腹腔内及腹膜后原发性平滑肌肉瘤的CT表现分析

CT Imaging Features of Primary Leiomyosarcoma in Intraperitoneal and Retroperitoneum

目的探讨腹腔内及腹膜后原发性平滑肌肉瘤(primary leiomyosarcoma,PLS)的CT影像学表现特点,以提高对该病的认识,为临床诊断、治疗提供依据。方法回顾性分析10例经病理证实的PLS患者的CT影像学资料,分别从病灶大小、形态、密度、边缘、境界及强化方式这5个方面进行分析。结果10例PLS中,1例位于腹膜后,9例位于腹腔,腹腔内灶中,有1例起源于胃,1例起源于结肠,另有1例起源于回盲部,余均为器官外软组织起源。除结肠及回盲部病灶外,其余病灶最大径均≥9 cm,其中胃部病变及腹腔内1例病变为较大病灶伴有多发转移;所有病灶中,边缘光整(6例)或欠光整(4例),境界清晰(6例)或欠清晰(4例);形态均为欠规则;密度多为不均匀(9例),其中以囊实性病变为主(8例),实性部分呈等或稍低密度;增强后病变动脉期为轻中度强化,静脉期进一步明显强化,其中4例病灶内可见血管穿行。结论PLS多表现为体积较大、形态不规则软组织肿块,边缘可光整或欠光整,境界可清晰或欠清晰,多呈囊实性改变,增强后多为渐进性明显强化;CT能够对病变的特征、与周围结构的邻近关系及鉴别诊断提供有价值的信息,但是最终确诊需要依靠病理。

Objective To investigate and analyze the features of primary leiomyosarcoma(PLS)in the intraperitoneal and retroperitoneum,so as to improve the understanding of the disease and provide the basis for clinical diagnosis and treatment.Methods The CT images of 10 patients with PLS confirmed by pathology were analyzed retrospectively from the 5 aspects:size,morphology,density,edge,boundary and intensification of the lesion.Results Of the 10 cases,1 located in the retroperitoneum and 9 in the intraperitoneal.1 of them originated from the stomach,1 originated from the colon,and 1 in the ileocecal region,and the rest all originated from soft tissue in external organ.In addition to the colon and ileocecal lesions,the maximum diameter of the lesions were more than 9 cm,of which 1 located in gastric and one case in intraperitoneal lesions with multiple metastases.Of all the lesions,6 had smooth edge and clear boundary while 4 had unsmooth edge and unclear boundary.The morphology were all irregular,and the density of 9 cases were not uniform,of which cystic-solid was the main components(8 cases),the solid part was equal or slightly low density,and had mild to moderate enhancement at the arterial phase,and at the venous phase it was further enhanced,of which 4 cases were seen vessels in the lesions.Conclusion PLS was imaged as lager and irregular mass,with smooth edge and clear boundary or unsmooth edge and unclear boundary,showing cystic-solid change and progressive obvious intensity after enhancement.CT can provide valuable information for the characteristics of the lesion,proximity relation with peripheral tissues and differential diagnosis.However,the final diagnosis depends on pathology.