滑膜肉瘤的影像学表现

Imaging findings of synovial sarcoma

目的：分析滑膜肉瘤的影像学表现,以提高对该病的认识。方法：回顾性分析11例经病理确诊为滑膜肉瘤患者的各种影像资料。结果：11例滑膜肉瘤发病部位分别位于足部（包括踝关节）4例,髋关节2例,胸椎2例,前肋骨、肱骨下段及臀部各1例。X线平片表现为类圆形、椭圆形或分叶状的软组织肿块,1例肿块近边缘出现斑点及斑片样钙化并伴有邻近骨质囊状破坏。CT表现为稍低于周围正常肌肉密度的不均匀软组织肿块,边界不清晰,增强扫描呈轻~中度不均匀强化。磁共振T1WI上,4例为等低信号,1例为稍高信号;T2WI上均呈中/高混杂信号,并见更高信号囊变区,T2WI压脂为不均匀高信号,部分呈多发结节样团块,并见低信号分隔,增强扫描呈明显不均匀强化。肿瘤具有侵袭性,位于臀部的病灶则向臀大肌、臀中肌及臀小肌侵犯。发生于胸椎附件区病灶邻近椎板及棘突骨质破坏,并沿椎间孔向椎管内突入。结论：滑膜肉瘤的影像学表现具有一定特征,对肿瘤的诊断也有帮助;但对于发生于罕见部位的滑膜肉瘤而言,仍有赖于病例组织学的检查。

Objective：To investigate the image characterisitics of Synovial Sarcoma so as to improve the diagnostic accuracy.Methods：Imaging data of 11 cases of Synovial Sarcoma of extremities confirmed pathologically were analyzed retrospectively.Results：4 cases occurred near the foot（including 1 near the ankele joint）,2 near the articulation of hip,2 in the thoracic vertebra,1 in the rib,1 in the lower humerus,1 in the hip.Synovial Sarcoma detected by radiography typically appeared as round,oval or multiloblated soft-tissue masses.1 case presented with calcification inside it and saccular bone destruction in vicinal bone.The mass density was slightly lower than that of the muscle on CT,it showed a heterogeneous slight or intermediate enhancement after contrast.On T1WI,4 tumors showed isointensity or hypointensity,1 case with slightly high signal intensity;on T2WI and on FS T2WI,Synovial Sarcomas appeared as prominent heterogeneity with predominantly hyperintensity,with much higher signal in cystic areas.Multiple nodular lumps,septa,hemorrhage and necrotic or cystic changes were frequently seen.The enhancement of Synovial Sarcomas was usually pronounced and inhomogeneous.The tumor located in the hip encroached the gluteus maximus,gluteus medius and gluteus minimus.The malignant tumor occurred in thoracic vertebra eroded the vertebral plate and spinous process,and it invaded vertebral canal by the intervertebral foramina.Conclusion：Some image features of Synovial Sarcomas are useful for accurate diagnosis of this disorder.But,for the diagnosis of some of tumor occurred uncommon area,it relies on the examination of the pathology.