原发性下腔静脉平滑肌肉瘤的影像学特征分析  

Imaging features of primary leiomyosarcoma of the inferior vena cava

作　　者：王海亮 李萍 徐雷鸣[2] 唐锦龙 Wang Hailiang;Li Ping;Xu Leiming;Tang Jinlong(Department of Radiology,Jiaxing Hospital of Traditional Chinese Medicine,Jiaxing 314001,China;Department of Radiology,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Pathology,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]嘉兴市中医医院放射科,嘉兴314001 [2]浙江大学医学院附属第二医院放射科,杭州310009 [3]浙江大学医学院附属第二医院病理科,杭州310009

出　　处：《中华全科医师杂志》2025年第4期471-476,共6页Chinese Journal of General Practitioners

基　　金：浙江省自然科学基金(LY22H180004)。

摘　　要：目的探讨原发性下腔静脉平滑肌肉瘤(PLV)的影像学特征。方法该研究为病例系列分析。收集浙江大学医学院附属第二医院2012年6月至2022年9月经病理证实的PLV患者的临床资料。纳入的患者需至少进行了CT、磁共振成像(MRI)中的一项。CT和MRI观察指标包括病灶数量、位置、大小、形态、边界、密度(信号)、强化特点、周围侵犯、转移等。结果共收集了17例PLV患者的临床资料,其中男性7例,女性10例,年龄32~78岁。17例患者影像学检查示均为单发肿瘤,肿块最大径为3.8~19.0 cm,走形与下腔静脉一致者12例;肿块囊变形态呈“花瓣状”者11例,呈“裂隙状”者6例;可见侧支循环者15例;管内型3例、管外型2例、交界型12例,管内型肿块呈“蠕虫样”,管外型、交界型肿块呈分叶状,局部见“脐凹征”;肿块边界清楚者3例,边界欠清者14例;肿块侵犯血管者7例。CT平扫PLV实性成分呈等或稍低密度,MRI T1加权像实性成分呈等稍低信号,压脂T2加权像呈等稍高信号,MRI弥散加权成像呈高信号者12例,相应表观弥散系数图呈低信号。CT增强扫描,动脉期PLV实性部分呈轻-中度强化者8例、明显强化者9例,静脉期及延迟期呈持续性强化者10例、渐进性强化者7例。MRI增强扫描,动脉期PLV实性部分中度强化者8例、明显强化者6例,静脉期及延迟期呈持续渐进性强化;坏死囊变区始终未见强化。结论PLV影像学特征包括多数肿块最大径与下腔静脉走行一致、肿块多呈现“花瓣状”坏死囊变形态、可见侧支循环、局部可见“脐凹征”,少数肿块具有嗜血管性。Objective To analyze the imaging features of primary leiomyosarcoma of the inferior vena cava(PLV).Methods This study was a case series analysis.The clinical and imaging data of 17 patients with PLV confirmed by pathology who underwent CT,MRI and/or PET-CT examinations in the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2012 to September 2022 were retrospectively collected.The CT or MRI findings,including the number,location,size,shape,margin,density(signal),enhancement characteristics,surrounding invasion,and metastasis of the lesion were analyzed.Results Among the 17 cases there were 7 males and 10 females,aged 32 to 78 years.All patients had single tumors,the maximum diameter of the mass was 3.8 to 19.0 cm,and in 12 cases it was consistent with the inferior venacava.There were 11 cases of"petal-like"necrosis cystic lesion,and 6 cases of"fissure"necrosis cystic lesion.Collateral circulation was found around the mass in 15 cases.There were 3 cases of intraluminal type,2 cases of extraluminal type,and 12 cases of junctional type.The tumors of intraluminal type presented as"worm-like"appearance,while the extraluminal and junctional type tumors presented as lobulated shape,with local"umbilical depression sign".The margins were clear in 3 cases and unclear in 14 cases.Vascular invasion by the mass was observed in 7 cases.On CT plain scan,the solid component of PLV presented as isodense or slightly hypodense.On MRI T1-weighted images,the solid component presented as isodense or slightly hypodense,and on fat-suppressed T2-weighted images,it presented as isodense or slightly hyperdense.On MRI diffusion-weighted imaging,12 cases showed high signal intensity,and the corresponding apparent diffusion coefficient map showed low signal intensity.On CT enhanced scan,8 cases showed mild to moderate enhancement of the solid part of PLV in the arterial phase and 9 cases showed obvious enhancement.In the venous phase and delayed phase,10 cases showed continuous enhancement and 7 cases showed prog

关 键 词：平滑肌肉瘤 下腔静脉 体层摄影术 磁共振成像 

分 类 号：R735.9[医药卫生—肿瘤] R732.2[医药卫生—临床医学]