孤立性纤维瘤的影像学分析

目的探讨多部位孤立性纤维瘤(solitary fibrous tumors,SFT)的影像学表现,提高对该疾病的诊断与鉴别诊断水平。方法回顾性分析10例经手术病理证实为SFT的CT/MR及手术病理资料。其中8例患者均行螺旋CT平扫并增强、多平面重建(MPR)、冠状、矢状重建,2例CT平扫及MRI平扫并增强。分析获取图像,探讨SFT的CT/MR表现。结果 8例位于胸膜腔内,1例骑跨胸腹部后纵隔,1例位于上颈部及颅内,形成勾通性肿块。胸膜来源的SFT常以宽基底附于胸膜,肿瘤与正常胸膜间夹角常为钝角,肿块较小(小于10 cm)推压肺组织,与肺组织尚可分界;肿块较大(大于或等于10 cm)时,与肺组织分界较模糊,提示有侵犯可能;胸膜来源的SFT的CT平扫表现为均匀或略不均匀软组织肿块,增强扫描病灶表现为不均匀强化,呈地图样强化,病灶较大时可见不规则坏死区。胸膜外(纵隔、头颈部)SFT表现为巨大软组织肿块,生长较缓慢,常生长于相对薄弱间隙内,推压或侵犯邻近器官。MRI平扫T1WI为等信号,T2WI为不均匀高信号,FS-T2WI呈不均匀混杂高信号,DWI呈低信号,增强扫描病灶明显不均匀强化,周缘强化略明显。结论 SFT好发于胸膜腔内,表现为孤立的软组织肿块,宽基底、界线较清楚、邻近肺组织受推压、血供丰富,无肺门、纵隔、腋窝淋巴结肿大;纵隔及头颈部可为胸膜外SFT的发病部位,肿块生长于肌间隙或薄弱间隙,血供丰富,明显强化。病灶大于10 cm、强化不均匀(伴坏死)、侵犯周围组织提示恶性可能。

Objective The aim of this paper is to study and evaluate the data of the patients with Solitary Fibrous Tumor in some position with emphasis on its imaging findings.Methods The clinical, imaging and pathology findings of 10 patients pathologically proved SFT were retrospectively analyzed. all of 10cases underwent spiral CT plain and contrast enhanced scans, All of 10 cases underwent multi-planar reformatting（MPR ）（coronal and sagital reformatting）,2 cases underwent MR plain scans and contrast enhanced scans. we analysis all the images and study the imagingfindings of CT/MR.Results 8 cases SFT located in pleura cavity,1 case SFT rode across chest and abdomen,1 case SFT located in Upper neck and intracranial,performing as mass formed with communication. The small SFT （〈10cm）inpleura cavity can be taken apart from the lung and the lung may be bulldozed;the large SFT （≥10cm） may be combined to the lung ,and we can’t distinguish the tumor from the lung. Sources of pleural SFT CT scan showed homogeneous or slightly inhomogeneous soft tissue mass, enhanced scan lesions showed heterogeneous enhancement, showing maps like enhancement, irregular necrotic lesions larger visible area. Extra pleural （mediastinum、 head and neck） SFT show the large soft tissue mass, growing more slowly, often relatively weak growth in the gap, push or invasion of adjacent organs. Unenhanced MRI T1WI as other signal, T2WI high signal is inhomogeneous, FS-T2WI showed heterogeneous mixed high signal, DWI showed low signal lesions significantly enhanced scan heterogeneous enhancement, peripheral enhancement slightly obvious.Conclusion SFT occur in the pleural cavity, expressed as an isolated soft tissue mass, wide base, and the boundary more clearly, pushing adjacent lung tissue,with the rich blood supply, no hilar, mediastinal, axillary lymph nodes; Mediastinum and head and neck can be the diseased parts of extrapleural SFT, tumor growth gap or weakness in the muscular gap, rich blood supply, significantly enhanced. Lesions greater than 10cm, inhomogeneous enhancement （with necrosis）, malignancy may invade surrounding tissues.