面部不明注射物磁共振及组织病理特征

Histopathological and MRI characteristics of facial unidentified filling objects

目的探讨磁共振(MRI)和组织病理初步诊断面部不明注射物的性质和注射部位,帮助临床医师制定手术方案.方法2013年1月至2017年12月,大连大学附属新华医院医学影像科将直视下切除面部不明注射物患者82例作为研究对象,其中男5例,女77例,年龄17~58岁,平均29.4岁.包块、面部肿胀涉及前额、颞部、颧部、颊部、鼻部、鼻唇沟、唇部、下颏等部位,依照MRI提示,直视下切除不明注射物及其周边包膜样组织,同时行组织病理检查.结果不明注射物主要为凝胶样注射物、颗粒样注射物、生长因子类注射物3种类型.凝胶样注射物在T1WI呈低信号,在T2WI脂肪抑制图像上呈现高信号;大体上可见注射物呈黏稠聚集物,周边被皮冻样组织包裹;组织病理见组织内大片均质蓝染区域,周围大量多核巨细胞和炎症细胞浸润.颗粒样注射物在T1WI或T2WI抑脂序列表现为低、等信号,注射物呈沙粒样物质,混合包裹在瘢痕样组织中,形成坚韧的块状包块;组织病理见形状不规则颗粒状物,周围纤维组织包绕,多核巨细胞和炎症细胞浸润.生长因子样注射物在MRI图像上与正常组织无界限,增生组织在T1WI呈低信号;在T2WI抑脂序列呈现等、高信号;注射区域脂肪组织相对致密、含有较多纤维、血管丰富、易出血;组织病理见皮下血管增多,胶原纤维含量明显增加.结论术前MRI检查可初步判定不明注射物的种类和注射层次,有助于直视下手术时判定注射物与邻近器官的关系.

Objective Unidentified filling objects(UFO)can cause adverse results including infections,overfilling,asymmetry,foreign body granulomas,dislocation or psychological panic.Tore-move UFO accurately,it is important to locate and identify the injected substances preoperatively.This study investigated the viability of using MRI to correctly locate and identify injected substances by relating MRI to gross and pathological microscopic examination.Methods Eighty-two facial UFO patients from 2013 to 2017 were studied by the experts of the Department of Image,Xinhua Hospital of Dalian University.Five of the patients were male and seventy-seven were female.The age ranged from 17 to 58 years with average 29.4 years.They came to our hospital for removal of UFO after they had facial injective fillers in the illegal medial offices.The injected sites involved in the forehead,temple,malar,cheek,nose,nasolabial folds,and chin.All the patients'faces were examined with MRI preoperatively,using T1W,T2W and fat-suppressed sequences.Based on the guides of MRI,UFOs were removed with their capsules by open approach.Samples were recorded with digital pictures and then were fixed in 10%formalin solution for microscopic examination of HE stained slices.Results Based on MRI,gross and microscopic examination,UFO were classified into 3 types,gel-like fillers,solid particles,and growth factors.Gel-like fillers appeared strongly hyperintense on T2 W and STIR sequences and hypointense on T1 W sequences.Grossly,they looked like gruel covered by altered soft tissue.Under the light microscope,many pieces of blue-stained material were dispersed in subcutaneous tissue infiltrated with a large number of mononuclear cells and foreign-body giant cells.Solid particles had low to intermediate signal intensity on T1 W and T2 W images.Grossly,they were like sand merging in soft tissue.The biopsy showed crowed bubbles surrounded by tissue filled with a large number of mononuclear cells and foreign-body giant cells.For growth factors affected tissue,it was hard to differentiate between normal and abnormal on MRI.The affected tissue appeared as somehow hypointense on T1 W sequences and hyperintense on T2 W fat suppressed sequences.During the operation,the affected region was easy bleeding and full of fibrofatty tissue.Under the microscope,there were increased small blood vessels and collagens.Conclusions Based on MRI,gross and microscopic examination,UFO can be classified into 3 types,gel-like fillers,solid particles,and growth factors.MRI is very important for doctors to assess the patients conditions and make the plan of operation.MRI is also useful for doctors to locate UFO and understand the relationship between UFO and their nearby organs.