The role of magnetic resonance imaging in giant cell tumor of bone

In six cases of giant cell tumor the magnetic resonance (MR) images obtained with various pulse sequences and field strengths were compared to the corresponding computed tomography (CT) scans and plain roentgenograms. MRI was superior to CT and plain films in demonstrating areas of tissue inhomogeneity within the tumor as well as soft tissue extension. CT was superior in demonstrating cortical thinning. Multiplanar imaging capability and visualization of articular cartilage may demonstrate intra-articular tumor spread. The characteristic MRI findings with short TR/TE (T1-weighting) and long TR/TE (T2-weighting) are described. We also describe one case where serial MR scans were used to assess response to therapy.     

Malignant giant cell tumor of soft parts

Giant cell tumor of soft parts (GCTSP) is an extremely rare lesion with an unpredictable behavior. Some patients are cured with a simple surgical excision whereas others will develop metastatic disease within a relatively short interval. To date, there are no consistently reliable criteria, either clinical or histologic, to separate the benign from more aggressive lesions. We describe the clinical, histologic and radiologic features of a case with malignant behavior. The patient presented with a fungating skin and soft tissue mass and concurrent pulmonary nodules. The lesion recurred rapidly despite wide resection with negative surgical margins. Biopsy of the pulmonary lesions demonstrated metastatic disease.     

Magnetic resonance appearance of granular cell tumor of the breast

Granular cell tumors (GCT) of the breast are rare lesions which can resemble primary breast carcinoma on clinical exam, as well as on mammographic and ultrasound imaging. Because they represent only a minute fraction of breast neoplasms, the magnetic resonance (MR) imaging appearance of GCT of the breast has not been extensively studied. We describe a GCT of the breast in a 53-year-old female, with gross and microscopic pathologic correlation to the tumor's MR imaging appearance.     

Gadolinium-DTPA enhancement of soft tissue tumors in magnetic resonance imaging—preliminary clinical experience in five patients

In a preliminary report of a clinical trial of gadolinium-DTPA (Gd-DTPA) for enhancement of soft tissue tumors in magnetic resonance imaging (MRI), experience of the first five cases is presented. Enhancement was found to give better delineation of the tumor in richly vascularized parts of the tumors, compressed tissue immediately surrounding the tumor, and in atrophic, but richly vascularized, muscle.     

Granular cell tumor of the subcutis: CT and MRI findings

Three cases of granular cell tumor (GCT) of the subcutis are presented. Computed tomography showed a mass isodense with muscle with an ill-defined margin. Magnetic resonance imaging showed a mass with inhomogeneous low signal intensity on both T1- and T2-weighted images. Another characteristic feature of subcutaneous GCT is its attachment in part to muscle. Histological examination confirmed the diagnosis in all cases. Received: 20 July 1998; Revision requested: 12 October 1998; Revision received: 30 October 1998; Accepted: 16 November 1998     

MR在乳腺肿瘤中的应用

随着MR成像技术的不断发展，MRI诊断乳腺疾病的敏感性有了很大的提高。近年来MRS及MR引导的乳腺定向活检技术的临床应用，进一步提高了腿诊断乳腺疾病的特异性。就近年文献中有关乳腺肿瘤的腿应用予以综述。     

Subcutaneous and musculoskeletal sparganosis: imaging characteristics and pathologic correlation

