软组织恶性纤维组织细胞瘤的临床影像学诊断

目的:回顾性分析26例恶性纤维组织细胞瘤(MFH)的临床影像学表现,讨论其影像学诊断。方法:搜集经手术病理及免疫组化证实的MFH 26例,男15例,女11例,40岁21例,占80.77%。病史3个月~5年。7例摄有X线平片。CT平扫17例,增强扫描8例。MR平扫15例,增强扫描8例。病灶大多位于大腿、小腿、前臂和臀部。23例位于深部软组织,3例位于表浅软组织。结果:21例(80.77%)呈不规则长圆形或长条形软组织肿块,直径5cm。3例X线平片表现为软组织肿块伴邻近骨质侵蚀性破坏,2例伴有骨膜增生。CT平扫多呈等、低或略低密度,仅1例高密度。CT增强均表现为明显不均匀强化,病灶边界均不清,累及邻近肌肉。CT上2个病灶内可见弧形钙化,其病灶直径均5.0cm。13例可见邻近骨骼破坏或骨膜增生。MR平扫15例,T1WI多呈等或低信号,合并出血4例。T2WI多呈高信号或混杂信号,10例病灶周围可见片状水肿信号。MR增强扫描8例,均呈明显不均匀强化,2例边界清楚,邻近肌肉受压推移,12例边界不清,邻近肌肉侵犯。6例可见邻近骨骼受侵。结论:发生于中老年人,位于下肢、前臂深部软组织的巨大肿块,尤其是呈长圆形分叶状或不规则长条状软组织肿块,边界不清,伴有邻近骨质破坏或骨膜反应,增强扫描呈明显不均匀强化者,应首先考虑恶性纤维组织细胞瘤。     

软组织转移瘤影像学诊断

目的探讨软组织转移瘤的影像学表现特点。方法选择经病理证实的软组织转移瘤35例,分析其CT和MRI表现特点。结果 CT检查31例,其中平扫13例,增强扫描15例,平扫并增强扫描3例。MRI平扫3例。19个肌肉内转移瘤CT平扫表现为等密度或略低密度肿块,边界不清,密度均匀或不均匀,最大径1.2~25.3cm;4例(21.52%)表现为弥漫性肌肉肿胀,密度均匀,与炎症相似;3例肿块内可见成簇的颗粒状或无定形钙化。9个皮下组织转移瘤CT平扫表现为多发或单发结节状或团块状等或略低密度灶,最大径0.5~5.2cm,边界清;2个表现为皮下组织内饼状软组织密度灶,边界不规则。CT增强扫描,病灶呈均匀或不均匀轻中度强化;其中7例(33.33%)呈环形强化,病灶中心不强化。3例MRI平扫表现为等长T1,不均匀长T2异常信号;2例边界清楚,1例边界不清。结论软组织转移瘤不罕见,在软组织肿瘤诊断中应注意鉴别。     

足底硬纤维瘤的MRI特征分析

【摘要】目的：探讨足底硬纤维瘤的MRI表现。方法：回顾性分析18例经手术病理证实的足底软组织硬纤维瘤患者的MRI资料。所有患者行MRI常规平扫,14例行增强检查。结果：18例中11例（61%）肿瘤发生于前足,5例（28%）发生于后足,2例（11%）发生于中足;形态上,肿瘤呈片状2例（11%）,团块形4例（22%）,不规则形12例（67%）;边界不清6例（33%）,边界尚清12例（67%）。肿块最大径为2.3~10.8cm,中位数为3.7cm。2例（11%）为多发病灶。MRI显示病灶在T1WI上呈等或等~低信号,T2WI及短时反转恢复序列（STIR）上呈稍高或高信号,但均低于脂肪组织的信号;15例（83%）可见病灶内信号不均匀,高信号区内有不同比例的星芒状或条带状低信号,1例（6%）病灶内可见点状出血信号;18例病灶内均未见囊变及钙化。增强扫描显示病灶内于T1WI、T2WI上呈低信号的区域无明显强化,其余部分呈较均匀明显强化。结论：足底硬纤维瘤的MRI表现具有一定特征性,MRI可为病变的诊断和鉴别诊断提供重要参考。     

