原发性软组织恶性纤维组织细胞瘤的MRI影像诊断(附15例报告)

目的:探讨原发性软组织恶性纤维组织细胞瘤(MFH)的MRI影像诊断。方法:回顾性分析15例经手术病理证实的原发于软组织的恶性纤维组织细胞瘤患者的影像学资料,15例患者均行MRI检查,有7例行CT检查,8例行增强扫描。结果:原发于软组织恶性纤维组织细胞瘤15例,肿瘤形态多样,以卵圆形、分叶状多见。病变于T1WI呈低信号或等信号,T2WI呈高信号或等信号为主混杂信号影,7例病变内可见低信号之分隔影。13例病变内见坏死或黏液样改变,2例伴出血。明确有包膜3例。增强扫描均呈显著不均匀强化。结论:MRI对原发性软组织恶性纤维组织细胞瘤的诊断具有重要价值,是首选的影像学检查方法。     

骨良性纤维组织细胞瘤的影像学表现（附4例报道及文献复习）

目的：探讨骨良性纤维组织细胞瘤的影像学特点,以提高对该病的影像学诊断水平及鉴别诊断能力。方法：收集4例骨良性纤维组织细胞瘤患者的临床及影像学资料,结合近年来国内外相关文献进行回顾性分析。结果：4例骨良性纤维组织细胞瘤均表现为类圆形或椭圆形骨质破坏区,边界清楚,有完整硬化环,环壁厚薄较均匀,无骨膜反应。2例为多发病变,病变累及双侧股骨及髂骨;2例MRI检查T1WI等信号,T2WI不均匀高信号,其中1例病变周围可见软组织肿块;1例CR及CT检查提示病灶内有骨性分隔和软组织密度影。结论：骨良性纤维组织细胞瘤影像学上具有一定特异性,认识其表现有助于对该病的诊断和鉴别诊断。     

骨良性纤维组织细胞瘤的影像学表现(附4例报道及文献复习)

目的:探讨骨良性纤维组织细胞瘤的影像学特点,以提高对该病的影像学诊断水平及鉴别诊断能力.方法:收集4例骨良性纤维组织细胞瘤患者的临床及影像学资料,结合近年来国内外相关文献进行回顾性分析.结果:4例骨良性纤维组织细胞瘤均表现为类圆形或椭圆形骨质破坏区,边界清楚,有完整硬化环,环壁厚薄较均匀,无骨膜反应.2例为多发病变,病变累及双侧股骨及髂骨;2例MRI检查T1WI等信号,T2WI不均匀高信号,其中1例病变周围可见软组织肿块;1例CR及CT检查提示病灶内有骨性分隔和软组织密度影.结论:骨良性纤维组织细胞瘤影像学上具有一定特异性,认识其表现有助于对该病的诊断和鉴别诊断.     

骨良性纤维组织细胞瘤的影像诊断与病理对照

摘 要：［目的］ 探讨骨原发性良性纤维组织细胞瘤(BFH)的影像学表现及其病理特点。［方法］ 回顾性分析15例经手术病理证实的骨良性纤维组织细胞瘤的影像资料,并将之与手术病理结果对比。［结果］ 临床以局部疼痛为主。发病部位以四肢长骨居多,单发病变14例,多发病变1例。10例病例行X线检查,11例行CT检查,6例行MRI检查。X线表现大部分为中央型溶骨性破坏,单房或多房状,部分病灶膨胀,皮质断裂。CT显示病灶边界清楚,周围可伴有或不伴有硬化边缘,硬化缘厚薄不均。MRI显示所有病例在T1WI上类似肌肉信号,4例T2WI及T2WI压脂像上见斑片状或条索状低信号区,2例病灶整体呈稍高信号。3例病灶穿破骨皮质向外侵犯,周缘软组织见反应性水肿。术中见瘤体为灰黄色或褐黄色组织,镜下由漩涡样排列的梭形纤维母细胞构成,其间散在多核巨细胞和泡沫细胞,无成骨组织。［结论］ 骨良性纤维组织细胞瘤的影像表现有一定的特点,也反映了其病理改变,综合各种影像表现并结合临床特点,多数典型病例可作出诊断。     

