影像学检查对鉴别头皮占位性病变良恶性的价值分析

Value of imaging examination in differential diagnosis of benign and malignant scalp space-occupying lesions

目的分析头皮占位性病变的影像及临床表现特点,提高头皮占位性病变的诊断及鉴别诊断能力。材料与方法收集本院近五年经病理证实、且具有影像资料的294例头皮占位性病变,观察其影像及临床表现,并利用统计学方法验证并分析头皮占位性病变的影像及临床特征,并分析不同影像检查方法优劣性。结果本研究共收集良性病例272例,恶性22例;平均年龄(23.8±24.8)岁(0～82岁),头皮占位性病变好发于顶枕部(62.8%),以单发为主(95.6%),病变发病性别无差异。良性头皮占位大多单发(97.1%)、形态规整(98.5%)、体积较小(<234 mm2)、较少发生邻近颅骨破坏(94.1%)及颅内侵袭(99.6%);恶性占位易多发(18.2%)、形态不整(22.7%)、体积较大(>234 mm2)、易发生邻近颅骨破坏(27.3%)及颅内侵袭(13.6%)。上述影像指标良、恶性病变的发生率均具有显著差异性(P<0.05)。头皮占位性病变病灶内密度或信号是否均匀,是否含有分隔、坏死、钙化、脂肪成分的发生率无显著差异(P>0.05)。本组病例中超声检查84例,CT 171例,MRI 80例,确诊率分别为67.9%、85.4%、91.3%;增强扫描23例,确诊率为82.6%。结论头皮占位性病变具有较为特征性的影像及临床表现,增强MRI检查对病变具有较高的诊断价值和极高的诊断特异度,是区分头皮良、恶性占位性病变的重要检查方法。

Objective:To analyze the imaging and clinical features of scalp space-occupying lesions and to improve the diagnosis and differential diagnosis of scalp space-occupying lesions.Materials and Methods:Two hundred and ninety-four cases of scalp occupying lesions confirmed by pathology and having imaging data in the past five years were collected,which were observed its imaging and clinical manifestations,and the imaging and clinical features of scalp occupying lesions were verified and analyzed by statistical methods.Then analyzed the advantages and disadvantages of different imaging methods.Results:A total of 272 benign cases and 22 malignant cases were collected in this study.The mean age was(23.8±24.8)years(range 0-82 years).The scalp occupying lesions occurred in the parietal and occipital area(62.8%),with a single incidence(95.6%),there was no difference in the sex of the lesions.Most of the benign scalp occupying single(97.1%),regular shape(98.5%),small volume(<234 mm^2),less adjacent skull destruction(94.1%)and intracranial invasion(99.6%);malignant scalp occupying multiple(18.2%),irregular shape(22.7%),large volume(>234 mm^2),prone to adjacent skull destruction(27.3%)and intracranial invasion(13.6%).The incidence of benign and malignant lesions was significantly different(P<0.05).There was no significant difference in the density,signal,and whether there were separation,necrosis,calcification,and fat components of the lesions in the scalp occupying lesions(P>0.05).In the groups of cases,84 cases were examined by ultrasound,171 cases were examined by CT and 80 cases were examined by MRI,the diagnosis rate was 67.9%,85.4%,91.3%,respectively.Twenty-three cases were examined by enhanced scanning,the diagnosis rate was 82.6%.Conclusions:Scalp occupying lesions have relatively characteristic imaging and clinical manifestations.Enhanced MR examination has high diagnostic value and high diagnostic specificity for lesions.It is an important method to distinguish between scalp and malignant occupying lesions.