Objective. To document the imaging characteristics of subcutaneous and musculoskeletal sparganosis. Design and patients. Ten patients with musculoskeletal sparganosis were examined, with a variety of imaging modalities including MRI (n=6), ultrasonography (n=8), plain radiography (n=7) and CT (n=1). Pathologic correlation was carried out in all cases. Results. Nine lesions involved soft tissues, of which seven were in the thigh, two in the trunk and one involved a vertebral body. The majority of the lesions in soft tissue were confined to the subcutaneous layer but two extended deep into underlying muscles. Sonography revealed low-echoic serpiginous tubular tracts (8/8), and an intraluminal echogenic structure (4/8). MRI revealed multiple serpiginous tubular tracts and peripheral rim enhancement. Two patients showed perilesional soft tissue edema. Pathologically, the lesion consisted of a larva surrounded by three layers of inflammation: an inner epithelioid granulomatous cell layer, middle chronic inflammatory cell layers, and an outer fibrous layer. Conclusion. The study suggests that if serpiginous tubular tracts are seen at imaging studies, musculoskeletal sparganosis should be included in the differential diagnosis. Received: 27 July 1999 Revision requested: 20 September 1999 Revision received: 11 February 2000 Accepted: 14 March 2000     

Sclerosing stromal tumor of the ovary in pregnancy: clinical, ultrasonography, and magnetic resonance imaging findings

We report a case of sclerosing stromal tumor of the ovary in a 30-year-old pregnant patient presenting with pelvic pain, dysuria, and metrorrhagia. Very few reports of sclerosing stromal tumor of the ovary during pregnancy have been presented. The purpose of our work is to present the findings at physical examination, ultrasonography, magnetic resonance imaging, and histopathology, to review the literature regarding this uncommon neoplasm, and to show the usefulness of magnetic resonance imaging in the assessment of pelvic masses during pregnancy.     

软组织肿瘤MR扩散成像与灌注成像的比较研究

目的 通过分析一组软组织肿瘤同一病例相同ROI的MR DWI及PWI的影像信息,比较这2种MR功能成像技术用于软组织肿瘤的定性诊断价值.方法 对50例软组织肿瘤(良性24例,恶性26例)同时行DWI及PWI.通过扩散及灌注软件分析DWI及PWI参数在良、恶性肿瘤中的表现,进行差异的t检验,对所获两法的诊断符合率进行x2检验.采用受试者操作特征曲线(ROC曲线)分析曲线下面积(AUC),确定诊断阈值并对2种诊断方法进行评价.结果 良、恶性软组织肿瘤的ADC值[(良、恶性分别为(2.03±0.36)和(1.52±0.39)×10-3mm2/s]、首过灌注(FP)期信号强度丢失率[良、恶性分别为(13.54±3.37)%和(47.57±5.21)%]的差异均有统计学意义(t值分别为2.515和2.938,P值均<0.05),时间-信号强度曲线(TIC)最大线性斜率[良、恶性分别为(5.51±2.54)%和(7.94±3.33)%]的差异无统计学意义(t值为1.272,P>0.05);以ADC值1.866×10-3mm2/s为阈值,DWI诊断恶性肿瘤的敏感度为84.6%(22/26),特异度为83.3%(20/24);以FP期最大信号丢失率40.33%为阈值,PWI诊断恶性肿瘤的敏感度为88.5%(23/26),特异度为75.0%(18/24);TIC类型的Ⅰa型在良性肿瘤中占3/24,在恶性肿瘤中占20/26;Ⅰb型在良性肿瘤中占14/24,在恶性肿瘤中占3/26;Ⅰc型在恶性肿瘤中占3/26.Ⅱ型TIC在良性肿瘤中占7/24.在DWI上用ADC值、PWI上用FP期最大信号强度丢失率作诊断,诊断符合率分别为84.0%(42/50)和82.0%(41/50),两者的差异无统计学意义(x2=0.8,P>0.05);AUC测得的准确度分别为81.7%和83.6%,PWI诊断恶性软组织肿瘤的敏感度高.结论 以DWI和PWI的ADC值、FP期信号强度丢失率分别为1.866×10-3mm2/s和40.33%为阈值时,均有利于软组织肿瘤良、恶性的鉴别;TIC最大线性斜率对于软组织肿瘤良、恶性的鉴别意义不大;软组织肿瘤的TIC形态有助于肿瘤良、恶性的鉴别.DWI和PWI用于诊断恶性软组织肿瘤的准确性均为中等,在DWI与PWI用于诊断恶性软组织肿瘤的准确性相近时,应选择诊断敏感度较高的PWI.     

