结节性筋膜炎的超声表现及误诊分析

The ultrasonic manifestation and misdiagnosis analysis of nodular fasciitis

目的探讨结节性筋膜炎二维及彩色多普勒超声声像图特点,分析超声误诊原因。方法回顾性分析53例经手术和病理证实的结节性筋膜炎患者的术前超声声像图表现,并归纳总结结节性筋膜炎的临床及超声病理特征。结果 53例结节性筋膜炎超声表现为单发圆形或类圆形结节,浅分叶状;43例为低回声,部分夹杂中高回声结构,8例为中等回声,2例为高回声;边界清楚或欠清楚,无明显包膜;53例结节后方回声均无衰减,50例结节后方回声增强;活动度好,与皮肤无粘连;CDFI:20例结节内部及周边未见明显血流,adler分级0级,33例结节内部或周边可测及血流信号,adler分级Ⅰ级18例,Ⅱ级15例,脉冲多普勒显示为动脉血流。其中病变累及皮下脂肪层45例,累及肌肉筋膜6例,累及血管2例。超声提示皮下结节44例(83%,44/54),超声误诊9例(17%,9/54,脂肪瘤5例,淋巴结2例,血管瘤2例)。结论结节性筋膜炎超声声像图有一定的特征性,彩色多普勒超声对结节性筋膜炎的诊断及鉴别诊断具有重要的临床价值。

Objective To investigate the features of nodular fasciitis and diagnosis value by two-dimensional and color Doppler flow imaging and the reasons of misdiagnosis were analysed. Methods A total of fifty-three patients confirmed as nodular fasciitis by operation and pathological test were evaluated by the sonographic images and pre-operation diagnosis retrospectively. Results Fifty-three nodules were described as single oval or lobulate. Among the fifty-three patients,forty-five showed hypoechoic nodules with mixed areas of isoechogenicity and hypoechogenicity, six nodules were isoechoic, two with hyperechoic. Fifty of them were well-defined, and mildly heterogeneous mass with posterior acoustic enhancement. Color Doppler sonagram showed increased internal flow within thirty-three masses, which consisted of both peripheral and central penetrating vessels. The pulsed Doppler analysis revealed arterial flow, while twenty-two nodules had no internal flow. Forty-five of those nodules were found in the subcutaneous tissue, six in the muscle, and two in the vessel. Eighty-three percent（44/54） of pre-operation diagnosis had subcutaneous nodules..Twenty-seven percent of them（9/54） were misdiagnosed including five as lipoma, two as lymph nodes, and two as angioma. Conclusion Color Doppler ultrasound is valuable for differential diagnosis of nodular fasciitis.