胸膜外孤立性纤维瘤影像学诊断与鉴别诊断  

Extra-pleural solitrary fibrous tumor:imaging diagnosis and differential diagnosis

作　　者：王国松[1] 夏瑞明[2] 孔一曼[3] 林坚[1] 

机构地区：[1]浙江省绍兴市中医院放射科,浙江绍兴312000 [2]绍兴文理学院附属医院放射科,浙江绍兴312000 [3]浙江大学医学院附属第二医院放射科,浙江杭州312009

出　　处：《医学影像学杂志》2015年第8期1388-1393,共6页Journal of Medical Imaging

摘　　要：目的探讨胸膜外孤立性纤维瘤(ESFT)的影像学特点,以提高对该病影像表现的认识,减少误诊率。方法回顾性分析10例经病理证实ESFT的CT、MRI表现,并对影像学表现与病理表现进行对照研究。结果 10例ESFT病例中,6例位于颅内,1例位于盆腔,1例位于左膝关节,1例位于左侧肾脏,1例位于右侧筛窦;恶性者4例,低度恶性或交界性者3例,良性3例;瘤体直径1.6~6.0cm,平均3.5cm;平扫肿瘤边界清6例,欠清或不清的4例;瘤体轮廓规则5例,不规则5例,其中脑内1例复发者形态呈多囊分隔状;肿瘤伴出血1例,8例CT检查病例中钙化3例,6例颅内病例中5例病灶周围伴明显水肿,另1例多囊病灶不伴有明显水肿;MRI T1WI上等低信号,T2WI上信号表现多样,多呈等高或高低混杂信号;良性ESFT增强后多呈轻中度'地图样'强化和延迟强化,较大病灶、恶性及复发ESFT多呈不均匀明显强化。结论 ESFT影像学表现具有一定的特征性,正确认识其影像表现,可以降低误诊率,但其最后确诊仍需依靠病理诊断。Objective To explore the imaging features of extrapleural solitary fibrous tumor,thoreby enhancing the understanding the imaging manifestation and reducing the ratio of misdiagnosis.Methods Ten cases of extrapleural solitary fibrous tumor were retrospectively analyized by the imaging findings of CT and MRI,and the imaging findings with addition of pathological manifestations were compared.Results Among ten cases of extrapleural solitary fibrous tumor,there were six cases in the encephalic.Three cases was recurrent cases,one case was malignant.There were one case in the pelvic cavity,one case in the left knee joint,one case in the left kidney,one case in right ethmoid sinus;4cases were malignant,3were low potential malignancy or borderline and 3were benign tumors.The tumor size was between 1.6cm and6.0cm,otherwise,the average size was 3.5cm;In terms of plain scanning,there were 6with clear boundary,four cases with owed clear boundary or ill-defined boundary.On the part of the tumor outline,there were five cases with regular outline and five ones with irregular outline.Also,one recidivist had polycystic separate like form.One case was with hemorrhage.Calcification was associated with eight cases confirmed by CT.In six-intracerebral tumor,five cases had marked edema around the lesion,one case with polycystic lesions had no marked edema.MRI MR showed low signal intensity on T1 WI and diverse clinical manifestations on T2 WI,which mostly had high or mixed signal signal intensity.In the aspect of the enhancd scaning,most of benign extrapleural solitary fibrous tumor had moderate ' map like' strengthening and delayed reinforcement,yet,the larger lesion,malignant,and recurrent ones were heterogeneously enhanced.Conclusion Imaging findings of ESFT were of characteristics,we should correctly understand its imaging features so as to reduce the rate of misdiagnosis,but the final diagnosis still depends on pathology diagnosis.

关 键 词：孤立性纤维瘤 体层摄影术 X线计算机 磁共振成像 

分 类 号：R734.3[医药卫生—肿瘤] R730.44[医药卫生—临床医学] R445.2