滑膜肉瘤的CT、MRI影像表现与鉴别诊断

CT,MRI Imaging Findings and Differential Diagnosis of Synovial Sarcoma

目的探讨滑膜肉瘤的影像学表现。方法回顾性分析8例经病理证实的滑膜肉瘤患者的临床及影像学资料,结合文献并分析其影像表现。行MR平扫6例,增强5例;行CT平扫及增强3例。结果病灶位于脊柱3例、关节旁3例、腹股沟区1例、大腿上段1例,均表现为深部组织内的边界不清或尚清的团块状或分叶状软组织肿块,肿瘤体积较大(均>5cm)。CT上,3例病灶密度均与肌肉密度呈等或稍低密度,其内可见更低密度坏死区,其中2例均伴钙化,且多位于肿块的周边。MRT1WI上,6例病灶与肌肉相比呈不均匀等信号或稍低信号,内见更低信号坏死、囊变,在T2WI上表现为以高信号或稍高信号为主的混杂信号;其中4例均伴出血信号或低信号分隔。8例中6例伴临近骨质破坏。7例增强后病灶均呈明显不均匀强化,囊变坏死及分隔无强化。结论滑膜肉瘤的影像学表现具有一定的特征性,综合分析CT、MRI表现及临床病史有助于提高其诊断符合率,最终确诊依赖病理。

Objective To discuss the imaging features of synovial sarcoma. Methods 8 cases of synovial sarcoma proved by pathology were analyzed retrospectively. Results 3 focuses located in spinal column side, 3 around joint, 1 in iliace region, 1 in upper leg. All lesions displayed ovate or lobulated soft tissue mass in deep part tissue, and tended to be large（〉5cm）. On CT imaging, 3lesion appeared as a soft tissue mass similar to muscles in density, 2 cases with demonstrating peripheral punctuate or mass calcification.On T1WI, 6 lesions were usually heterogeneous with signal intensity similar to or slightly higher than that of muscles and on T2Wl they presented prominent heterogeneity with low or high signal intensity, 4 lesions showed hemorrhagic foci or septation.6 of 8 lesions showed around bone destruction and 7 of 8 lesions demonstrated obviously enhancement on MRI and CT after contrast. Conclusion Synovial sarcoma in the Rare Site has some special imaging features.Comprehensive analysis of CT and MRI can improve its diagnostic accuracy, the final diagnosis still depends on pathology.