原发性心脏血管肉瘤的临床影像分析  

Clinical Imaging Analysis of Primary Cardiac Angiosarcoma

作　　者：黄文鹏 侯佳蒙 刘娜娜 李莉明[1] 张永高[1] 高剑波[1] HUANG Wenpeng;HOU Jiameng;LIU Nana(Department of Radiology,The First Afiliated Hospital of Zhengzhou University,Zhengzhou 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院放射科,450052

出　　处：《临床放射学杂志》2021年第11期2105-2110,共6页Journal of Clinical Radiology

基　　金：国家自然科学基金资助项目(编号:81971615)。

摘　　要：目的探讨原发性心脏血管肉瘤(PCAS)的临床特点及影像特征,提高对该病的认识水平和术前诊断的准确率,避免误诊。方法回顾性搜集2012年1月至2021年1月郑州大学第一附属医院9例经病理组织学确诊的PCAS患者的临床及影像资料,分析其超声心动图(7/9)、CT(9/9)、心脏磁共振(2/9)、PET-CT(5/9)的影像学结果,观察并评估病灶的位置、形态、最大直径、边缘、密度或信号、强化方式、强化程度以及邻近组织浸润和转移情况。结果本组男4例,女5例,年龄26~61岁,平均(44.78±11.46)岁。胸闷5例,其中合并胸痛2例、乏力1例,发热咳嗽、咯血、意识障碍、低热各1例,3例患者出现过心包填塞。5例CA-125升高。肿瘤侵犯邻近心包7例,上腔静脉2例,三尖瓣、心肌、房间隔各1例;2例分别出现肝和双肺的多发转移。9例PCAS均位于右心房,瘤体最长径为28~88 mm,平均(55.11±20.02)mm,伴有不同程度的心包积液,超声表现为形状不规则、边界欠清晰的不均质肿块,附着面较宽,无蒂,可向局部心肌浸润性生长;CT平扫表现为右房内等密度或低密度的肿块,未见脂肪和钙化成分,强化方式与病理组织有关,多为不均匀持续性明显强化;心脏MRI表现为T_(1)WI等信号、T_(2)WI高或稍高信号,首过增强未见明显强化,延迟增强为不均匀轻中度强化。PET-CT均发现肿物或代谢增高病灶,葡萄糖摄取增加。结论PCAS作为罕见的心脏恶性肿瘤,早期临床表现不典型,影像学检查能提供病变大小、形态、内部结构、生长特征及邻近部位侵犯情况等丰富的辅助诊断信息,做到早发现、早诊断、早治疗,确诊仍依赖于病理学检查。Objective To explore the clinical and imaging features of primary cardiac angiosarcoma,so as to improve the clinical understanding of the disease and the accuracy of preoperative diagnosis and to avoid misdiagnosis.Methods The clinical and imaging data of 9 patients with PCAS diagnosed by histopathology in the first affiliated Hospital of Zhengzhou University from January 2012 to January 2021 were retrospectively collected.The imaging results of echocardiography(7/9),CT(9/9),cardiac magnetic resonance(2/9)and PET-CT(5/9)were analyzed.Thelocation,shape,maximumdiameter,edge,density or signal,enhancementmode,enhancementdegree,adjacent infiltration and metastasis of the lesions were observed and evaluated.Results There were 4 males(44.4%)and 5 females(55.6%)in this group,aged from 26 to 61(44.78±11.46)years old.Among them,there were 5 cases of chest tightness,including 2 cases of chest pain,1 case of fatigue,fever,cough,and hemoptysis.1 case each,disturbance of consciousness,and low fever,3 cases had pericardial tamponade.CA-125 was elevated in 5 cases,7 cases of tumor invading adjacent pericardium,2 cases of superior vena cava involvement,1 case each of tricuspid valve,myocardium,and atrial septum involvement,and 2 cases had multiple metastases to the liver and lungs respectively.All 9 cases of PCAS were located in the right atrium.The longest diameter of the tumor was 28-88 mm(mean 55.11mm±20.02mm),accompanied by different degrees of pericardial effusion.The ultrasonographic findings were heterogeneous masses with irregular shape and unclear boundaries,with wide base and no pedicle,and could infiltrate into the local myocardium.CT plain scan showed isodensity or low-density mass in the right atrium,no fat and calcification were found and the enhancement mode was related to pathological tissue,and most of them were inhomogeneous and had persistent enhancement.Cardiac MRI showed equal signal intensity of T1WI and high or slightly high signal intensity of T_(2)WI.There was no obvious enhancement in first-pass enhanc

关 键 词：血管肉瘤 心脏 体层摄影术 X线计算机 磁共振成像 

分 类 号：R732.1[医药卫生—肿瘤]