肝硬化结节与小肝癌的临床及MRI诊断

目的:探讨MRI对肝硬化结节(再生结节、退变结节)与小肝癌的诊断及鉴别诊断价值。方法:收集120例临床诊断为肝硬化的MRI资料,其中32例行Gd-DTPA动态增强扫描。结果:全部病例均见再生结节,其中合并退变结节14例、原发小肝细胞癌18例,再生结节为肝内弥漫的小于1.0cm结节状病灶,T1WI呈等或略高信号、T2WI呈略低信号影;退变结节为直径1.0cm～3.5cm结节状病灶,T1WI呈等或略高信号、T2WI呈等信号影;小肝细胞癌为直径小于3.0cm结节状病灶,T1WI呈略低信号、T2WI呈略高信号影。Gd-DTPA动态增强扫描见小肝癌于肝动脉期明显强化,门静脉期强化消退。结论:根据结节大小、信号改变MRI可区分大部分再生结节、退变结节及小肝细胞癌。Gd-DTPA动态增强扫描有助于鉴别困难的退变结节及小肝细胞癌。     

3.0T磁共振成像对卵巢纤维卵泡膜细胞瘤诊断的优势

目的 探讨卵巢纤维卵泡膜细胞瘤的3.0T磁共振成像(MRI)的影像学特点,提高对其影像表现的认识能力.方法 回顾性分析32例卵巢纤维卵泡膜细胞瘤患者的临床病理及影像学资料.结果 32例卵巢纤维卵泡膜细胞瘤患者的肿瘤均有包膜,30例单发,2例多发;17例呈圆形、椭圆形,15例呈不规则形或分叶形.与子宫信号相比,T1WI表现为等信号为主,伴斑片状低信号,T2WI表现为以位于上方的云雾状高信号为主,其下方伴片状低信号.28例T2WI夹杂斑片状、云絮状高信号影明显,4例见囊变、出血.30例瘤周见环绕积液影.DWI序列呈局部弥散受限,ADC值范围(1.02~1.25)×10-3 mm.结论 3.0T MRI有助于卵巢纤维卵泡膜细胞瘤的术前诊断.     

骨孤立性浆细胞瘤的影像学表现

目的:探讨骨孤立性浆细胞瘤（SBP）的影像学表现,以提高对该病的诊断水平。方法:回顾性分析2012年9月至2020年9月山西省原平市第一人民医院就诊的8例不同部位SBP患者临床及影像学资料,影像学检查包括CT、磁共振成像（MRI）平扫及MRI增强扫描。结果:8例患者病变部位包括胸椎3例、腰椎2例、颅骨2例、肋骨1例,其中影像学检查误诊为胸椎转移瘤、胸椎结核、腰椎淋巴瘤、颅骨脑膜瘤各1例。所有患者均呈溶骨型骨质破坏,可伴有骨质膨胀性改变及软组织肿块。5例椎体病灶均表现为椎体压缩变扁,CT呈等/低密度,T1WI呈等/低信号,T2WI呈低/稍高信号,其中2例呈典型"微脑征"。2例颅骨病灶CT呈稍高密度,T1WI呈等信号,T2WI呈等/混杂高信号。肋骨病灶CT呈等密度,T1WI呈等信号,T2WI呈稍高信号。4例MRI增强扫描病灶呈明显均匀强化。结论:不同部位SBP均表现为溶骨型骨质破坏,病灶及软组织肿块均一强化。"微脑征"为脊柱SBP特异性影像学征象。     

软组织血管瘤的影像诊断

目的：研究软组织血管瘤的X线平片、CT和MRI征象，探讨CT和MRI对该肿瘤的诊断价值。方法：对经手术病理或临床确诊的软组织血管瘤35例进行回顾性分析。所有病例均行X线平片、CT平扫和增强扫描。其中动态增强扫描8例，MRI检查15例。结果：海绵状血管瘤19例，蔓状血管瘤8例，毛细血管瘤3例，混合型血管瘤2例，血管瘤病3例。CT平扫肿瘤呈结节状、分叶状、管状或团块状低密度病变。增强扫描后血管成分显著强化，可呈扭曲血管状，而非血管成分不强化或轻度强化。MRIT1WI上肿瘤呈略高信号或等信号，T2WI上呈显著高信号，其中夹杂不均匀信号，病理上代表了脂肪、纤维组织、平滑肌、血栓、静脉石和钙化。结论：CT和MRI对血管瘤均可作出定性诊断，但MRI在显示血管瘤内特征性的血管及血管成分间的脂肪纤维组织方面较CT优越。     