结节性筋膜炎的临床和CT诊断

目的：探讨结节性筋膜炎的CT表现。方法：对12例经手术病理证实为结节性筋膜炎患者的临床及CT 检查资料进行回顾性分析。结果：12例中病变位于上肢5例、下肢4例、颈部、腹壁和腰背部各1例,病灶最大径1．0～4．0 cm,11例为单发肿块,1例于腰背部可见2个肿块。主要CT表现：病灶均为实性软组织肿块,呈扁平状或椭圆形,与周围肌肉密度相比呈均匀等密度,增强扫描示肿块明显强化;肿块与周围脂肪层及邻近肌肉分界清晰10例,边界不清2例,其中1例颈部肿块侵及颌下腺及周围颈部肌群;8例可见“筋膜尾征”,未见肿块突破筋膜面向浅（深）侧侵犯。结论：结节性筋膜炎的CT表现有一定特征性,结合其临床表现,有助于结节性筋膜炎的诊断。     

泌尿生殖系统孤立性纤维瘤的CT与MRI表现

目的 探讨泌尿生殖系统孤立性纤维瘤(SFT)的CT与MRI表现.方法 回顾性分析6例经手术病理证实的SFT患者的影像学资料,6例均行CT检查,1例行MRI扫描.结果 6例SFT中,肾脏、前列腺、睾丸、子宫、阴道及尿道各1例,均为单发圆形或类圆形肿块,5例边界清楚,1例边界欠清,大小约1.0 cm ×0.9 cm～ 15.2 cm×14.1 cm,平均约8.3 cm×7.1 cm.CT平扫3例呈等稍低均匀密度,3例呈不均匀等密度,伴斑片状低密度区;增强扫描动脉期肿块不均匀明显强化,延迟期肿块进一步持续强化,3例内见坏死无强化区;4例肿块内或表面可见粗大供血血管.MRI 1例T1WI呈等稍低信号,T2 WI呈等稍低信号,其内见小斑片状高信号及粗大的流空血管.结论 CT或MRI表现为孤立性、类圆形、实性肿块,边界清楚,密度或信号均匀或不均匀,增强动脉期明显不均匀强化,延迟期肿块进一步持续强化,尤其看到肿块内粗大的供血血管时,应考虑SFT可能.     

腱鞘纤维瘤的影像学表现

目的总结腱鞘纤维瘤的临床表现特点,探讨其影像学表现特征,以提高影像诊断水平。方法回顾性分析8例经手术病理证实的FTS的临床和影像学资料,总结其X线平片、CT、MRI表现特点。结果 8例FTS均位于四肢小关节,手部3例,足部5例,其中位于关节背侧5例。病灶最大径0.6~3.5cm,平均2.5cm。所有病灶为单发软组织密度信号肿块,X线平片、CT平扫病灶密度与肌肉相仿,周边呈略高密度,部分病灶内见钙化,可压迫或侵蚀邻近骨质;在MR T1_WI呈等信号,在T_2WI上呈低、等或高信号,DWI上呈高信号。结论结合CT及MRI能为诊断FTS提供有价值的信息。     

腹部外硬纤维瘤的磁共振成像诊断

目的:了解腹部外硬纤维瘤的MR成像特征.方法:对经手术病理证实的10例硬纤维瘤的MR图像进行回顾性分析.所有的病例均采用Siemens Magnetom Vision 1.5T超导全身MR扫描仪,10例常规行T1WI和T2WI,9例行MR增强扫描.结果:10例腹部外硬纤维瘤中,韧带状纤维瘤1例;侵袭性纤维瘤病9例,其中颈项部3例,右肩背部3例,右大腿2例,左上臂2例.肿瘤的平均大小约为10 cm× 7 cm× 5 cm.除1例韧带状纤维瘤有包膜,边缘清楚外,其余肿块没有包膜,边界不清.所有肿块的信号欠均匀,在T1WI、T2WI及增强扫描像上可见低信号的纤维成分,肿块的非纤维成分在T1WI上与肌肉信号相同,在T2WI上的信号高于肌肉小于脂肪,呈明显强化.1例颈项部侵袭性纤维瘤病伴有邻近肌肉的广泛浸润,1例侵犯右肩胛骨部分内缘.结论:虽然硬纤维瘤与恶性肿瘤的MR信号有相似之处,但它在T1WI和T2WI上及增强扫描像上显示的低信号纤维成分,可以与软组织恶性肿瘤相鉴别.     

