头皮鳞状细胞癌的临床及影像学表现分析

Analysis of clinical features and imaging findings of the squamous cell carcinoma of scalp

目的探讨发生于头皮的鳞状细胞癌的临床及影像学表现,重点分析MRI表现。方法选取2016年6月~2019年8月有完整的CT或MRI资料并经病理证实为头皮鳞状细胞癌的8例患者的临床资料及影像学表现,包括临床表现、发病年龄、发病时间、病灶位置、边界、密度或信号强度,病灶内部信息以及对周围骨质破坏、硬膜受累等情况。结果8例头皮鳞状细胞癌的患者中,男性5例,女性3例,年龄32~82岁,平均年龄54.3岁。其中1例位于额部头皮,3例位于顶部,1例位于枕部,2例位于顶枕部,1例位于额顶枕部,平均发病时间为19个月(2~48个月);2例(25%)为头皮肿块,6例(75%)为外伤、烧烫伤瘢痕反复破溃、不愈合的病变。2例行CT平扫检查,表现为突出于头皮的等密度局限性肿块,边界较清晰,平均密度约42 HU(hounsfield unit,HU);6例行MRI检查,其中5例行增强检查,MRI平扫表现为突出于头皮局限性病灶(5例)或弥漫性病变(1例),平扫病灶信号均匀或不均匀,T1WI为等或稍低信号,T2WI为等或稍高信号,增强后病灶呈不均匀显著强化4例,轻度均匀强化1例;8例中皮下脂肪层密度或信号中断7例,5例侵犯颅骨,4例累及硬膜。所有病例均行手术或穿刺组织病理学证实为鳞状细胞癌。结论头皮鳞状细胞癌在影像学表现有一定特征性,结合其临床病史,可以在术前作出诊断;MRI显示病灶范围及浸润深度优于CT,可作为术前及治疗前有效评估的影像学手段之一。

Objective To analyze and discuss the clinical features and imaging findings of the squamous cell carcinoma(SCC)of scalp,especially on magnetic resonance imaging(MRI)findings.Methods The clinical features and preoperative CT(computed tomography)or MRI findings of 8 cases with SCC of scalp which had been proved by histopathology after the operations or punchers were analyzed retrospectively from 2016 to 2019,including the clinical features,age of onset,diseased time,sex,locations of lesions,margin,density or signal intensity of lesions,internal information and abnormality of adjacent bone or dural matter.Results In 8 SCC of scalp cases,5 cases were male and 3 were female,whose mean age was 54.25 y(arrange 32~82 y).The lesions’locations were frontal part(1/8),top part(3/8),occipital part(1/8),top and occipital part(2/8),and frontal-top-occipital part(1/8)and the mean onset cause time was 19 months(arrange 2~48 m);2 cases were masses of scalp,and 6 cases were repeated rupture,nonhealing lesions after injury or burning and scald.Non-enhanced CT scan was performed in 2 cases,which showed well defined boundary and iso-intense density masses protruded from the scalp with mean 42 HU(hounsfield unit);MRI was performed in 6 cases in which 5 cases were enhanced MRI.On non-enhanced MRI images,the lesions showed focal lesions protrudes from the scalp(5/6)or diffused lesion in the scalp(1/6).The lesions were homogeneously or heterogenously iso-or hypo-intensity signal on T1WI and iso-or hyper-intensity signal on T2WI on non-enhanced MRI.After the contrast medium injection,the lesions showed heterogeneous obviously(4/5)or slightly(1/5)enhanced.In all 8 cases,the subcutaneous fat layers were disrupted in 7 cases,the adjacent bone structures were destroyed in 5 and the dura matters were infiltrated in 4.All cases had been confirmed for SCC of scalp on histopathology after operations or punctures.Conclusion There are special characteristics of imaging features in SCC of the scalp,and with clinical features,a suitable diagnosis of SCC could be performed before histopathology test.MRI,which is superior to CT on the assessment of the scale or depth of SCC lesions,could be one of the efficient examinations before clinical managements.