侵袭性血管黏液瘤的CT、MRI征象  

CT and MRI features of aggressive angiomyxoma

作　　者：钟群[1] 张盼[1] 方梦诗 陈振[1] 林燕[1] 曲利娟[2] 

机构地区：[1]南京军区福州总医院影像科,350025 [2]南京军区福州总医院病理科,350025

出　　处：《中华放射学杂志》2016年第11期856-859,共4页Chinese Journal of Radiology

摘　　要：目的：探讨侵袭性血管黏液瘤（AAM）的CT、MRI表现特征。方法回顾性分析经手术病理证实为AAM，术前1周内行CT和（或）MRI检查的7例患者。6例行腹部及盆腔CT平扫，其中4例行多期CT增强扫描；5例行胸部、上腹部或盆腔MRI平扫及增强扫描。手术切除病灶标本行常规病理检查。观察患者的影像表现和病理特征。结果（1）CT表现：病变密度均匀接近肌肉1例，密度不均匀呈囊实性低密度影5例。其中囊变2例，附壁结节2例。增强扫描表现较均匀持续性强化1例，不均匀逐渐强化并强化范围扩大3例，3例可见分层旋涡征，3例病灶内可见小血管影。（2）MRI表现：病灶T2WI呈高或略高信号5例，其中分层旋涡征3例，囊变2例；T1WI均呈等低信号，DWI呈高或略高信号。增强扫描1例全瘤呈较均匀持续强化；4例表现为动脉期始少量不均匀强化，随后强化范围扩大，强化程度增加，其中3例有分层旋涡状强化。3例行多时相动态增强扫描患者的病灶时间信号曲线均为缓升型。（3）病理表现：肿瘤由含稀疏的胞质、界限不清的梭形和星形细胞、大小不同的薄壁或厚壁血管组成，分布于富含纤细胶原纤维的黏液样基质中，各成分分布不均，集中区形成较为致密的细胞团。4例间质富于胶原纤维，并与黏液基质及瘤细胞疏密相间排列。结论 AAM的CT、MRI表现具有一定特征，影像表现和病理特征相对应。Objective To analyze the imaging features of aggressive angiomyxoma （AAM） on CT and MRI. Methods Seven patients with pathologically confirmed AAM had CT and/or MRI examination within 1 week prior to surgery. Six patients had multi-slice helical CT scanning while four of the six patients had multi-phase contrast enhancement. Five patients had MR scanning with contrast administration covering the chest, mid-abdomen or pelvis. The imaging and pathological findings were retrospectively reviewed. Results （1） CT presentations：pre-contrast CT images revealed isodensity （1 case）, heterogeneous density （5 cases）, cystic degeneration （2 cases） and mural nodule （2 cases）. Contrast CT images showed homogeneous and gradual enhancement （1 case）, heterogeneous and progressive enhancement （3 cases）, whorl sign （3 cases） and opacification of small vessels （3 cases）. （2） On MR images, five cases showed high or slightly high signal on T2WI; three cases presented with whorl sign; two cases had cystic degenerations. Iso-signal or low-signal was shown at T1WI in all five cases. DWI demonstrated high or mildly high signal in five cases. At contrast images, a whole-lesion homogeneous and gradual enhancement was present in one case. Four cases revealed progressive and expanding enhancement, where whorl sign and gradual enhancement were present in three cases. A progressive ascending pattern of time-signal curve was delineated in three cases. （3） Microscopically, the tumor comprises of poorly-defined satellite or spindle cells with sparse cytoplasm and varied sizes of vessels, which distribute among stroma with rich collagen fibre and myxoid. Those components were heterogeneous to congregate compact cell cluster. The stroma in four cases was abundant in collagen fibre that was aligned with myxoid stroma and tumor cell alternately. Conclusion AAM exhibits characteristic CT and MRI features. The imaging features correlated well with pathological findings.

关 键 词：黏液瘤 体层摄影术 X线计算机 磁共振成像 病理学 

分 类 号：R732.2[医药卫生—肿瘤]