结节性筋膜炎的CT和MRI表现

目的：探讨结节性筋膜炎的CT和MRI表现。方法：回顾性分析10例经病理证实的结节性筋膜炎的CT和MRI表现。结果：10例中4例位于上肢,4例位于下肢,2例位于腹壁。病灶均表现为单发实性软组织肿块（肌内型6例,肌间型2例,皮下型2例）,CT平扫示肿块密度稍低于肌肉密度,增强扫描有明显强化。MRI检查：病灶于T1WI呈等或稍低信号,T2WI呈不均匀高信号,其中1例病灶边缘可见囊变区,3例病灶中央可见低信号,增强扫描肿块呈均匀或不均匀中度一重度强化,边界清。结论：结节性筋膜炎的CT和MRI表现有一定特征性,两种方法均有助于本病的诊断及鉴别诊断。     

软组织恶性纤维组织细胞瘤的临床和MRI诊断

目的：探讨软组织恶性纤维组织细胞瘤的临床和MRI表现特点。方法收集6例经手术病理证实的软组织恶性纤维组织细胞瘤,分析其临床和MRI表现。结果肿瘤发生于右颈深部、右侧上臂深部软组织各1例,大腿深部、小腿深部软组织各2例。4例可见分叶。肿瘤最大约5．5cm×9．8cm,T1WI表现为稍低信号或低信号,信号欠均匀,其中3例在低信号中可见更低信号阴影;T2WI表现为较明显高信号,但内部信号不均,其中4例病灶内部夹杂不规则低信号;增强后病灶呈不均匀的明显强化,其中2例肿瘤内可见点、线状血管流空之低信号影。病灶多位于深部肌肉内,对邻近肌肉形成推移改变。平扫肿瘤边界多数欠清晰,邻近肌肉可见浸润或周围水肿,增强后,病灶边界则可清晰显示。5例病灶邻近骨未见明显改变,1例见邻近骨质破坏,但边界较锐利。结论软组织恶性纤维组织细胞瘤的临床和MRI具备一定特点,最后确诊依赖病理检查。     

软组织滑膜肉瘤的CT和MRI诊断

目的：探讨软组织滑膜肉瘤的影像学表现。方法：回顾性分析17例经手术病理证实的软组织滑膜肉瘤患者的临床及影像学资料,分析其影像学征象。结果：大部分滑膜肉瘤影像表现为邻近关节边界较为清楚的团块状或分叶状软组织肿块,肿瘤体积一般较大（〉5 cm,88%）。CT平扫可见肿瘤大部分密度与肌肉密度相似,其内可见范围不等的低密度区,1例见团块状钙化,2例见斑点状钙化,主要位于肿块的周边。较大的肿瘤（〉5 cm）在MR T1WI上与肌肉信号相比呈不均匀等信号或稍高信号,在T2WI上表现为以高信号或稍高信号为主的混杂信号,5例肿块内可见低信号分隔;较小的肿瘤（〈5 cm）在各序列上均表现出信号的均匀性;增强扫描大部分肿瘤呈明显不均匀强化。结论：软组织滑膜肉瘤的影像学表现具有一定的特征性,CT和MRI综合评价有助于提高滑膜肉瘤的诊断准确性。     

儿童臀部硬纤维瘤的影像表现

目的:探讨臀部硬纤维瘤的超声、CT、MRI表现特征。材料和方法:搜集10例经手术病理证实的儿童臀部硬纤维瘤病例,均行超声、CT平扫及增强扫描,5例行MRI检查,分析其影像学特点。结果:臀部硬纤维瘤主要累及臀部肌肉、筋膜、骨膜等,呈浸润性生长,易复发。超声表现为不规则低回声肿块。CT表现为低密度软组织肿块(9例),等高密度肿块(1例),强化程度不等。MRI表现为臀部肿块,T1WI等低信号,T2WI多为稍高信号夹杂斑片低信号(3例),或等低信号(2例),增强后可见不均匀强化。结论:超声、CT及MRI检查可显示硬纤维瘤的大小、形态;MRI能从多个切面显示肿瘤范围以及周围组织受侵情况,并可推断组织成分,为临床治疗提供重要信息。     

经皮股动脉全植入式导管药盒系统

目的：探讨经皮股动脉全植入式导管药盒系统（ＰＣＳ）的临床应用。方法：对３０例腹、盆部晚期恶性肿瘤病人，采用介入技术植入ＰＣＳ，作局部动脉内长期灌注化疗。肝转移瘤１９例，直肠癌４例，卵巢癌７例。结果：植入ＰＣＳ３０副。导管留置肝动脉１９例，左髂内动脉６例，右髂内动脉５例。药盒埋植右下腹皮下２５例，左下腹皮下５例。植入成功率１００％。结论：应用介入技术植入ＰＣＳ，创伤小，成功率高，是长期局部动脉内灌注化疗的新方法。     

Imaging of intra- and extraabdominal desmoid tumors.

