肢体和躯干软组织肿块的CT评价

CT manifestation of soft tissue masses of limbs and trunk

目的 探讨肢体和躯干软组织肿块的CT征象在诊断中的价值。方法 分析20例经手术病理证实的肢体及躯干软组织肿块增强前后的CT资料。2例恶性肿瘤,18例良性病变。结果 良性病变中囊肿4例,3例为边缘光滑的水样密度,1例有出血感染密度增高,无强化;脂肪瘤3例,有特征性,为边界清楚的CT值-50～—130Hu的低密度灶;血肿2例和软组织感染1例均有明显的临床病史,病灶边缘不规则,界限不清。侵袭性血管瘤1例,增强后肿块强化伴有增粗扭曲的强化血管影;其他良性肿瘤7例,包括神经鞘瘤2例,侵袭性纤维瘤2例,CT表现为边界清楚,密度均匀,强化不明显;间叶瘤3例,表现为密度不均,其内见脂肪、血管等组织的不同强化特点。恶性肿瘤2例,为肉瘤,在CT上均表现为巨大密度不均匀肿块,增强后病灶不均匀强化,其内见坏死区,边界部分清楚,邻近骨骼未见破坏。结论 软组织肿块中脂肪瘤、囊肿的CT表现因具有特征性可作出诊断,血肿、感染的CT特征结合病史及临床体征也可作出诊断。软组织肿块平扫均匀,增强后无或轻度强化,形态规则支持良性;平扫不均匀及增强后不均匀强化支持恶性。

Purpose To analyze the CT features of soft tissue masses of the limbs and trunk. Methods Twenty 20 cases of soft - tissue masses confirmed by surgery and pathology were studied. There were 2 cases of malignant tumors and 18 cases of benign tumors. Results Three of 4 cyst cases displayed watery density with smooth border, the other with high density because of hemorrhage and infection. Lipomas(3 cases) were typically showed as the low density with clear margin and CT value of - 50 - 130Hu. Hematoma(2 cases) and infection( 1 case) had obviousl clinic history, with irregular and/or unclear margin. Aggressive hemangiomaO case) was enhanced with enlarged and distorting blood vassels. Other benign tumors including Neurolemmoma(2 cases) and Aggressive fibromatosis(2 cases) demonstrated with clear margin and homogeneous density without enhancement, but 3 mesenchymomas revealed with nonhomogeneous density including fat and blood vassel as well as different enhancement. Two malignant tumors were sarcoma, appearing as large mass with inhomogeneous density, nonhomogeneous enhancement and necrosis, without bone destruction. Conclusion The Lipoma and the cyst with specific CT features could be diagnosed. The soft tissue masses with homogeneous density, regular shape and without contrast enhancement might be benign tumors, and those with heterogeneous enhancement could be malignant tumors.