3．0TMRI对四肢软组织神经源性肿瘤的诊断价值

The value of soft tissue neurogenic tumors in the extremities with 3. 0 T magnetic resonance imaging

目的探讨3．0TMPd对四肢软组织神经源性肿瘤的诊断与鉴别诊断价值。方法回顾性分析2009年7月至2012年9月首都医科大学附属北京朝阳医院经病理证实的17例四肢软组织神经源性肿瘤的MRI表现，总结其影像学征象并进行分析比较，通过ROC曲线分析评价各种指标对肿瘤性质的预测价值。结果良性肿瘤中神经鞘瘤和神经纤维瘤的发病部位的差异有统计学意义（P=0．044）；二者在T2WI抑脂序列上信号表现差异有统计学意义（P=0．020）；ROC曲线分析结果表明对肿瘤性质具有较高预测价值的指标分别为肿瘤形状（Au=0．967，P=0．037），肿瘤短径最大直径（Au=0．923，P=0．048），瘤周水肿（Au=0．981，P=0．034），与邻近筋膜的关系（Au=0．981，P=0．034）。结论四肢软组织神经源性肿瘤在3．0TMRI上具有这些特征（边缘不规则，体积较大，瘤周水肿，邻近筋膜具有受侵征象）中的任何一种或几种都预示其恶性可能性大。T2WI抑脂序列对于区分肿瘤组织学类型可提供更多信息。

Objective To explore the diagnostic value of 3.0T MRI in neurogenic tumor of soft tissue in the extremities. Methods The MRI appearance of 17 neurogenic tumors with pathologieal confirmation was retrospectively analyzed. Various imaging characteristics of tumors were evaluated and different imaging findings were compared. The diagnosis value of each MRI features was evaluated with receiver-operating-characteristics （ROC） analysis. Results In the benign tumors significant differences between neurilemmoma and neurofibromas were noted for the position （ P = 0. 044 ）. Heterogenicity on T2- weighted fat suppression images was also significant in differentiating between neurilemmoma and neurofibromas （ P = 0. 020）. The shape of tumors, maximum length of tumor short diameter, edem around masses, relationship with adjoining fascia had the best discriminatory ability. The ROC analysis yield the area under curve （AUC） of them was 0. 967 （ P = 0. 037 ）, 0. 923 （ P = 0. 048 ）, 0. 981 （ P = 0. 034 ）, 0. 981 （P = 0. 034）, respectively. Conclusion If the neurogenic tumors of soft tissue in the extremities had one or several features of these characteristics （irregular margin, big volume, edem around masses, aggressive behavior with adjoining fascia） on 3.0T MRI, they had more possibility to be malignant. T2- weighted fat suppression series on 3.0TMRI was very important for discrimination of tumor histological characteristics.