号：R732.2[医药卫生—肿瘤] R543[医药卫生—临床医学]