孤立性纤维瘤的影像诊断及病理分析

Pathological analysis and imaging diagnosis of solitary fibrous tumors

目的探讨不同部位孤立性纤维瘤(solitary fibrous tumor,SFT)的CT和MR特点。方法分析7例经病理证实为SFT的CT和MR表现。结果7例术前均行CT检查,其中2例(眼眶)行MR检查,均为单发病灶;其中1例为恶性,位于右侧胸膜腔,其余均为良性。CT平扫实性成分以等密度为主,1例肿块边缘有低密度区;增强动脉期病灶强化差异较大,部分病灶轻度强化,部分病灶明显强化。部分瘤内及周边可见多发迂曲匍行的血管影;1例行延迟扫描,病灶进一步强化。MR图像上,T 1WI呈等-低信号,T 2WI呈略高信号,增强扫描肿块明显均匀强化。病理结果:肿块由多种排列方式的梭形细胞构成;免疫组化:cd34、cd99及b21-2阳性。结论SFT是以实性成分为主的富血供肿块,较大病灶伴不同程度坏死、囊变,密度或信号不均匀,且明显不均匀强化。熟悉其影像特征可为其临床诊断提供参考依据。

Objective To explore the CT and MR features of solitary fibrous tumor(SFT)in different parts,to increase the knowledge and to improve the diagnostic rate.Methods The CT and MRI findings of 7 patients with SFT confirmed by histopathology were analyzed retrospectively.Results All patients underwent CT(including contrast-enhanced dual-phase CT),and MR imaging was obtained in 2 patients(orbital).All 7 lesions were found solitary masses,one of which was malignant,located in the right pleural cavity,the rest were benign.The solid components on CT were isodensity,and 1 case had low density area at the edge of the mass.The enhancement of the lesions in arterial phase was different,some lesions were slightly enhanced,and some were enhanced obviously.Several lesions showed vasculopathy with circuitous creeping in and around the tumor,and one case underwent delayed scanning and was further enhanced.On MR,both of the 2 lesions showed equal or slightly low signal on T 1WI,slightly high signal on T 2WI.Histologically,the mass was composed of spindle cells arranged in various ways.Immunohistochemistry showed that the tumor was positive for cd34,cd99 and b21-2.Conclusion SFT is a hypervascular mass mainly composed of solid components.Larger lesions are accompanied by necrosis,cystic degeneration,inhomogeneous density or signal,and markedly inhomogeneous enhancement.Familiarity with its imaging features can provide a basis for clinical diagnosis.