幕下孤立性纤维瘤的影像学表现（附5例报道及文献复习）

目的:探讨幕下孤立性纤维瘤（solitary fibrous tumor,SFT）的影像学表现,以提高其诊断准确率。方法:回顾性分析5例经手术病理证实的幕下SFT的影像及临床、病理资料,1例行CT平扫,3例行MRI平扫及增强检查,1例仅行MRI增强检查。结果:本组5例（4例女性,1例男性）均为单发病灶,均宽基底与脑膜相连,2例位于右侧小脑半球,1例位于左侧小脑半球凸面,1例跨右侧小脑幕上下生长,1例位于左侧桥小脑角区,肿瘤最大径范围约4.1~5.2 cm,5例边界均清楚,4例呈浅分叶状,1例呈类圆形。肿瘤CT平扫呈稍高密度,MRI T1WI呈等信号或稍低信号,T2WI呈稍高信号或低信号,3例T2WI病灶内见片状低信号区,2例病灶内见囊变,2例病灶内见迂曲血管,4例病灶周围可见轻度水肿,3例病灶周围见脑脊液环绕征象。增强扫描实性成分及囊壁均明显强化,2例可见脑膜尾征。结论:幕下SFT影像学表现具有一定的特征性,当幕下肿块呈浅分叶状并具有脑外肿瘤的征象,CT上呈稍高密度,T1WI呈等或稍低信号,T2WI呈稍高信号或低信号,明显强化,T2WI病灶内见低信号区及迂曲血管影时,可考虑诊断该病,但最终确诊仍需依靠病理及免疫组织化学检查。     

骨巨细胞瘤影像学诊断价值的比较

目的通过骨巨细胞瘤常见和典型的X线、CT及MRI表现的比较,提高对该病诊断和鉴别诊断的能力。方法回顾性分析19例经手术病理证实为骨巨细胞瘤患者的X线、CT及MRI表现。结果 X线平片表现:溶骨性骨质破坏14例,均呈膨胀性生长,边界尚清晰;硬化性骨质破坏1例,病理性骨折。CT表现:13例呈偏心膨胀性骨质破坏,均见局限性硬化边,12例见棘状、尖角状、条索状骨嵴及硬化边征象,10例软组织肿块影。MRI表现:7例MRI T1WI上均主体呈等信号夹杂少量低信号,T2WI及T2压脂相呈低信号等信号、高混杂信号,DWI呈高信号。结论骨巨细胞瘤的影像学表现为偏心性、膨胀性溶骨破坏,X线平片、CT及MRI影像检查相互补充,能够增加骨巨细胞瘤诊断及鉴别诊断的准确性。     

原发性骨恶性纤维组织细胞瘤的影像学诊断

目的探讨原发性骨恶性纤维组织细胞瘤(PBMFH)的影像学改变,以及X线平片、CT及MRI不同影像学检查方法的应用价值。方法总结经病理证实的35例(PBMFH)的影像学表现,回顾性分析X线平片、CT及MRI的影像学特征,探讨其对(PBMFH)的诊断价值。结果(PBMFH)具备全部恶性骨肿瘤的影像学特征,表现呈多种多样。X线平片和CT常表现为偏心性、侵袭性、溶骨性长骨端骨质破坏,并伴超过溶骨破坏范围的软组织肿块,骨膜反应少见。MR影像改变以等T1、等T2信号为主,其中夹杂斑片状、囊状长T1、长T2信号,但缺乏特异性。结论X线平片是首诊骨肿瘤的主要手段;CT及MRI检查的价值则在于显示病灶范围、皮质破坏、内部坏死及致密残留骨或钙化等骨和软组织细微结构变化情况,特别是MRI还可作为监测病变化疗、放疗疗效及术后复发的重要手段。     