MRI对卵巢颗粒细胞瘤的诊断价值

目的:探讨MRI对卵巢颗粒细胞瘤(GCTO)的诊断价值。方法:回顾性分析经手术与病理证实的20例GC-TO患者的临床和MRI资料。所有病例均行MRI平扫及增强扫描。结果:20例术前MRI诊断正确16例(80%)。MRI平扫主要表现:子宫附件区边界清楚、形态较规整、包膜完整的囊性、囊实性、实性肿块。6例为囊性肿块,其中1例为单一大囊性肿块,多囊性肿块内见厚薄不一分隔,以较厚为主,囊内壁光滑,囊内容物T1WI呈等低信号,T2WI呈高信号;9例为囊实性肿块,T1WI呈等低混杂信号,T2WI呈混杂高信号,内有多发大小不等的囊性变,囊内壁光滑;5例为实性肿块,T1WI和T2WI高于同层肌肉信号。合并症:12例子宫增大,内膜增厚,3例合并子宫内膜癌(1例同时合并子宫肌瘤)、3例合并子宫肌瘤。增强扫描20例GCTO患者的肿瘤实性部分及囊壁均明显强化。结论:卵巢颗粒细胞瘤MRI表现具有一定的特征,能清晰显示其合并症,对其诊断及鉴别诊断具有重要的临床应用价值。     

兔肢体VX2软组织肿瘤MR扩散加权成像

目的:建立兔肢体软组织肿瘤模型,探讨MR扩散加权成像在软组织肿瘤诊断中应用的可行性及适用于软组织肿瘤成像的合适的b值。方法:25只新西兰大白兔(月龄2～3个月,体重1.5～2.0kg,雌雄不限),将肿瘤瘤株种植在左前上肢内侧。在种植瘤株后2～3周使用1.5T磁共振仪行常规MRI及DWI检查,b值取200、400、600、800和1000s/mm2。在MRI检查后3～4周分批处死荷瘤兔,取出肿瘤组织,观察肿瘤的大体形态及病理学表现。结果:肿瘤成瘤率96%(24/25)。种瘤后14、21和28天,肿瘤直径分别约为2.0、4.0和5.5cm。肿瘤直径比较小(14天)时,质地硬,肿瘤坏死、瘤周水肿很少见。在常规T1WI上肿瘤实质多呈等信号,瘤内出血少见;T2WI上肿瘤实质为不均匀高信号,肿瘤中央和瘤周可见信号更高的坏死、水肿区;增强后肿瘤实质明显强化,肿瘤边缘强化更显著。DWI图像上,当b值较小时(200s/mm2)受T2透过效应影响明显,b值比较大时(1000s/mm2)图像信噪比下降明显,b值为600和800s/mm2时,图像质量比较好;b值为200、400、600、800和1000s/mm2时肿瘤的ADC值分别为(1.56±0.11)、(1.32±0.12)、(1.25±0.10)、(1.19±0.08)和(1.14±0.07)mm2/s;b值为600和800s/mm2时,肿瘤实质的ADC值明显小于坏死区及周围肌肉组织,差异有显著性意义(P<0.005)。结论:DWI可以用于兔肢体VX2软组织肿瘤的观察,b值为600和800s/mm2时可以获得比较好的DWI图像。肿瘤组织、肌肉组织及坏死组织的ADC值明显不同,DWI在软组织肿瘤的诊断和预后评估等方面具有广阔的应用前景。     

Sertoli-stromal cell tumor of the right ovary: radiological-pathological correlation

A case of Sertoli-stromal cell tumor of the right ovary is reported. The patient was a 50-year-old perimenopausal woman with abdominal distention due to a large pelvic tumor. She had no signs of androgen excess. A large solid sponge-like tumor with multicystic areas throughout, in which there were some small hemorrhagic spots, was shown on magnetic resonance (MR) imaging. No endometrial thickening of the uterus was seen. Pathology examination revealed a Sertoli-stromal cell tumor with intermediate-to-poor differentiation. The edematous, watery, sponge-like appearance on the MR images correlated with the pathological findings.     

