胸膜外孤立性纤维瘤的CT和MRI表现及临床特点

CT and MRI finding and clinical feature of extrapleural solitary fibrous tumor

目的探讨胸膜外孤立性纤维瘤(ESFT)的CT和MRI表现,以期提高对此类肿瘤的术前诊断水平。方法回顾性分析浙江中医药大学附属嘉兴市中医医院2007年1月至2018年6月11例经病理证实的ESFT患者的临床资料及CT、MRI表现。其中,9例行CT扫描,4例行MRI扫描。结果11例ESFT患者中发生于腹腔6例,盆腔3例,眼部2例。均为单发,病灶最大径(8.3±4.2)cm。肿块边界清楚7例,分界不清4例;呈类圆形或梭形6例,分叶状5例(局部可见"脐凹"征)。CT平扫呈等或不均匀稍低密度,其中"网格状"囊变区4例,斑片状钙化3例;增强扫描肿瘤呈"地图样"强化6例,"蚯蚓钻土"征7例。MRIT1WI呈等稍低信号,T2WI压脂像呈等稍高信号2例、等高低混杂信号2例,DWI呈不均匀高信号3例;增强扫描示肿瘤实性部分呈"快进慢出"表现。结论ESFT常表现为孤立性肿块,其CT和MRI表现具有一定特征性,特别是"地图样"强化和"蚯蚓钻土"征等对此病诊断及鉴别诊断具有重要意义。

Objective To investigate the CT and MRI finding of extrapleural solitary fibrous tumor (ESFT) to improve the preoperative diagnostic ability of such tumors. Methods The clinical data and CT/MRI finding of 11 ESFT patients confirmed by pathology from January 2007 to June 2018 in Jiaxing Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medicine University were retrospectively analyzed. CT scan was performed in 9 cases and MRI scan in 4 cases. Results Of the 11 patients with ESFT, 6 cases occurred in the abdominal cavity, 3 cases in the cavitas pelvis and 2 cases in the ocular region. All the tumors were solitary, and the maximum diameter of the lesion was (8.3 ± 4.2) cm. The boundary of the tumor was clear in 7 cases, and the boundary was not clear in 4 cases. The tumor form was circular or fusiform in 6 cases and lobulated in 5 cases (some tumors had notch sign). CT scanning presented isodensity or inhomogeneous low density, including 4 cases of cystic degeneration accompanied by inner grid separation, and 3 cases of patchy calcification. The enhanced scanning mass showed 6 cases of geographic enhancement and 7 cases of earthworm drilling soil. MRI T1WI showed slightly lower signal intensity;T2WI fat-suppression sequences showed slightly higher mixed signal intensity in 2 cases and an iso-to high mixed signal intensity in 2 cases;and DWI showed uneven high signal intensity in 3 cases. The solid part of the enhanced scanning showed' fast enhancement and slow washout'. Conclusions ESFT is usually manifested as isolated mass, and its CT and MRI finding has certain characteristics, especially in the diagnosis and differential diagnosis of the disease, such as geographic enhancement and earthworm drilling soil signs.