原发性肾肉瘤的影像表现

目的探讨肾脏原发性肉瘤的影像特点。方法回顾性分析有影像检查经手术病理证实的７例原发性肾肉瘤,包括平滑肌肉瘤３例,脂肪肉瘤、纤维肉瘤、恶性纤维组织细胞瘤及恶性神经鞘瘤各１例。ＣＴ检查６例,超声检查６例,ＭＲＩ检查１例。结果肿瘤发生在肾实质６例,肾盂１例。肿瘤形态为不规则块状５例,球形２例。边缘模糊６例,与肾实质分界不锐利。ＣＴ显示４／６例肾实质病变密度不均匀,内有坏死区,其中２例增强扫描有中或高度强化,２例平扫密度均匀。声像图中４／６例呈中等不均质混合回声,恶性纤维组织细胞瘤及脂肪肉瘤呈低回声且均匀。ＭＲＩＴ１ＷＩ相肿瘤为近等信号团块;Ｔ２ＷＩ相肿瘤为中等不均质高信号;Ｔ１ＷＩ增强后肿瘤有强化,且低于肾实质,内信号更加不均匀。纤维肉瘤伴有下腔静脉及肾静脉内大瘤栓。结论肾脏原发性肉瘤具有典型的恶性肿瘤影像表现,而无组织学特异征象,与肾癌无法区别。ＣＴ增强扫描及ＭＲＩ检查有助于显示肿瘤部位、范围、密度／信号改变,有益于术前诊断及治疗计划的制定     

Primary Malignant Fibrous Histiocytoma of the Stomach: (A Case Report)

A case of primary malignant fibrous histiocytoma (MFH) of the stomach is reported. The patient was a 51-year-old man who had a laparotomy for a malignant gastric tumour diagnosed by radiological studies and endoscopic examination. An inoperable gastric malignancy was found at operation. Histopathological studies of tissue biopsied at surgery showed characteristic light microscopic findings and strong positivity for alpha-1-antitrypsin by immunoperoxidase technique indicating the diagnosis of malignant fibrous histiocytoma. The absence of any other soft tissue or retroperitoneal tumour strongly indicated the stomach is the primary site.     

MRI在诊断宫颈癌复发中的价值

目的：探讨MRI在评估诊断宫颈癌复发中的价值。方法：36例经病理证实宫颈癌复发患者,均行盆腔的MRI轴位T1WI、T2WI、SPIR以及GD-DTPA增强扫描后T1WI轴位、矢状位扫描。在不同序列MRI图像上观察复发肿瘤的形态、大小及信号改变。结果：326例病人中出现复发36例,发生率为11%。25例宫颈癌手术后复发病例,MRI可见在阴道残端或盆腔内出现软组织信号肿块影,增强扫描可见肿块明显强化。其中5例可见肿块侵及一侧输尿管,其上方输尿管扩张积水。11例宫颈癌放化疗后复发病例,MRI可见宫颈较前明显增厚,肿块T1WI为略低信号,T2WI为略高信号,增强扫描可见肿块呈不均匀强化。其中2例可见肿块侵及膀胱壁。结论：由于MRI具有非常好的软组织分辨率,MRI成像已成为宫颈癌手术前后或放化疗前后检查和随访最重要的手段,它能够准确判断宫颈癌临床分期,并且可以早期、及时发现肿瘤复发;在评估宫颈癌复发诊断中有重要价值。     

Surrounding muscle edema detected by MRI is valuable for diagnosis of intramuscular myxoma

We recently experienced 4 cases of intramuscular myxoma and analyzed MRI findings, comparing them with histological ones. Results showed that all tumors were depicted with a homogeneous low signal intensity on T1-weighted images and a markedly high signal intensity on T2-weighted images, findings which are similar to those of cystic lesions like intramuscular ganglions. However, tumors were diffusely and finely enhanced on T1-weighted images with intravenous gadolinium administration. Three cases showed the characteristic fat rim and fat cap. A diffuse edematous lesion demonstrating intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images was also found in the adjacent muscle surrounding the tumor in 3 of 4 cases. In this lesion, tumor invasion, diffuse and severe muscle degeneration, blood and lymphatic congestion with exudates, and reactive adipose tissue formation were observed. The present results suggested that for the clinical diagnosis of intramuscular myxoma with MRI examination, the combination of three MRI signs such as homogeneous low signal intensity on T1-weighted mages, markedly high signal intensity on T2-weighted images, and an enhancement effect with contrast medium are important, but the fat rim or fat cap, and the surrounding muscle edema as detected by MRI are also characteristic and allow for a more firm diagnosis. We presume that the diffuse and severe muscle fiber degeneration induced by tumors may cause such specific surrounding muscle edema.     

