胸膜及胸膜外孤立性纤维瘤病患者CT、MRI表现及鉴别诊断  

CT and MRI Findings and Their Differential Diagnosis in Patients with SFTP and ESFT

作　　者：周鑫 石义志 ZHOU Xin;SHI Yi-zhi(Department of Radiology,Huangshi Central Hospital of Edong Medical Group,Huangshi 435000,Hubei Province,China)

机构地区：[1]鄂东医疗集团黄石市中心医院放射影像科,湖北黄石435000

出　　处：《中国CT和MRI杂志》2022年第2期63-65,165,共4页Chinese Journal of CT and MRI

摘　　要：目的分析胸膜及胸膜外孤立性纤维瘤病(SFT)患者的CT、MRI表现及诊断价值。方法收集2015年1月至2020年6月本院收治的44例SFT患者的病例资料,回顾性分析其临床资料及CT和MRI图像资料,观察记录病灶部位、病灶大小、边界等相关信息,总结SFT患者在CT和MRI中的影像学征像。结果收集的18例SFTP病例均为单发病灶,病灶的最大径1.8~13.4cm,中位值6.5cm,其中有3例患者病灶的最大径>10cm。多数患者病灶部位位于肋胸膜(66.67%),其次是膈面胸膜(22.22%)、纵隔胸膜(5.56%)和叶间裂胸膜(5.56%),CT平扫可见病灶边界均清晰光整,瘤体呈软组织密度影,10例病灶密度均匀,8例病灶密度不均,CT增强扫描后,密度均匀的病灶仅轻度强化,密度不均病灶强化不均匀,在MRI平扫中,T_(1)WI多呈等、稍低信号,仅2例呈稍高信号;T_(2)WI呈等、稍高信号或高低混杂信号,可见“假包膜征”;12例加行MRI增强扫描的患者,其病灶多呈明显均匀强化或“地图状”强化,有5例瘤体内部或周围观察到流空影血管。26例ESFT病例均为单发病灶,病灶的最大径1.1~14.8cm,中位值6.2cm,其中有5例患者病灶的最大径>10cm。多数患者病灶部位位于颅内(30.77%)、眼眶(26.92%)及腹腔(23.08%),亦有部分病灶位于盆腔或腹腔内,各部位病灶表现不一,肿瘤形态多样,边界清或欠清,CT平扫呈等或不均匀密度,MRI平扫中T_(1)WI多呈等信号,T_(2)WI信号表现多样,主要为高低混杂信号,增强扫描后病灶明显不均匀强化,影像学表现与SFTP类似。结论SFTP和ESFT的影像学表现均与其自身肿瘤的大小、部位及病理特征关系密切,二者CT及MRI表现较为相似,出现不均匀持续性强化或“地图状”改变即流空影血管等特征对鉴别SFT具有重要价值。Objective To analyze CT and MRI findings and their differential diagnosis value in patients with solitary fibrous tumor(SFT)of the pleura(SFTP)and extrapleural solitary fibrous tumor(ESFT).Methods The medical data of 44 SFT patients who were admitted to the hospital from January 2015 to June 2020 were collected.Their clinical data,images data of CT and MRI were retrospectively analyzed.The relevant data such as site,size and boundary of lesions were observed and recorded.The imaging features of SFT patients in CT and MRI were summarized.Results All the 18 SFTP cases were single lesions,the maximum diameter and median value of lesions were 1.8-13.4 cm and 6.5 cm,respectively.Among them,there were 3 cases with maximum diameter longer than 10 cm.The lesions of most patients were located at costal pleura(66.67%),followed by diaphragmatic pleura(22.22%),mediastinal pleura(5.56%)and interlobar fissure pleura(5.56%).CT scan showed that boundaries of lesions were clear and smooth.The tumors showed soft tissue density shadow.There were 10 cases with uniform density of lesions and 8 cases with uneven density.After CT enhancement scan,lesions with uniform density were only slightly enhanced,while lesions with uneven density were unevenly enhanced.In MRI plain scan,T_(1)WI mostly showed equal or slightly low signal.There were only 2 cases showing slightly high signal.T_(2)WI showed equal and slightly higher signal or high-low mixed signal,and there was pseudocapsule sign.Among the 12 patients undergoing enhanced MRI scan,the lesions mostly showed uniform or map-like enhancement.There were 5 cases with empty shadow vessels in tumors or around them.All the 26 ESFT cases were single lesions,the maximum diameter and median value of lesions were 1.1-14.8 cm and 6.2 cm,respectively.Among them,there were 5 cases with maximum diameter longer than 10 cm.The lesions of most patients were located at brain(30.77%),orbit(26.92%)and abdominal cavity(23.08%).And there were some lesions located at pelvic cavity or abdominal cavity.The manif

关 键 词：孤立性纤维瘤 胸膜 胸膜外 电子计算机断层扫描 磁共振成像 

分 类 号：R655.2[医药卫生—外科学] R445.3[医药卫生—临床医学]