滑膜肉瘤的临床特点及影像学特征分析  

Analysis of clinical and imaging features in synovial sarcoma

作　　者：李冠 林祥涛[2] 肖连祥[2] 渐楠[2] 石岩[2] 田迷迷 张帅[2] LI Guan1,2, LIN Xiangtao2, XIAO Lianxiang 2 , JIAN Nan2, SHI Yan2 , TIAN Mimi2, ZHANG Shuai2(1. Taishan Medical University, Tan＇an 271000, P. R. China;2. Shandong Medical Imaging Research Institute, Affiliated to Shandong University, Jinan 250021, P. R. China)

机构地区：[1]泰山医学院,山东泰安271000 [2]山东大学附属山东省医学影像学研究所,山东济南250021

出　　处：《医学影像学杂志》2018年第9期1526-1529,1539,共5页Journal of Medical Imaging

摘　　要：目的探讨滑膜肉瘤的临床特点及影像学特征。方法回顾性分析71例经手术病理证实的滑膜肉瘤的临床资料及34例CT或/及MRI资料,分析其影像学征象。结果滑膜肉瘤多见于青壮年,好发于四肢关节(下肢,46%)。大多数病变较大(> 5cm; 82%),呈结节状或分叶状。CT表现:病变类似于肌肉密度,大多数病变内可见坏死、囊变,增强扫描病变呈异质强化; 8例(44%)于病灶周边见点状、长条状钙化。MRI表现具有两组特征:1)直径> 5cm的病变(18例),均表现为异质性,T1WI呈等或低信号,其中7例病灶内T1WI高信号提示出血;在T2WI中,10例(43%)观察到"三重信号征",12例见内部线样低信号分隔,其中6例呈多囊样改变; 2例存在液-液平信号;增强扫描病变呈不均质强化; 2)直径<5cm的病变(6例),其中4例信号较均匀,T1WI呈等或稍低信号,T2WI呈高信号,病变呈均匀强化; 2例呈多囊样改变,可见"三重信号征",呈结节样强化。12例病变DWI呈现高信号。结论滑膜肉瘤的临床特点及影像学表现具有一定特征性,综合分析有助于术前诊断。Objective To explore the clinical and imaging features of synovial sarcoma. Methods The present study retrospectively examined 71 cases of pathologically confirmed synovial sarcoma, including CT or MRI imaging of 34 cases and analyzed the imaging manifestations. Results Synoviai sarcoma is more common in young adults and most often affects the extremities （ particularly lower limb, 46% of cases）. The majority of the lesions were large （ 〉5 cm; 82% ）, nodular or lobulated. On computed tomography （CT） scans, the lesions demonstrated intensity signals similar to those of muscle, and most of lesions show necrosis and cyst changes, contrast-enhanced scanning revealed heterogeneous enhancement; 8 cases （44%） exhibited punctate or strip calcification in the periphery of the tumor. On magnetic resonance imaging （MRI） scans, there were two sets of MRI features seen with synovial sarcomas： 1）tmnor size of 〉 5 cm （18 cases） were usually heterogeneous, On T1-weighted images, equal or low-intensity signals were observed, 7 cases demonstrated a hypointensive T1 signal, suggesting hemorrhage; On T2-weighted images, 10 cases （43%） showed ＂triple signal＂, 12 cases presenting signals that indicated internal septations including 6 cases showed multilocular cystic lesions, 2 cases showed fluid-fluid level signal; Contrast-enhanced scanning revealed heterogeneous enhancement; 2） Tumor size of 〈 5 cm （6 cases） including 4 cases showed homogeneous signal, On T1 -weighted images, equal or low-intensity signals were observed ; On T2-weighted images, high-intensity signals were observed ; Contrast-enhanced scanning revealed homogeneous enhancement in the lesions. 2 cases showed multilocular cystic lesions, ＂triple signal＂, revealed nodular enhancement. 12 patients underwent DWI showed high-intensity signals. Conclusion There are characteristic for the diagnosis of synovial sarcoma in clinical features and imaging manifestations, comprehensive analyses are helpful for preoperative diagnos

关 键 词：滑膜肉瘤 体层摄影术 X线计算机 磁共振成像 

分 类 号：R445[医药卫生—影像医学与核医学] R738.1[医药卫生—诊断学]