背部弹力纤维瘤的超声、CT和MRI诊断及病理表现

Diagnosis of Elastofibroma Dorsi by Using Ultrasound, CT, MRI and Its Pathological Manifestations

目的探讨背部弹力纤维瘤的超声、CT和MRI表现及其诊断价值。资料与方法收集经手术病理证实的21例背部弹力纤维瘤患者的资料,测量肿块大小、分析影像学特征,比较肿块、前锯肌及周围脂肪的CT平扫及增强CT值,评价超声及CT对病灶显示的一致性。结果①所有病灶均位于前锯肌、背阔肌内侧,表现为扁丘状或梭形软组织肿块。②影像学表现:超声表现为肿块边界不清,以中强回声为主,可见条索状高低回声,所有病灶均未探及血流信号;CT平扫示病灶密度稍低于或接近邻近肌肉组织,肿块边缘不清,其内可见条纹状脂肪密度,增强扫描呈轻度强化或无强化;MRI示病灶T1WI呈中等信号为主的肌纤组织与高信号脂肪组织交替排列,T2WI呈稍低信号,其内夹杂条纹状高信号,后者在脂肪抑制序列呈低信号,增强扫描呈轻度强化。③单、双侧发病率及左、右侧病灶大小比较,差异均有统计学意义(P<0.05);超声和CT对病灶的显示一致性较好(Kappa=1.000,P=0.000)。结论背部弹力纤维瘤具有典型的发病部位及影像学特征,仔细观察可做出明确诊断。

Purpose To investigate the ultrasound,CT and MRI manifestations and diagnostic value of elastofibroma dorsi.Materials and Methods The data of 21 patients with elastofibroma dorsi confirmed by surgery and pathology were analyzed,the size of the tumor was measured,and the imaging characteristics were analyzed,the CT scan and enhanced CT value of the tumor,anterior serratus muscle and surrounding fat were compared,the consistency of ultrasound and CT for lesion display was evaluated.Results①All lesions were located in the deep subscapular region,and presented as flat mound or spindle soft-tissue mass.②Imaging manifestations:ultrasound showed all masses were appeared to be hyperechogenic,interchanging hyperechogenicity and hypoechogenicity,and blood flow was usually absent in the masses.All masses had almost slightly decreased density or equal density compared to that of muscle on plain CT scanning.In addition,the masses had irregular edge,with some interlaced linear or patch fat-like areas along the long axis of lesions.On enhanced CT scan,all lesions showed slight or without enhancement.MRI showed that the lesions were alternately arranged with medium-signal muscle fibers and high-signal adipose tissue on T1WI.On T2WI,there was a slightly low signal,which was streaked with a stripe high signal.The latter was a low signal in the fat suppression sequence,and it was slightly strengthened after enhancement.③Statistical differences were found in the incidence between the unilateral elastofibroma dorsi and bilateral elastofibroma dorsi and lesion volume between the left and right(P<0.05).The ultrasound was in good consistency with CT in displaying elastofibroma dorsi lesions(Kappa=1.000,P=0.000).Conclusion Elastofibroma dorsi has typical onset site and imaging appearance,definite diagnosis could be made according to the features of ultrasound,CT and MRI imaging if examined carefully.