MRI features of the soft tissue tumors

目的:分析下肢软组织良、恶性肿瘤的MRI特点,探讨MRI对软组织良、恶性肿瘤的诊断及鉴别诊断价值.方法:回顾性分析经手术病理证实的48例下肢软组织良、恶性肿瘤的MRI表现,总结其不同影像学征象并进行统计学分析.结果:囊壁特征及侵袭性特点在软组织良、恶性肿瘤中的差异具有统计学意义(P均＜0.05),肿瘤大小、瘤周水肿、瘤内出血、T2信号均匀性及对周围结构的侵犯在两组肿瘤中的差异无统计学意义(P均＞0.05).MRI对软组织肿瘤潜在恶性评估的敏感度、特异度分别是82.61％和80.77％.结论:囊壁特征及侵袭性特点在软组织肿瘤的定性诊断中具有重要意义.MRI对软组织肿瘤的诊断和鉴别诊断具有重要意义.     

软组织良恶性肿瘤的MRI鉴别诊断

目的: 探讨MRI鉴别诊断软组织良恶性肿瘤的价值.材料和方法: 回顾性分析本院经手术病理确诊的23例软组织肿瘤的大小、边缘、瘤周水肿、骨骼及神经血管束的侵犯、肌包膜关系以及不同序列的信号特点及其相互之间的变化特征,并探讨这些征象在鉴别诊断中的价值.结果: 18例良性肿瘤通过MRI表现特征可以做出正确的诊断,4例恶性肿瘤可以从良性肿瘤中鉴别出来,但是在判断其组织起源时,恶性肿瘤受到限制.结论: MRI在鉴别诊断软组织肿瘤中有重要的价值.     

四肢软组织肿块MRI恶性征象的可靠性分析

目的 探讨四肢软组织肿块MRI恶性征象的可靠性.方法 对68例四肢软组织肿块的MRI进行回顾性盲法阅片,以病理为诊断标准,重点对其中30例MRI表现为恶性征象的肿块分2组(恶性征象的良性肿块组、恶性肿瘤组)进行分析,分析恶性征象对恶性肿瘤诊断的可靠性.结果 (1)MRI对68例四肢软组织肿块的良恶性定性准确率为89.7%,组织学定性为66.2%;(2)MRI恶性征象中,侵袭性与瘤周水肿对恶性肿瘤的诊断有显著统计学意义(P＜0.01),其余3项(范围弥漫、边缘模糊、信号混杂)无统计学意义(P＞0.05);(3)在MRI恶性征象的肿块中,肌纤维结构不清征象,在良性肿块与恶性肿瘤组间有统计学意义(P＜0.05).结论 在MRI恶性征象中,侵袭性、瘤周水肿对恶性肿瘤诊断可靠性大,其余3项(范围弥漫、边缘模糊、信号混杂)可靠性小.肌纤维结构不清征象对恶性肿瘤的诊断具有较大的可靠性.     

DWI在软组织肿瘤中的应用价值

目的 :探讨DWI在软组织肿瘤中的应用价值。方法 :回顾性分析经病理证实的25例软组织肿瘤的DWI表现,其中恶性16例,良性9例;b值为0、800 s/mm~2;ROI置于肿瘤实性部分及同层面正常肌肉组织,尽量避开坏死、出血、瘢痕、钙化、肌间隙等部位,测量病灶与正常肌肉组织ADC值,比较良恶性肿瘤及正常肌肉组织ADC值的差异。结果:恶性肿瘤组ADC值低于良性肿瘤组(t=3.35,P0.05);恶性肿瘤组与正常肌肉组织ADC值差异无统计学意义(P0.05)。25例中瘤周水肿16例,其中恶性13例,良性3例,差异有统计学意义(P0.05)。结论 :DWI对鉴别良恶性软组织肿瘤具有重要价值。     

