颈肩部韧带样型纤维瘤病CT与MRI表现

CT and MRI manifestations of desmoids-type fibromatosis in neck and shoulder girdle

目的探讨颈肩部韧带样型纤维瘤病CT和MRI表现,了解其影像特征及其诊断价值。方法回顾性分析本院4例经手术病理证实的颈肩部韧带样型纤维瘤病CT及MRI表现,术前4例均行CT平扫加增强检查,2例行MRI检查。结果全部病例均表现为沿肌纤维长轴生长;1例呈卵圆形,3例呈不规则形侵袭性生长,边缘模糊;全部病例累及1块或多块肌肉及肌间隙,3例可见推移、压迫相邻的重要大血管,其中1例累及臂丛神经和侵袭相邻的椎体骨质,并包埋斜角肌和头臂血管。CT平扫1例密度均匀,低于肌肉,3例表现为不均匀低、等密度;增强后1例周边强化,3例呈不均匀轻度强化。MRI平扫T2WI肿瘤呈高、等混杂信号,内见斑片状或条带状分布的低信号,其中1例包埋低信号斜角肌。结论 CT和MRI可显示韧带样型纤维瘤病大小、形态、侵袭范围及与重要大血管的关系,肿瘤的MRI信号比CT密度更能反映有助于诊断的瘤内组织学成分。

Objective To explore the CT and MRI features of desmoids-type fibromatosis and to evaluate their clinical value. Methods CT and MRI appearances of 4 patients with desmoids-type fibromatosis confirmed by surgical and pathologic findings were retrospectively analyzed, which were correlated to the pathologic features. All 4 patients underwent CT scan, 2 of 4 underwent MRI scan at the same time. Results All cases presented as a solid mass,growing along the long axis of muscles. One case presented expanded features and appeared an ovoid in shape with an almost-clear border. 3 cases presented infiltrative features and appeared irregular in shape with ill-defined margin. The lesions were inseparable from the adjacent musculature. The invasion of adjacent important vessel and the musculature may occur in 3 cases. One of them invaded the anterior and middle scalene muscles, cephalic vein, brachial plexus and vertebrae. On unenhanced CT, the masses showed homogeneous low attenuation （1 case） or slightly low attenuation with several heterogeneous areas in it （3 cases）. One showed peripheral enhancements and three were slightly inhomogeneous enhancements after contrast injec- tion. On T2-weighted images, two lesions were heterogeneity of signal, which predominantly slightly high intensity with strip and patchy low signal intensity. One of them invaded the anterior and middle scalene muscles. Conclusion CT and MRI may both show the overall size and location of the lesion and whether there is any involvement of surrounding vital structures. MRI is more suitable for evaluation of different components in tumor, which may be useful to guide diagnosis.