食管原发性恶性纤维组织细胞瘤:3例报告及文献复习

We reported three cases of polypoid tumor of the esophagus, among them one case of sarcomatous tumor partly covered with superficial squamous cell carcinoma. The sarcoma was consisted of anaplastic spindle and pleomorphic tumor cells, which was similar to malignant fibrous histiocytoma (MFH) of the soft tissue. Diagnosis of the surgery resected speci-men was confirmed by histological, immunohistochemical and electron microscopic methods. Both diagnostic and differential diagnostic problems of primary MFH of the esophagus and world medical literatures were discussed.     

Malignant fibrous histiocytoma of the lung

Twenty-two cases of primary malignant fibrous histiocytoma (MFH) of the lung are described, and a review of the literature is presented. As in the soft tissue, this sarcoma is found primarily in older individuals, usually as a solitary peripheral mass. Chest wall invasion at diagnosis was seen in four cases. The most common histologic subtype was the storiform-pleomorphic type of MFH. Vascular invasion was seen in 50% of cases. Histologic features did not correlate with prognosis, and subsequent aggressive behavior was related primarily to symptomatic presentation, advanced stage at diagnosis, incomplete excision, invasion of the chest wall or mediastinum, and subsequent recurrence or metastasis. Primary MFH of the lung should be distinguished from spindle cell carcinoma and inflammatory pseudotumors, and this histologic differential diagnosis is discussed.     

滑膜肉瘤MRI影像特征与组织病理学的相关性研究

背景与目的：磁共振成像(magnetic resonance imaging,MRI)是检查软组织肿瘤最好的影像学方法。滑膜肉瘤是常见的恶性软组织肿瘤之一,本研究探讨滑膜肉瘤的MRI影像特征与病理组织学的相关性．以期提高MRI对该肿瘤的诊断水平。材料和方法：12例滑膜肉瘤均经手术病理证实,位于上肢2例,位于下肢lO例;患者年龄35～50岁,中位年龄45岁;男女比例为3：1。MRI扫描采用PHILIPS GYROSCAN 0．5T超导型磁共振成像系统．扫描序列采用SE、FSE、FFE和Stir等序列,所有病例均作T,WI、T2WI和T1W Gd-DTPA静脉内注射增强扫描检查。取手术标本进行病理学检查,比较滑膜肉瘤MRI影像学表现与病理组织学的关系。结果：MRI可见12例肿块均位于关节旁,其中2例向关节内侵犯,3例侵犯邻近的骨质。在T1W12例肿块均呈以等信号为主的肿块．但其中3例肿块可见部分斑片状和囊状高信号区。在T2W6例肿块信号表现为三重信号;6例肿块表现为多结节状,3例呈不规则状,3例为圆形或椭圆形肿块。5例肿瘤内可见分隔征象,液-液平面征l例,肿块最大直径3～13cm。T1WGd-DTPA增强肿块均呈明显不均匀性强化。12例滑膜肉瘤病理分型：低分化单相梭形细胞为主型7例,高分化3例;双相分化2例。肿块内有大范围出血和囊性变6例,大量瘤组织坏死5例,钙化2例。结论：滑膜肉瘤的MRI具有一些特征性,并和肿瘤的组织学类型具有一定相关性。     

Imaging Analysis of Primary Malignant Intracranial Lymphoma

OBJECTIVE To investigate the images characteristics of primary malignant intracranial lymphoma.METHODS Retrospective study was conducted on CT/MRI imaging characteristics of 9 cases with primary malignant intracranial lymphoma.RESULTS The patients had lesions mostly in the supratentorial region, including the parts of deep white matter, para-ependymal regions, and corpus callosum. The shapes of the lesions were round or irregular. CT scan showed equal or slightly high density of the tumor images, compared with the normal tissue in the brain.The TIWI of MRI scan on the tumor showed low signal and the T2WI showed equal or slightly high signal. The MRI signals were homogenous. Cystic lesion, calcification, and hemorrhage were rarely seen in MRI. Edema around tumor and its occupational effect was lessened. Edema around tumor shown in MRI was not in accordance with the true volume of the tumor mass. Enhanced scan on the lesions showed homogenous enhancement, and the pia mater invaded and/or the spread along ependyma. CONCLUSION Images of primary malignant intracranial lymphoma have specific characteristics that are useful in its diagnosis and differential diagnosis.