卵巢良恶性肿瘤的MRI特征及鉴别诊断

目的 探讨卵巢良恶性肿瘤的MRI特征及其鉴别诊断能力.方法 结合病理结果对48例卵巢肿瘤的MRI表现进行回顾性对照分析,并使用SPSS19统计分析软件,分别对卵巢良恶性肿瘤的分布、形态、境界、成分、以及强化程度进行卡方检验.结果 恶性肿瘤33例,其中浆液性囊腺癌15例,黏液性囊腺癌6例,未分型低分化腺癌2例,转移瘤7例,宫内膜样腺癌、卵黄囊瘤、无性细胞瘤各1例；共检出53个病灶,双侧病灶20例,单侧病灶13例；MRI表现为囊实性或实性肿块,边缘不规则,境界不清,明显强化.良性肿瘤15例,其中畸胎瘤6例,浆液性囊腺瘤、黏液性囊腺瘤各4例,纤维瘤1例；共检出16个病灶,双侧病灶1例,单侧病灶14例；MRI表现为囊性肿块,边缘规则,境界清楚,无或轻度强化.卵巢良恶性肿瘤的分布、形态、境界、肿瘤成分、增强比较,其差异具有显著统计学意义(X2分别为12.192、24.422、22.724、49.331、53.059,P＜ 0.01).结论 因生物特性的差异,卵巢良恶性肿瘤的MRI表现各有特征,对定性诊断和鉴别诊断很有意义.     

MRI对纤维源性软组织肿瘤的诊断价值

【摘要】目的：总结分析纤维源性软组织肿瘤的MRI表现，提高诊断水平。方法：回顾性分析经病理证实的70例纤维源性软组织肿瘤患者（良性组20例，中间性组30例，恶性组20例）的MRI资料，并对三组肿瘤的大小、瘤内信号、瘤周水肿、侵袭性及肿瘤特殊征象进行统计学分析。结果：肿瘤大小在三组病变中差异均具有统计学意义（P＜0.01）；瘤周水肿、坏死囊变、“筋膜尾征”在三组病变中差异具有统计学意义（P＜0.01），在恶性组中最为多见；肿瘤的侵袭性征象在中间性组和恶性组中更多见，与良性组的差异有统计学意义（P＜0.01）。此外，韧带样纤维瘤病的“树根征”及皮肤隆突性纤维肉瘤的“皮肤尾征”、“脂肪尾征”以及黏液样纤维肉瘤的“筋膜尾征”等征象均为其特征性影像表现。结论：肿瘤大小、侵袭性、瘤周水肿、坏死囊变结合肿瘤的特殊征象进行综合分析，可提高纤维源性软组织肿瘤的术前定性诊断符合率。     

成人骶前乏脂肪型成熟型畸胎瘤的CT、MRI表现及鉴别诊断

目的 :分析成人骶前乏脂肪型成熟型畸胎瘤的CT、MRI表现及其与常见原发骶前占位性病变(神经鞘瘤、脊索瘤)的鉴别诊断。方法:回顾性分析经手术、病理证实的8例成人骶前乏脂肪型成熟型畸胎瘤及7例神经鞘瘤、10例脊索瘤的术前CT或MRI资料,分析肿瘤钙化、大小、成分、骨质破坏、形态、与骶尾骨的关系、骶孔扩大、强化等影像学特征,采用方差分析及Fisher’s确切概率法进行统计学分析。结果:成人骶前乏脂肪型成熟型畸胎瘤多为囊性病变,囊壁常钙化,常多个囊腔独立存在且呈"囊挤囊样"改变,与骶前神经鞘瘤及脊索瘤相比,表现为完全囊性或以囊性为主病灶,与尾骨相连,无骨质破坏,无骶孔扩大,增强扫描无强化,且差异有统计学意义(P0.05)。结论:术前CT、MRI对成人骶前乏脂肪型成熟型畸胎瘤的诊断及鉴别诊断具有很高价值。     

侵袭性与非侵袭性软组织肿瘤临床及MRI影像表现分析

目的 探讨侵袭性与非侵袭性软组织占位临床特点与MRI平扫及增强扫描影像表现的相关性,以期提高定性诊断准确率,尽早制订个性化治疗方案。方法 回顾性分析160例经手术病理证实的软组织病变MRI平扫及增强扫描影像表现,其中侵袭性肿瘤包括恶性51例、中间性(局部侵袭性)30例,非侵袭性肿瘤即良性肿瘤79例,共纳入分析指标8项,包括发生部位、年龄、边界、瘤周水肿、囊变/黏液样变/坏死、T₂信号特点、强化特点及肿瘤最大径,除了发生部位,余进行单因素及多因素分析。结果 单因素分析结果显示：侵袭性与非侵袭性的肿瘤最大径、年龄、边界、瘤周水肿差异具有统计学意义(P<0.05)。多因素分析结果显示：两组变量中上述4项影响因素曲线下面积(AUC)从大到小依次是肿瘤最大径(AUC=0.788)>瘤周水肿(AUC=0.718)>边界(AUC=0.649)>年龄(AUC=0.629),其中肿瘤最大径价值最大,临界值为5.2 cm,大于临界值,提示恶性可能性大。结论 肿瘤最大径、瘤周水肿、边界、年龄在软组织肿瘤侵袭性与非侵袭性鉴别中具有一定参考价值,结合DWI及ADC等...     

