滑膜肉瘤的临床影像学诊断(附33例报告)

Clinical imaging diagnosis of synovial sarcoma(report of 33 cases)

目的：总结33例滑膜肉瘤的临床影像学表现特点,探讨其诊断依据。方法：搜集经手术病理证实的滑膜肉瘤33例,其中男性20例,女性13例,病史1个月~5年,主要症状为局部软组织肿块。33例均摄有X线平片;21例行CT检查,其中14例同时行增强扫描。18例行MR平扫,15例行增强扫描。结果：33例X线表现为局部软组织肿块,5例（15.15%）可见斑点状钙化灶,2例（6.06%）可见大片状钙化。21例CT平扫均表现为低密度类圆形或分叶状软组织肿块,6例边界清楚,周围肌肉受推压变薄;15例边界不清,周围肌肉与病灶间无清楚边界。病灶最大径2.10~18.60cm。9例伴有邻近骨质侵蚀性溶骨性破坏,破坏边缘锐利,无硬化边;6例（28.57%）软组织肿块内可见斑点状或斑片状钙化灶;2例（9.52%）可见大片状不均匀钙化。7例包绕邻近关节生长。14例行CT增强扫描,病灶呈明显不均匀逐渐强化,其中12例（57.14%）可见到大小不一的囊状无强化区。18例T1WI均表现为不均匀低信号或略低信号,T2WI上呈不均匀高信号,11例（61.11%）出现高、中、低＂三重信号＂征。病灶最大径2.40~20.10cm。8例边界清楚;10例侵犯邻近肌肉,边界不清,周围出现明显水肿信号。4例病灶中可见短T1长T2出血信号;2例（11.11%）病灶囊变区内可见明显的液-液平面。15例MR增强扫描表现为病灶明显不均匀强化,其中10例（66.67%）病灶内含有大小不一、无强化的囊状结构。7例包绕邻近关节生长的病灶,侵蚀性骨质破坏表现较CT明显。结论：滑膜肉瘤具有一定的临床影像学特征,但需要与多种软组织肿瘤进行鉴别。

Objective：To summarize the imaging features of 33 synovial sarcoma and discuss the diagnostic standard.Methods：33 cases imaging materials of synovial sarcoma proven pathologically were reviewed.Patients include 20 males and 13 females.The medical history from 1 month to 5 years.The main symptoms were local bump and pain.All of the 33 cases were performed X-ray films.21 cases were CT scaned and 15 cases were performed post-contrast scan.MRI were performed in 18 cases and post-contrast scan performed in 14 cases.Results：X-ray films of the 33 cases displayed local soft tissue bump,5（15.15%） revealed mottled calcification,and another 2（6.06%） manifested flaky calcification.CT of the 21 cases displayed ovate or lobulated soft tissue mass of hypointensity,6 masses showed clearly defined margins and muscles around were pushed,15 lesions showed ill defined margins,and no clear interface between lesions and muscles.The diameters of the lesions on CT was 2.10～18.60 cm.9 lesions were accompanied by osteolytic destruction of neighboring bones,with sharp margins and no sclerosis.6（28.57%） revealed mottled calcification within masses,and another 2（9.52%） manifested flaky calcification.7 lesions wraped neighboring joints.14 lesions demonstrated heterogeneous gradual enhancement after contrast media injection,12 of the 14 lesions manifested no enhanced cystic areas.18 lesions which were performed MR scan demonstrated heterogeneous low or light low density on T1WI,and heterogeneous high signal on T2WI.11（61.11%）of the 18 lesions displayed ＇triple signal ＇sign.The diameter of the lesions on MRI was 2.40 ～20.10 cm.8 masses showed clearly defined margins,10 lesions infringed neighboring muscles with ill defined margins and neighboring edema.4 lesions showed hemorrhagic foci.2 lesions（11.11%） showed fluid-fluid levels.15 lesions manifested heterogeneous post-contrast enhancement on MRI and 10（66.67%） of 18 showed no enhanced cystic areas.The 7 lesions wraped neighboring joints on MRI showed clear erosive bone destruction than CT pictures.Conclusion：There are some clinical and imaging characters of synovial sarcoma,but differential diagnosis should include multiform soft tissue tumors.