足部原发性软组织肿瘤的影像学分析

Imaging Analysis of Primary Soft Tissue Tumors of the Foot

目的探讨足部原发性软组织肿瘤的影像学诊断价值。方法搜集我院足部软组织肿瘤患者55例,其中男性28例,女性27例,年龄4个月～79岁,18例行X线检查,17例行CT检查,44例行MRI检查,分析其临床资料及影像学表现,包括位置、大小、形态、信号或密度、增强特点。结果 55例中,良性49例,恶性6例,大小1.1～8.3cm,单发居多(41例,74.5%),影像学定性诊断39例,其余16例中3例恶性肿瘤误诊为良性。X线、CT、MRI可有效发现病灶,敏感度分别为88.9%、94.1%及100%。部分肿瘤MR表现较有特征:19例海绵状血管瘤T2WI及STIR上明亮高信号,可见分隔;6例脂肪瘤及脂肪母细胞瘤在T1WI,T2WI上信号较高,STIR信号降低;2例滑膜肉瘤有侵袭性表现;3例黑色素瘤见短T1短T2信号;色素沉着绒毛结节性滑膜炎与腱鞘巨细胞瘤均见骨质破坏,由于相似T2WI低信号,难以鉴别。结论影像学检查可有效发现病灶且能准确定位,对于部分特征性肿瘤还能做出定性诊断;熟悉足部常见软组织肿瘤的影像学表现有利于临床诊疗。

Objective To investigate the imaging diagnostic value for the primary soft tissue tumors of the foot. Methods 55 pa- tients with primary soft tissue tumors of foot were enrolled in this study, including 28 men and 27 women,with age ranging 4 months - 79 years. 18 cases, 17 cases and 44 cases underwent X -ray, CT, and M RI examination, respectively. We mainly analyzed the lesion＇s an- atomic location, size, morphology, signal intensity or density, characteristic of enhancement respectively. Results Of 55 cases, 49 cases were benign （89.1%） and 6 cases malignant （ 10.9% ） , with size ranging from 1.1cm to 8.3cm, and predominantly solitary （n =41, 74.5% ）. 39 cases （70.9%） were qualitatively diagnosed,and 3 cases malignant tumors of the others were misdiagnosed as benign ones. X - ray, CT and MRI can effectively detect the abnormalities （ sensitivity 88.9% vs 94.1% vs 100% ）. Some tumors could show charac- teristic MR signal intensity, including 19 cases of hemangioma （high light signal intensity on T2WI and STIR, internal septa can be seen） , 6 cases of lipoma and lipoblastoma （high signal intensity on T1WI and T2WI, low signal intensity on STIR） , 2 cases of synovial sarcoma （the invasive rim） , 3 cases of melanoma （short time on T1WI and T2WI）. Of course, it is also difficult to differentiate pigmen- ted villonodular synovitis （PVNS） from giant cell tumor of the sheath （GCTTS） because of the similar low signal intensity on T2WI and bone destruction. Conclusion Imaging examinations can accurately locate the foot tumors and also give qualitative diagnosis for some characteristic tumors. The knowledge of common tumors of the foot aids in clinical planning.