Desmoid tumors are characterized by proliferation of fibroblastic cells that arise from the fascia or aponeurosis of muscle. They are most commonly found in the abdomen of adults, arising from the anterior abdominal wall, mesentery, or retroperitoneum. At sonography, desmoids have variable echogenicity, with smooth, well-defined margins. On contrast-enhanced computed tomographic scans, the tumors are generally high attenuation (relative to muscle) and have either ill- or well-defined margins. At magnetic resonance imaging, desmoids have low signal intensity relative to muscle on T1-weighted images and variable signal intensity on T2-weighted images. There are no specific imaging features to distinguish desmoid tumors from other solid masses. The diagnosis of desmoid tumor should be considered in patients with an abdominal mass, a history of abdominal surgery or injury, or Gardner syndrome.     

Mesenteric desmoid tumor: De novo occurrence or recurrence following appendectomy?

Desmoid type fibromatosis (DF) is a rare, locally aggressive but benign proliferation of fibrous tissue which produces a fibroblastic mass that can cause a wide range of symptoms secondary to mass effect. When resected, these masses most commonly recur in the first 2 years. We present a case of a 33-year-old male with a history of an appendectomy 2 years prior, though his pathology report did not identify inflammation in the appendix, who presented with gradual onset of abdominal pain, and radiographs that demonstrated a large mass in the right lower abdomen. Given his symptoms the mass was resected and pathologic evaluation revealed a desmoid tumor. This case presents a unique possibility of a recurrent desmoid tumor in which the patient''s surgical history and radiographic findings can contribute to the overall management strategy of the patient given the evolving options for treatment of desmoid fibromatosis.     

Utility of posterior oblique views in (99m)Tc-DMSA renal scintigraphy in children

OBJECTIVE: Procedure guidelines suggest that optimal (99m)Tc-dimercaptosuccinic acid (DMSA) planar scintigraphy of the kidney should include right and left posterior oblique views in addition to the posterior projection. However, in a small number of restless children, it is sometimes difficult to get 3 good-quality images. The aim of this study was to evaluate the prevalence of cases in which posterior oblique views were useful for interpreting (99m)Tc-DMSA renal scintigraphy. METHODS: Three nuclear medicine specialists were asked to interpret 40 (99m)Tc-DMSA renal scans twice, first on the basis of the posterior projection only and then by using the posterior and the right and left posterior oblique views. RESULTS: The oblique posterior views were considered useful by observers 1 and 2 for 4 kidneys and by observer 3 for 5 kidneys and were considered somewhat useful for up to 7 kidneys. The addition of oblique posterior views changed the interpretation on 5 occasions for observer 1, on 9 occasions for the observer 3, and on no occasion for observer 2. On average, therefore, changes in interpretation occurred for fewer than 6% of the kidneys. Moreover, no relationship was observed between the opinion of the clinicians that oblique views were useful and changes in the scintigraphic interpretations. CONCLUSION: Oblique views were found useful in only a few cases and, even in these cases, did not significantly modify the interpretations. Therefore, when restless children are being imaged, the focus should be on obtaining a good posterior projection, even at the price of not having oblique posterior views.     

胸膜孤立性纤维瘤的影像学诊断

目的 探讨胸膜孤立性纤维瘤的CT及MRI表现及其诊断价值.资料与方法 对11例经手术病理证实的胸膜孤立性纤维瘤患者的CT及MRI表现特征进行回顾性分析.结果 11例11个病灶,7例来源于右侧胸膜,其中斜裂胸膜2例,水平裂胸膜3例;左侧胸膜4例,其中斜裂胸膜2例,CT表现为边界清晰的混杂密度影,其内见不规则低密度区,2例可见结节状钙化,增强扫描实性部分不同程度强化,低密度区无强化,9例可显示肿瘤内血管;MRI表现为边界清晰的混杂信号实性部分T_1WI与肌肉相比呈高信号,T_2WI呈等或稍低信号,囊变部分表现为长T_1、长T_2信号,扩散加权成像(DWI)表现为等或稍高信号;增强扫描肿瘤实性部分不同程度强化.结论 胸膜孤立性纤维瘤的CT及MRI表现有一定的特征,分析其影像学特征,可做出较明确的诊断并能够与其他胸部肿瘤相鉴别.     