Detection of local recurrent disease in musculoskeletal tumors: magnetic resonance imaging versus computed tomography

A 2 1/2-year prospective study of surgically treated malignant mesenchymal neoplasms showed magnetic resonance imaging (MRI) to be superior to computed tomography (CT) in sensitivity for local recurrent disease measuring less than 15 cm³. Larger masses were detected with similar sensitivity; specificity and predictive values did not differ. The presence of areas of high signal intensity on T2-weighted images proved to be a reliable criterion except in fibrous neoplasms. However, differentiation between non-hemorrhagic fluid collections, cross-sectioned veins or bowel contents and small tumor nodules cannot be made simply by signal intensity, but has to be based upon the evaluation of gross morphologic criteria.     

Soft-tissue signs of the upper extremity revisited: radiologic and magnetic resonance imaging correlation

More modern imaging techniques allow us to supplement the information available on soft-tissue signs seen on radiographs. This improves our diagnostic capability, as demonstrated here in the upper extremity.     

Magnetic resonance imaging of malignant soft tissue neoplasms in the adult

This review addresses the spectrum of malignant soft tissue tumors frequently found in adults. Rather than presenting a complete review, the focus of this discussion is on common lesions or lesions in which the diagnosis may be suggested on the basis of imaging. Diagnoses covered include undifferentiated high-grade pleomorphic sarcoma, fibrosarcoma, dermatofibrosarcoma protuberans, liposarcoma, synovial sarcoma, malignant peripheral nerve sheath tumor, clear cell sarcoma, hemangioendothelioma, hemangiopericytoma, angiosarcoma, and leiomyosarcoma.     

Infantile fibrosarcoma: Magnetic resonance imaging findings in six cases

Purpose

To retrospectively review magnetic resonance (MR) imaging features in a series of six infantile fibrosarcomas to find out if MR can suggest this unusual diagnosis and to highlight the value of MR during and following treatment.

Materials and methods

The records of six cases of histologically proven infantile fibrosarcoma were retrieved from the files of our cancer center. All imaging data available were consensually reviewed by two radiologists.

Results

There were five females and one male (age range at diagnosis, 0-12 months; mean, 6 months). The most common finding was a well-circumscribed single mass in five patients (83%). All tumors had arisen on limbs; at their proximal or distal extremity or at the root of the limb. The masses were 9 cm large in mean diameter. The initial tumor signal was isointense to muscle on T1-weighted and hyperintense on T2-weighted sequences. All masses were well circumscribed and half of them contained internal fibrous septa. The internal signal was homogeneous in three patients and heterogeneous in the three others. An intense enhancement was seen in all three contrast-enhanced exams available; heterogeneous in two cases and homogeneous in one. Osseous erosion was observed in only one patient who was the only one with distant metastasis. After treatment (chemotherapy and very limited surgery), tumors had totally disappeared, leaving muscle fat infiltration in two patients and subcutaneous fat hypertrophy in one patient.

Conclusion

Although imaging findings are not specific of infantile fibrosarcoma, this diagnosis could be suggested when MR imaging depicts a large well-circumscribed mass arising in a limb at birth or during the neonatal period. This mass is sometimes heterogeneous and septate and exhibits an isointense T1- and hyperintense T2-weighted signals and strong enhancement. MR is also the technique of choice for follow-up during treatment which consists nowadays almost exclusively in chemotherapy.     

