腹盆部韧带样纤维瘤的影像学表现与病理对照分析

The Comparative Analysis between the Imaging Findings and Pathological result of Abdominal and Plevic Desmoid Fibromatosis

目的探讨CT及MRI在腹盆部韧带样纤维瘤(desmoid fibromatosis,DF)诊断中的应用价值。方法回顾性分析13例经手术病理证实腹盆部DF患者的CT、MRI资料和病理结果,其中4例行CT检查,6例行MRI检查,3例同时行CT、MR检查。结果 7例病变位于腹壁、2例位于腹腔内,4例位于盆部肌间隙跨坐骨大孔或闭孔向盆腔蔓延。CT表现:平扫7例为软组织密度,与邻近肌肉相近,未见钙化、坏死,3例内见条索状稍高密度影,增强扫描均匀或不均匀强化。MRI表现:与肌肉相对比,T1WI上7例表现为不均匀等低信号,2例为均匀等信号,T2WI上病灶信号不均匀,呈高信号或略高信号,7例内可见条索状低信号区,增强扫描8例呈中等或明显不均匀强化,1例轻度强化,其中长T1短T2信号区未见强化。组织病理学上肿瘤组织内成纤维细胞、纤维母细胞呈束状、编织状排列,细胞间胶原组织包绕,偶见核分裂。结论腹盆部DF的CT和MRI表现有一定的特征性,对其术前诊断有重要的价值;MRI优于CT,能更好的显示肿瘤内部结构及周围神经、血管、深部脏器等结构的关系。

Objective To investigate diagnostic value of CT and MRI in abdominal and plevic demoid fibromatosis（DF）. Methods To analyze the CT and MRI images of 13 patients with DF confirmed by operations and pathology retrospectively. Four patients underwent CT scan, 6 patients underwent MR scan,3 patients underwent both CT scan and MR scan. Results Seven cases of DF were located in the abdominal wall, 2 cases in the abdominal cavity, 4 cases in spatium intermuscula of pelvic crossed foramen ischiadicum majus or obturator spreading to the pelvic cavity. CT examination revealed： 7 cases with plain CT scan showed soft tissue density similar to muscle without calcification and necrosis, 3 cases with linear or reticular slightly high density, all tumors were homogeneous or heterogeneous enhancement. MRI examination revealed： compared with muscle, 7 cases showed inhomogeneous low signal and 2 cases homogeneous iso-signal on T1WI; all cases showed inhomogeneous high or slightly high signal and 7 cases with linear or reticular low signal area on T2 WI. Eight cases showed moderately or obviously inhomogeneous enhancement, 1 case showed mild enhancement, and no enhancement in long T1 and short T2 signal area after contrast administration. Histopathologically, the arrangment of tumor tissue was composed of fiber cells and fibroblast arranged in cords and weaves, intercellular collagen tissue wrapping, and occasionally nuclear fission. ConclusionDemoid fibromatosis of the abdomen and pelvic have certain CT and MRI characteristics, which have important value for the preoperative diagnosis, but MRI is superior to CT, which could better show the internal structure of tumor and the relationship of peripheral nerve, blood vessel, deep organs around the tumor.