Intramuscular metastasis of carcinoid tumor: a rare manifestation

A 43-year-old man presented with a 2-month history of left upper lobectomy due to an atypical lung carcinoid tumor. The patient was referred to our department for further evaluation. An In-111 octreotide (Octreoscan) whole body scan and single photon emission computed tomography were performed. The scans showed slightly increased diffused tracer uptake in the apex of the left lung, most probably due to postoperative changes. A focal area of increased uptake in the right lower abdomen was also noted. Fusing octreotide tomographic construction with CT images allowed accurate determination of the area of increased uptake to be in the right transverse abdominal muscle.     

Mesenteric desmoid with uptake on gallium-67 citrate scintigraphy

A 72-year-old man was hospitalized for further evaluation of a space-occupying lesion in the abdomen. Magnetic resonance imaging revealed a tumor 40 mm in diameter in the abdomen. Anterior Ga-67 citrate scintigraphy revealed a region of accumulation of radioactivity in the abdomen corresponding to the tumor. Mesenteric desmoid was diagnosed on the basis of histological findings for the excised tumor. These finding suggested that mesenteric desmoid may be one of the tumors which show high uptake of Ga-67.     

阴道斜隔综合征的M RI影像表现

目的：通过MR成像对罕见阴道斜隔综合征进行全面的认识。方法回顾性分析7例阴道斜隔综合征患者（6例为青少年,1例为流产孕妇）,均行常规MRI（横断面T1WI、T2WI ,冠状面T2WI）及增强扫描。结果7例阴道斜隔综合征,MR主要表现如下：双子宫、双宫颈畸形7例;右侧斜隔5例、均合并右肾缺如,其中2例伴右侧盲端输尿管异位开口、1例子宫内膜异位膀胱后壁;左侧斜隔2例,1例左肾缺如、1例右侧盆腔异位肾;斜隔侧隔后腔积血5例,隔后腔内混杂性血性肿块1例（流产孕妇）,斜隔侧阴道扩张积液1例（误诊术后病例）;对侧阴道积液2例,阴道少许积血3例,阴道正常2例（1例误诊术后病例,1例流产孕妇）。结论阴道斜隔综合征是一种泌尿生殖系统发育畸形,M RI检查不仅较直观地显示双子宫畸形、斜隔侧隔后腔积血以及同侧肾缺如等常见情况,而且在发现异位肾、盲端输尿管异位开口以及子宫内膜异位膀胱后壁等罕见情况也具有明显的优势。     

腹壁外韧带样瘤MRI诊断探讨

目的：讨论腹壁外韧带样瘤的MRI平扫及增强扫描的表现，评价MRI对该病的诊断价值。方法：回顾分析5例经手术切除及病理证实的腹壁外韧带样瘤的术前MRI平扫及增强扫描表现，其中2例同时行CT平扫，3例同时行血管造影。结果：5例腹壁外韧带样瘤均位于四肢肌肉及软组织，年龄11岁～28岁，其病灶MRI表现为在T1WI上，肿物呈中等信号，其间可见条片状及斑点状低信号，在T2WI上则呈高信号，其间夹杂中等、稍低及更低的条片状、斑点状信号，后与在T1WI上所见的低信号相吻合。增强扫描后在平扫中呈等T1、长T2或长T1、长T2信号改变的区域均强化非常明显，而在T1WI及T2WI上均呈条片状、斑点状低信号区域则未见强化，5例病灶周围组织均未见水肿，3例邻近骨出现压迫性改变，2例CT显示病灶密度欠均匀，边界清晰，3例血管造影可见肿瘤染色明显。结论：MRI可以较为精确的显示腹壁外韧带样瘤的病灶形态及范围，对韧带样瘤的诊断与鉴别诊断有重要价值，是目前最好的影像学检查方法。