卵巢上皮性肿瘤的CT表现

本文分析了４２例经病理证实的卵巢上皮性肿瘤。良性肿瘤ＣＴ表现为：边缘清晰的囊性肿块，囊壁及囊内的分膈形状规则、无增厚。囊液均匀。恶性肿瘤ＣＴ表现为：与周围组织分界模糊的囊实性或实性肿块。肿瘤壁及分隔不规则增厚，呈结节状。囊内可发现赘生物。分析了大网膜、横膈膜、腹膜等转移的ＣＴ表现。讨论了卵巢上皮性肿瘤的组织学分型及病理特点、良恶性肿瘤的鉴别诊断。我们认为，卵巢上皮瘤的厚度及形态是诊断恶性肿瘤的重要特征。     

多层螺旋CT在胰腺浆液性腺瘤与黏液性囊性肿瘤中的诊断价值

目的 探讨胰腺囊腺瘤的多层螺旋CT(MSCT)表现,提高诊断准确率.方法 回顾性分析经手术病理证实的25例胰腺囊腺瘤患者的MSCT表现特点.应用SPSS 18对浆液性囊腺瘤与黏液性囊性肿瘤两组病例的一般特征和影像特征进行X2检验和t检验.结果 浆液性囊腺瘤与黏液性囊性肿瘤两组病例瘤体大小差异有统计学意义(F浆液性囊腺瘤=4.95 1.63,F黏液性囊性肿瘤=9.21 3.70,t=2.925,P＜0.05);而两组间性别、年龄、分布及瘤体个数[性别(x2 =2.136,P=0.141);年龄(t=1.019,P=0.319);部位(x2=2.778,P=0.096);瘤体个数(x2 =0.329,P =0.566)]差异均无统计学意义;浆液性囊腺瘤与黏液性囊性肿瘤在形态、分房个数、有无钙化及囊壁特征[形态(x2 =0.116,P=0.734);分房个数(x2=0.146,P=0.702);钙化(x2=0.529,P=0.467);囊壁(x2=2.778,P=0.096)]差异均无统计学意义.2例黏液性囊腺癌出现病灶边缘钙化;3例黏液性囊腺癌均出现壁结节、囊壁厚薄不均及囊内较多实性成分.结论 胰腺囊腺瘤具有一定的影像学特征性,MSCT可较好地做出诊断及鉴别诊断.     

软组织肿块的MRI诊断价值

目的：探讨软组织肿块的MRI诊断价值。方法：回顾性分析43例经手术或穿刺活检病理证实的软组织肿块患者的MRI资料。结果：MRI能清晰显示出肿块的形态学改变及其范围，尤其对邻近结构受侵情况以及与神经血管柬的关系的显示较为敏感。部分有特异性形态及信号强度征象的肿块如脂肪瘤、血管瘤等依据其MRI可以明确诊断。良恶性两组肿块在大小、信号均匀性、边界及对周围结构的侵犯等方面差异无显著性意义（P〉0．05），其MRI特征有很大重叠性。MRI对软组织肿块潜在恶性评估的敏感性、特异性分别是66．67％、60％。结论：MRI对于发现肿块及显示病变所侵及的范围是最敏感、最准确的，对软组织肿块的诊断有很大的帮助，但在鉴别肿块良恶性方面的价值存在一定局限性。     

小b值扩散加权成像对乳腺癌的诊断价值

目的:探讨小b值扩散加权成像(DWI)在诊断乳腺癌中的价值.方法:采用Philips 1.5T磁共振扫描仪对48例乳腺疾病患者行常规SE序列扫描、单次激发自旋回波-回波平面成像(SE-EPI)序列DWI及动态增强扫描.48例患者共检出53个病灶,其中良性肿瘤29个,恶性肿瘤24个,均经手术及病理证实;选择健康志愿者20...     

