滑膜肉瘤临床及磁共振图像表现分析  

Clinical and MRI findings of synovial sarcoma

作　　者：常承[1] 彭晓新[1] 蒋雯[1] 宫丽华[2] 程晓光[1] 于爱红[1] CHANG Cheng;PENG Xiao-xin;JIANG Wen;GONG Li-hua;CHENG Xiao-guang;YU Ai-hong(Department of Radiology,Beijing Jishuitan Hospital,Beijing,100035,China)

机构地区：[1]北京积水潭医院放射科,100035 [2]北京积水潭医院病理科,100035

出　　处：《中国骨与关节杂志》2021年第11期816-821,共6页Chinese Journal of Bone and Joint

基　　金：北京市卫生系统高层次卫生技术人才培养项目(2009-02-03,2013-3-033)。

摘　　要：目的分析滑膜肉瘤的临床和MRI表现,探讨相关的临床影像特点。方法回顾分析51例滑膜肉瘤(57处病灶)的临床及影像学表现,总结滑膜肉瘤的临床和影像学特征。结果本组51例,男27例,女24例,男女比例为1.125∶1。发病年龄5~68岁,平均33.2岁。位于躯干者8例(15.7%),上肢者16例(31.4%),下肢者28例(54.9%)。47例(92.2%)为局限性单发病灶。29例(56.9%)位于关节旁。31例(60.8%)肿瘤最大径>5 cm。16例(31.4%)呈分叶状或多结节状,29例(56.9%)呈不规则形,9例(17.6%)呈椭圆形或类圆形。9例(17.6%)病灶边界清楚,44例(86.3%)边界模糊。在T_(1)WI上,有20例(39.2%)信号均匀;在T_(2)WI上,7例(13.7%)信号均匀。29例(56.9%)可见"三重信号征",40例(78.4%)可见分隔征、鹅卵石征、铺路石征。其它影像学征象包括瘤内出血20例(39.2%),坏死/囊变29例(56.9%),液-液平面15例(29.4%),瘤周水肿29例(56.9%);钙化或骨化9例(24.3%);相邻骨质破坏14例(27.5%);包绕邻近大血管3例(5.9%)。50例行MR增强扫描,有45例(90.0%)呈明显不均匀强化。结论滑膜肉瘤病例临床和MRI表现存在一些共性,如"三重信号征"、"分隔征"、"鹅卵石征、铺路石征",部分肿瘤影像学无特异性,最终诊断仍需临床、影像、病理三方面结合。Objective To analyze clinical and MRI manifestations of synovial sarcoma to explore the diagnostic value of MRI.Methods Fifty-one cases(57 lesions)with synovial sarcoma were analyzed to present its clinical and MRI characteristics.Results There were 27 males and 24 females(1.125:1)with a mean age of33.2 years(range:5-68 years).Tumors locations:8 cases(15.7%)at the trunk,16 cases(31.4%)at the upper extremity,and 28 cases(54.9%)at the lower extremity.Local monofocal lesion was found in 47 cases(92.2%);lesions in 29 cases were adjacent to the joints(56.9%);lesions with diameter longer than 5 cm were noted in31 cases(60.8%).Shapes of lesions:lobulated or multinodular in 16 cases(31.4%),irregular in 29 cases(56.9%),and elliptical or nearly round in 9 cases(17.6%).Boundary was clearly delineated in 9 cases(17.6%),while not in44 cases(86.3%).Signal intensities were homogeneous in 20 cases(39.2%)on T_(1)WI and in 7 cases(13.7%)on T_(2)WI."Triple signal intensity"was demonstrated in 29 cases(56.9%).Septation and"paving stone signal"were seen in 40 cases(78.4%).Other radiological manifestations included internal hemorrhage in 20 cases(39.2%),necrosis/cysts in 29 cases(56.9%),fluid-fluid level in 15 cases(29.4%),perilesional edema in 29 cases(56.9%),calcifications in 9 cases(24.3%),bone destruction in 14 cases(27.5%),and vascular encasement in 3 cases(5.9%).Forty-five cases(90.0%)showed heterogeneous enhancement.Conclusions Similarities including"triple sign","septation",and"paving stone signal"are found in clinical and MRI manifestations of synovial sarcoma.However,imaging features of some tumors are not specific so that clinical data,imaging,and pathology need to be integrated to reach accurate diagnosis.

关 键 词：肉瘤 滑膜 磁共振成像 软组织肿瘤 肿瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R738.5[医药卫生—诊断学]