卵巢颗粒细胞瘤的MRI诊断

目的：探讨卵巢颗粒细胞瘤的MRI特征。方法：回顾性分析10例经手术病理证实的卵巢颗粒细胞瘤的MRI表现。结果：10例中双侧病变1例,单侧病变9例。肿瘤直径3.0-18.0 cm,平均6.5 cm,呈卵圆形、圆形,包膜完整,表面光整,界限清楚。10例中实性3例,囊实性7例,瘤内多发大小不等囊变,囊隔厚薄不均,其中囊变大于3 cm者7例。10例T1WI及T1WI FS均呈等低信号;T2WI及T2WI FS呈等高信号6例,T2WI及T2WI FS呈高低混杂信号4例;DWI b值800呈等高信号6例,高低混杂信号4例,ADC图呈高低混杂信号7例,等低信号3例。所测得的ADC值提示卵巢颗粒细胞瘤趋向恶性。10例中子宫体增大及内膜增厚7例,雌激素水平升高8例。结论：卵巢颗粒细胞瘤易囊变、出血,MRI信号较混杂;多合并子宫体增大及内膜增生,有助于MRI诊断及鉴别诊断。     

Magnetic resonance imaging of benign soft tissue neoplasms in adults

This article reviews a spectrum of benign soft tissue tumors found in adults. Rather than presenting a complete review, the focus of this article is on benign tumors for which the diagnosis may be confidently made or strongly suggested on the basis of imaging. Diagnoses presented include nodular fasciitis, superficial and deep fibromatosis, elastofibroma, lipomatous lesions, giant cell tumor of the tendon sheath, pigmented villonodular synovitis, peripheral nerve sheath tumors, Morton neuroma, hemangioma, and myxoma.     

睾丸生殖细胞肿瘤的MRI诊断

目的：探讨睾丸生殖细胞肿瘤的 MRI 表现,提高对该疾病的 MRI 诊断水平。方法回顾性分析经手术病理证实的25例睾丸生殖细胞肿瘤患者临床及 MRI 资料,所有病例均行 MRI 平扫,其中16例行动态 MRI 增强扫描。利用 MRI 对睾丸肿瘤的大小、形态、信号特点、毗邻关系、强化方式及肿瘤血管情况进行评估,并与病理对照。结果25例睾丸生殖细胞肿瘤中,精原细胞瘤10例,其中 T2 WI 呈均匀低信号8例,稍低信号2例,增强扫描轻度结节样强化5例,明显均匀强化2例,其中4例可见纤维间隔强化;卵黄囊瘤4例,T1 WI 呈等低信号,T2 WI 呈稍高信号,增强扫描后肿瘤呈渐进式强化;成熟型畸胎瘤、表皮样囊肿、混合性生殖细胞肿瘤各3例,T1 WI 呈混杂低信号,T2 WI 呈混杂高信号;胚胎性癌2例,T1 WI 呈等低信号,T2 WI 呈混杂低信号,其内可见出血信号,增强扫描呈分隔强化。结论MRI 对睾丸生殖细胞肿瘤诊断正确率较高,对其病理分型、分期及鉴别诊断具有重要价值。     

胆管囊腺癌的MRI表现与病理的对照分析

目的 探讨MRI诊断胆管囊腺癌（BCAC）的价值。方法 回顾性分析5例经手术病理证实的BCAC患者的MRI表现，并与病理所见对照。结果 4例单发，1例多发。5例均为囊实性肿物，2例单房、3例多房，囊内可见多个大小不等的壁结节及厚薄不均的间隔。液性部分呈均匀的长T1、长T2信号，实性部分呈稍长T1、稍长T2信号。注射钆喷替酸葡甲胺（Gd—DTPA）后，囊性部分无强化，实性部分动脉期轻度强化、门静脉期及延迟期呈中度至明显强化。MRI表现与病理所见对应良好。术前4例诊断为囊腺瘤或囊腺癌，1例诊断为胆管癌。结论 MRI能显示BCAC的特征性表现，可以做到术前正确诊断。