软组织神经源性肿瘤的MRI诊断

目的：评价ＭＲＩ对软组织神经源性肿瘤的诊断价值。材料与方法：回顾分析１３例软组织神经源性肿瘤的ＭＲＩ表现,其中良性神经源性肿瘤１０例,恶性３例,均经手术病理证实。结果：大部分肿瘤表现为卵圆形或梭形（ｎ＝１１）,边缘清晰（ｎ＝１１）,与邻近神经血管束关系密切（ｎ＝１２）。Ｔ１ＷＩ上均匀或轻度不均匀（ｎ＝９）,均为等于或稍高于肌肉信号。Ｔ２ＷＩ上为中等或明显不均匀（ｎ＝１０）高信号,仅１例神经纤维瘤于     

骨肉瘤的MRI诊断(附35例分析)

总结骨肉瘤NRI表现及其特点。方法：收集经手术病理或活检证实的35例骨肉瘤，分析其MRI、X线平片征象并与手术病理对照，总结NRI诊断骨肉瘤的特征。35例均进行NRI平扫，其中18例平扫后行增强扫描。结果：骨肉瘤MRI上可表现瘤骨、骨质破坏、骨膜反应、软组织肿块等征象。此外，NRI还可显示肿瘤坏死、出血，肿瘤侵犯骨骺、关节及“跳跃”病灶。增强扫描有利于骨肿瘤良恶性的鉴别。结论：NRI可以提供比X线平片更全面的影像学信息，并指导临床治疗。     

Contrast-enhanced imaging features and differentiation of benign and malignant focal splenic lesions

To assess the value of imaging features for differentiating malignant from benign focal splenic lesions, 79 pathologically proved cases with contrast-enhanced CT or MRI were retrospectively studied. The morphological characteristics were assessed and the enhancement patterns were classified into five categories. After multivariate logistic analysis, the lesion margin and enhancement patterns were significantly different between benign and malignant lesions. The combination of ill-defined margin and hypovascular enhancement for suggesting malignant lesions had a good specificity (94.9%) and accuracy (89.9%). Morphological and enhancement characteristics on CT/MRI may be valuable in differentiating malignant from benign focal splenic lesions.     

MR imaging of extraabdominal desmoids: differentiation from other neoplasms.

A retrospective review of MR images of 36 patients with histologically proved extraabdominal desmoids was done to define the MR characteristics of these tumors and to determine if MR could be used to differentiate desmoids from other benign and malignant soft-tissue neoplasms. The desmoids evaluated included eight primary and 30 recurrent lesions. Our study was conducted in parallel with another study in which the MR appearance of 95 benign and malignant soft-tissue masses was evaluated, and the MR images of these masses were compared with our findings. The four desmoids from that study are included in our data. The signal intensity of the tumor on T1- and T2-weighted images was graded relative to the intensities of muscle and fat. Homogeneity, margin, neurovascular and bone involvement, and fibrosis (low-signal regions within the tumor on both T1- and T2-weighted images) were evaluated. On MR imaging, the desmoids showed inhomogeneous signal (97%), poor margination (89%), neurovascular involvement (58%), and bone involvement (37%). Fibrosis was present in 88% of primary desmoids and 90% of recurrent ones, and intermediate signal (greater than that of muscle and less than that of fat) was present in 75% and 50% of these, respectively. Our results show that the MR features of desmoids have characteristics that are commonly found in malignant tumors (inhomogeneous signal, poor margination, and neurovascular involvement). MR features of desmoids that distinguish them from malignant neoplasms are the presence of fibrosis and intermediate signal in the regions of the tumor.     

Magnetic resonance imaging of musculoskeletal tumors: skeletal and soft tissue masses

The purpose of this article is to review the MRI characteristics of musculoskeletal tumors, including skeletal and soft tissue masses. MRI has become the premier imaging modality for the evaluation of musculoskeletal tumors because of its excellent soft tissue contrast, its sensitivity to bone marrow and soft tissue edema, and its multiple imaging planes. In a substantial subset of cases, MRI can provide a diagnosis or a short differential diagnosis, while certain tumors have no distinguishing signal characteristics. MRI of musculoskeletal tumors can also be challenging, because the MRI appearance of certain lesions can be misleading, and a knowledge of the instances in which MRI over- and underestimates the malignancy of lesions is invaluable. The importance of correct protocols for tumor evaluation, both in diagnosis and in pre-operative evaluation, are discussed. Common pitfalls that may over- or underestimate the aggresivity of lesions will be highlighted, as will the role of gadolinium enhancement in the evaluation of lesions. The MRI appearance of common benign and malignant muculoskeletal lesions will be illustrated.     

