颅内孤立性纤维性肿瘤/血管周细胞瘤的MRI表现

MRI findings of intracranial solitary fibrous tumor/hemangiopericytoma

目的:探讨颅内孤立性纤维性肿瘤(SFT)/血管周细胞瘤(HPC)的MRI表现。方法:回顾性分析经病理证实的41例颅内SFT/HPC患者的临床及MRI资料,比较不同病理分级SFT/HPC的MRI表现。结果:41例患者肿瘤均为单发,位于幕上31例,呈分叶或浅分叶状31例,边界清楚34例。肿瘤信号不均,实性部分在T1WI上呈低信号10例、等信号21例、高信号10例。21例行DWI扫描,其中肿瘤呈低信号15例、高信号6例。病理分级为Ⅰ级的肿瘤在T2WI上以等、低信号为主,Ⅱ级和Ⅲ级的肿瘤在T2WI上以等、高信号为主。增强扫描显示肿瘤的实性部分有明显强化。其它征象:病灶内可见囊变/坏死27例;病灶与脑膜关系密切22例,其中9例可见脑膜尾征;肿瘤表面及内部有流空血管征28例;可见瘤周水肿28例,主要为轻度水肿;伴颅骨骨质破坏12例。对不同病理分级SFT/HPC的MRI征象进行比较,Ⅲ级肿瘤中边界不清的出现率明显多于Ⅰ级和Ⅱ级(P值分别为0.005和0.011);Ⅱ级、Ⅲ级肿瘤的流空血管和瘤周水肿的出现率均明显多于I级(P值均小于0.0167)。对所有患者进行随访(>10个月),14例患者术后复发,其中3例伴有颅外转移,2例Ⅱ级SFT/HPC术后复发进展为Ⅲ级。结论:颅内SFT/HPC的MRI表现有一定特征性,不同病理分级间的表现也有一定差异,术前MRI检查有助于指导临床制订合理的治疗方案。

Objective:To investigate the MRI features of intracranial solitary fibrous tumor(SFT)/hemangiopericytoma(HPC).Methods:The clinical and imaging data of 41 cases of histopathologically proven intracranial SFT/HPC were retrospectively analyzed.The MRI features of different pathological grades of SFT/HPC were compared.Results:All forty-one patients had single tumor.31 were located in supratentorial;31 were lobulated or shallow-lobulated,and 34 had clear boundaries.Tumors had heterogeneous signal intensity.The solid part of tumors showed hypointensity in 10 cases,isointensity in 21 cases,hyperintensity in 10 cases on T 1WI.DWI were performed in 21 cases,15 cases showed hypointensity and 6 cases were hyperintensity.GradeⅠtumors mainly showed iso-or hypointensity on T 2WI,while gradeⅡand gradeⅢtumors mainly iso-or hyperintensity.The solid part of the tumor in all cases was markedly enhanced after contrast administration.Cystic degeneration and necrosis was found in 27 cases.Close relation to the meninges was found in 22 cases,and 9 cases demonstrated"dural tail sign".Vascular flow void were seen within or around the tumor in 28 cases.Peritumoral edema was seen in 28 patients,mainly mild.Adjacent skull destruction was found in 12 cases.Unclear boundary was significantly more often appearing in gradeⅢtumors than in gradeⅠand gradeⅡ(P=0.005 or P=0.011,respectively).Vascular flow void and peritumoral edema were significantly more found in gradeⅡand gradeⅢtumors than in gradeⅠ(all P<0.0167).All patients were followed up for more than 10 months.Recurrence occurred in 14 cases,3 of them had extracranial metastases.Malignant progression was identified by recurrent surgery in two cases form gradeⅡto gradeⅢ.Conclusion:Intracranial SFTs and HPCs have some characteristic MRI features,and some differences of MRI findings can be found between different pathological grades of the tumor,MRI may be helpful for the clinical management.