腹盆部孤立性纤维瘤的影像表现及病理对照  

Imaging manifestations and pathological features of solitary fibrous tumors in abdomen and pelvis

作　　者：李守红[1] 蒋沫轩[1] 邹先进[1] 郭晓华 陈明 LI Shouhong;JIANG Moxuan;ZOU Xianjin;GUO Xiaohua;CHEN Ming(Departmentof Radiology,the First People’s Hospital of Jingmen,Jingmen,Hubei Province 448000,China;Department of General Surgery,Yingde People’s Hospital,Yingde,Guangdong Province 513000,China;Department of Radiology,the Second People’s Hospital of Jingmen,Jingmen,Hubei Province 448000,China)

机构地区：[1]荆门市第一人民医院放射科,湖北荆门448000 [2]英德市人民医院普外科,广东英德513000 [3]荆门市第二人民医院放射科,湖北荆门448000

出　　处：《实用放射学杂志》2021年第7期1118-1121,1168,共5页Journal of Practical Radiology

摘　　要：目的 探讨腹盆部孤立性纤维瘤(SFT)的CT、MRI表现与病理特点的关系.方法 回顾性分析手术病理证实的21例腹盆部SFT的影像学及病理特征,21例均行MRI检查,15例行CT检查.结果 21例SFT发生于腹部11例、盆部10例.肿块最大径2.2~25 cm.肿瘤呈圆形和椭圆形,其中8例边缘光滑,13例呈分叶状,13例有完整包膜或包膜样结构.CT平扫以等密度或等低密度为主,肿块未见钙化及出血.增强扫描:6例呈渐进性均匀强化,门脉期及延迟期持续强化,其中3例动脉期可见蚓状血管影;4例各期无强化;5例呈不均匀强化.MRI平扫病灶T_(1)WI呈不均匀等信号,T_(2)WI8例呈均匀高信号,其中4例见蚓状血管影,增强扫描呈渐进性中等或明显强化;4例T_(2)WI呈低信号,其增强扫描各期无强化;9例T_(2)WI呈混杂信号,增强呈不均匀强化.按照CT及MRI强化程度的不同将病灶分成3型:A型结节8例,增强呈均匀中等度或明显均匀强化;B型结节4例,增强各期无强化;C型结节9例,增强呈不均匀强化.病理示:SFT的免疫组化中CD34、CD99、bcl-2、Vimentin和STAT6的阳性率较高.3种强化方式的差异主要取决于细胞和胶原纤维的不同以及血管的生长方式.结论 腹盆部SFT在CT平扫为等密度或等低密度;MRI平扫T_(1)WI呈等信号或等低信号,T_(2)WI呈均匀高信号、低信号或混杂信号.CT和MRI增强表现为3种强化方式.这种影像特征与病理成分的变化有相关性,结合两者有助于提高诊断水平.Objective To explore the correlation between imaging manifestations and pathological features of solitary fibrous tumors(SFT)in abdomen and pelvis.Methods The imaging and pathological manifestations of 21 patients with SFT in abdomen and pelvis confirmed by pathology were analyzed retrospectively.All of the patients underwent MRI examinations and 15 cases underwent CT scans.Results Of 21 SFT,there were 11 cases in the abdomen and other 10 cases in the pelvis.Maximal diameter of the tumors ranged from 2.2 cm to 25 cm.All tumors were round and oval in shape,in which 8 cases had smooth margin,13 cases were lobulated,and 13 cases had complete capsule or capsule-like structure.Iso-or hypo-density of masses without calcification and hemorrhage were showed on plain CT images.On enhanced CT,progressive and homogeneous contrast-enhancement(persistent enhancement in the portal vein and delayed phases)was showed in 6 cases,the "earthworm-like vessels"in the arterial phase was seen in 3 cases.In addition,4 cases had no enhancement in each phases,but 5 cases had heterogeneous enhancement.MRI showed heterogeneous isointensity of the tumor on T_(1)WI in all cases,homogeneous hyperintensity on T_(2)WI in 8 cases,and“earthworm-like vascular”in the arterial phase with moderate or marked enhancement progressively in 4 cases.4 lesions were hypointense on TOWI without enhancement in each phase.9 lesions were heterogeneous signal on T_(2)WI with heterogeneous enhancement.These tumors were classified into 3 categories according to different enhancement degrees.Type A,the masses with homogeneous,moderate or marked enhancement in 8 cases;Type B,non-enhancement or mild enhancement in 4 cases;and Type C,heterogeneous enhancement in 9 cases.The positive rate of CD34,CD99,bcl-2,Vimentin and STAT6 were higher in the immunohistochemistry of SFT.The difference between the three types of enhancement mainly depended on the different types of cells and collagen fibers as well as the growth pattern of the blood vessels.Conclusion SFT in abdomen

关 键 词：孤立性纤维瘤 计算机体层成像 磁共振成像 病理学 

分 类 号：R730.262[医药卫生—肿瘤] R814.42[医药卫生—临床医学]