乳腺疾病的动态增强MRI研究

目的　评价动态增强MRI对乳腺良、恶性病变的诊断价值。方法　对 63例临床疑为乳腺疾病的患者进行前瞻性常规MRI平扫和动态增强MRI扫描。分析比较良、恶性病变的形态学及强化特征 ,根据MRI表现鉴别良、恶性疾病 ,并与X线及病理结果比较。结果　 63例患者共计 78个病灶 ,恶性 33个 ,良性 45个。动态增强MRI根据病变的形态学和强化特征诊断乳腺良、恶性病变的准确率为 92 %。结论　动态增强MRI能清晰显示乳腺病变并作出定性诊断 ,因而是评价乳腺疾病的一种有效的影像学方法。     

骨肿瘤与瘤样病变周围组织影像表现分析

目的 分析骨肿瘤与瘤样病变引起的骨髓水肿(BME)和软组织水肿(STE)的影像表现,加强对此征象的认识.方法 复习绛手术病理证实的99例骨肿瘤与瘤样病变资料,将病变分成良性组和恶性组,观察病灶周围BME和STE范围、信号特点、是否有强化、BME区域在X线平片和(或)CT 上是否有骨质硬化、有无关节积液等,比较BME和STE出现率及范围差异.采用X2检验对组间数据进行比较.结果 良性组40例,恶性绀59例.BME和STE在T1WI上呈低信号,脂肪抑制T1WI上为高信号;部分BME在T2WI上呈低信号,相应区域在X线平片和(或)CT上为骨质硬化,离病灶越近,密度越高,在脂肪抑制T2TI上信号越低.增强扫描BME、STE皆均匀强化.BME、骨质硬化出现率及BME、STE范围长径中位数良性组分别为57.5%(23/40)、25.0%(10/40)、2.7 cm、1.3 cm,恶性组分别为32.2%(19/59)、3.4%(2/59)、1.6 cm、1.7 cm,差异均有统计学意义(P值均<0.05);STE和关节积液出现率良性组分别为50.O%(20/40)、12.5%(5/40),恶性组分别为52.5%(31/59)、8.5%(5/59),差异无统计学意义(P值均>0.05);良性绀内BME和STE 出现率差异无统计学意义(P>0.05);恶性组内BME和STE的出现率筹异有统计学意义(P<0.05).结论 良性骨肿瘤与瘤样病变及恶性骨肿瘤周围均可出现BME和STE,良性组BME范围大于恶性组,恶性骨肿瘤STE范围大于良性组.

Abstract：

Objective To explore the imaging features of bone marrow edema(BME)and soft tissue edema(STE)caused by bone tumors and tumor-like lesions.Methods Ninety nine patients with bone tumors and tumor-like lesions which were proved by surgical pathology were reviewed.The patients were divided into benign and malignant groups.Evaluation parameters included the size and signal intensity of BME and STE,the features of enhancement,the bone sclerosis and its relation with BME,and joint effusion,et al.The data of two groups were analyzed by X2 test.Results There were 40 patients in benign group and 59 patients belonged to malignant group.BME and STE demonstrated low signal on T1-weighted images and high signal on fat-suppressed T2-weighted images.Some BMEs demonstrated low signal on T2weighted images,which corresponded to sclerosis on X-ray film and(or)CT.Both BME and STE demonstrated uniform enhancement.There were statistically significant differences between benign and malignant groups including the frequency of BME.sclerosis.the median of the size of the BME and STE (P<0.05),which were 57.5%(23/40),25.0%(10/40),2.7 cm,1.3 cm,and 32.2%(19/59).3.4%(2/59),1.6 cm,1.7 cm respectively.No significant differences between the frequency of STE,joint effusion in 2 groups(P>0.05).Conclusions Both benign bone tumors and tumor-like lesions and malignant bone tumors can be accompanied by BME and STE.The size of BME in the benign bone tumors and tumor-like lesions is bigger than those in malignant ones,and the size of STE in malignant bone tumors is bigger than benign ones.