颅内孤立性纤维性肿瘤/血管外皮细胞瘤MRI影像特征与病理对照

MRI Features and Pathological Comparison of Intracranial Solitary Fibrous Tumor/Hemangiopericytoma

目的:探讨颅内孤立性纤维性肿瘤/血管外皮细胞瘤(SFT/HPC)的MRI影像特征与病理学特点,以期提高对本病的认识,减少误诊。方法:回顾性分析经手术病理证实的11例颅内SFT/HPC的临床资料、病理与MRI表现,分析总结MRI特点并结合临床病理进行探讨。结果:肿瘤均位于颅内脑外,8例幕上,2例在幕下,1例跨小脑幕。肿瘤形态不规则,1例为类圆形,10例表现为不规则分叶及边缘多发结节样改变。T_(2)WI信号混杂,以稍高信号为主,其中8例病灶T2WI见“阴阳征”,5例见囊变坏死。增强扫描肿瘤2例均匀强化,9例明显不均匀强化,肿瘤靠近边缘区域强化明显,中心区域强化幅度较低。6例出现血管流空影。病理分级I级3例,II级5例,Ⅲ级3例。免疫组化肿瘤细胞核7例表达STAT6蛋白阳性。结论:颅内SFT/HPC容易误诊为脑膜瘤,其形态、T_(2)WI“阴阳征”、囊变以及明显不均匀强化与脑膜瘤存在差异,充分认识其MRI影像表现,有助于正确诊断。

Objective:To investigate the MRI and pathological features of intracranial solitary fibrous tumor/hemangiopericytoma(SFT/HPC),in order to improve the understanding of the disease and reduce misdiagnosis.Methods:the clinical data,pathology and MRI findings of 11 cases of intracranial SFT/HPC confirmed by surgery and pathology were analyzed retrospectively.The MRI characteristics were analyzed and discussed combined with clinical pathology.Results:the tumors were located outside the intracranial brain,8 cases were supratentorial,2 cases were infratentorial and 1 case crossed the cerebellar tentorium.The shape of the tumor was irregular,1 case was quasi circular,and 10 cases showed irregular lobulation and multiple nodular changes at the edge.T_(2)WI signals were mixed,mainly with slightly high signals,of which 8 cases showed"Yin-Yang sign"on T_(2)WI and 5 cases showed cystic necrosis.On contrast-enhanced scanning,2 cases of tumors were uniformly enhanced,9 cases were significantly non-uniform enhanced,the enhancement near the edge of the tumor was obvious,and the enhancement range in the central region was low.Vascular flow cavitation was found in 6 cases.The pathological grade was grade Ⅰ in 3 cases,grade Ⅱ in 5 cases and grade Ⅲ in 3 cases.STAT6 protein was positive in 7 tumor nuclei by immunohistochemistry.Conclusion:intracranial SFT/HPC is easy to be misdiagnosed as meningioma.Its morphology,T_(2)WI"Yin-Yang sign",cystic transformation and obvious uneven enhancement are different from meningioma.A full understanding of its MRI findings is helpful for correct diagnosis.