结节性筋膜炎MRI表现(附2例报告及文献复习)

结节性筋膜炎(nodular fasciitis, NF)是以成纤维细胞和成肌纤维细胞增生为特征的良性软组织肿瘤样病变,病因不明,组织学上,因其生长速度快、细胞构成丰富和有丝分裂活跃,常被误诊为肉瘤[1-3].本文报告2例经病理证实的NF病例.     

结节性筋膜炎的MRI表现

目的分析结节性筋膜炎（NF）的MRI表现,以提高影像诊断水平。材料与方法:回顾性分析经手术病理证实的6例NF的MRI表现。结果:6例NF中,3例位于上肢,2例位于面颊部,1例位于下肢。所有病灶均表现为单发实性软组织肿块,T₁WI呈等或低信号,在T₂WI呈稍高或高信号,增强扫描肿块呈均匀或不均匀强化。结论:MRI检查能为临床诊断及鉴别诊断NF提供有价值的信息。     

结节性筋膜炎的MRI表现

目的 观察结节性筋膜炎(NF)的MRI表现。方法 回顾性分析8例经手术病理确诊的NF患者的MRI表现。结果 8例患者中,发生前臂皮下型3例,骶尾部皮下型2例,肩部皮下型、下肢肌内型和下肢肌间隙型各1例;病灶直径1.23~9.52 cm。皮下型病灶T1WI均呈等信号;T2WI均表现为高信号,2例病灶周围轻度水肿;肌内型病灶T2WI呈中央高信号,周边稍低信号改变;肌间型病灶T2WI比T1WI信号低。皮下型病灶增强扫描可见明显强化的"筋膜尾"征;肌内和肌间型病灶增强后均呈不均匀强化,肌内型可见"筋膜尾"征。结论 NF病灶的MRI表现与其病理类型有关,位于皮下的病灶较具特征性,"筋膜尾"征具有一定的诊断价值。     

结节性筋膜炎1例

患者女,57岁,因无意中发现右乳上方小包块就诊.超声所见:右乳上象限显示一1.0 cm×0.8 cm的较强回声团,边界欠清晰,内部回声不均匀,肿物周边及内部均未见血流(图1).同侧腋窝及锁骨上未探及肿大淋巴结.超声诊断:右乳腺实质性肿物,不除外乳腺癌.     

结节性筋膜炎的MRI表现与病理分型对照

目的 探讨结节性筋膜炎(NF)的组织病理学分型及其相应的MRI特征。方法 回顾性分析19例经手术病理证实的软组织NF患者的MRI资料,分析其MRI表现特点,并与组织病理学分型进行对照分析。结果 19例患者中,黏液型8例,细胞型4例,纤维型7例。黏液型NF含有较多黏液基质,其中6例病灶中央区细胞排列疏松并见液化区;8例患者T1WI均呈稍高信号,6例T2WI呈"反靶征"表现。细胞型NF细胞成分较多,毛细血管分布均匀,4例病灶的MRI信号及内部强化均相对较均匀。7例纤维型NF病灶中5例中央富含胶原成分,T2WI于相应区域可见"中央纤维瘢痕征"。结论 各型NF的MRI表现具有一定特征性,可反映其组织病理学改变。     

颈部结节性筋膜炎1例

患者男性 ,6 4岁。发现颈部肿物一周。查体 :肿物位于左颈部 ,直径 3ｃｍ。术中见肿物无包膜 ,与周围组织粘连。病理检查　巨检 :切除肿物大小 2ｃｍ× 1ｃｍ× 0 5ｃｍ ,包膜不完整 ,切面灰粉及淡黄色。镜检 :肿物中有许多梭形细胞 ,似纤维细胞 ,又似肌细胞 ,此外还有单核或多核巨细胞 ,胞浆红染 ,外形不规则 ,核仁也很明显 ,可见少量核分裂 (图1、2 ) ,免疫组化 :ＮＳＥ和Ｓ 10 0 (- )。病理诊断 :结节性筋膜炎。讨论　因为梭形细胞较细、束状 ,又呈波浪形排列 ,曾考虑为神经纤维瘤 ,其中有巨细胞 ,认为是神经节细胞 ,有少数核分裂 ,生长…     

坏死性筋膜炎1例并文献复习

<正>病例女,34岁,因“发现右臀部突起一包块2月”就诊。无畏寒、发热、胸闷、气促、恶心、呕吐、腹胀、腹泻等症状。体检触及右臀部软组织内一大小约5.0 cm×3.0 cm肿物,质韧,无压痛,活动度差,局部皮肤无发红等改变。患者无活动障碍,右下肢无麻木。患者既往体健,无外伤史、手术史等特殊病史。彩色多普勒超声检查显示：右臀部软组织内见一分叶状不规则形极低回声团块,位于浅层与中层之间,大小约5.7 cm×2.4 cm×3.5 cm,边界清,边缘光滑,内回声均匀,后方回声增高,彩色多普勒血流显像显示病灶内无血流信号（图1,2）。     

外阴结节性筋膜炎1例

患者女性,46岁.发现外阴部肿块20天,近来逐渐增大,抗炎治疗无效,遂到我院就诊.妇科检查大阴唇上方扪及一约3 cm×2cm×2 cm质硬肿块,境界清楚,无压痛,活动度尚可.局麻下行外阴肿块切除术. 病理检查 巨检:不整形组织1个,2 cm×1.5 cm×0.8 cm大小;切面灰白色、质中,无肉眼可见出血,边界清.镜检:在疏松黏液水肿样背景中,可见增生的纤维母细胞和肌纤维母细胞呈束状、"S"形排列,但未形成旋涡状,纤维母细胞和肌纤维母细胞之间可形成裂隙和大小不等的囊状结构(图1),裂隙中常见外渗的红细胞,形成渗出性微小出血,并可见少量淋巴细胞、组织细胞.纤维母细胞、肌纤维母细胞生长活跃,细胞幼稚,可见细胞的多形性,但无异型性;细胞核圆形、卵圆形,核肥胖淡染,核浆比不高,可见大量的生理性核分裂象(图2),未见病理性核分裂象.免疫组化:SMA(图3)和vimentin(图4)(+),Ki-67阳性率20％;bcl-2、desmin、S-100、CD34、MyoD1、CD117和CKpan(-).     

8例室管膜下瘤MRI表现

目的 观察室管膜下瘤MRI表现。方法 回顾性分析8例经手术病理证实的室管膜下瘤，观察平扫及增强MRI表现。结果 8例均为单发室管膜下瘤，病灶位于右侧侧脑室(RLV)前部近室间孔区5例、左侧侧脑室前部近室间孔区域2例、RLV颞角1例；4例呈规则卵圆形、4例为边缘呈分叶状的类圆形，边界均清晰，最大径21～47 mm,平均33 mm; MRI主要表现为长T1长T2信号，快速液体衰减反转恢复序列(FLAIR)呈高信号，弥散加权成像(DWI)呈等-低信号，病灶内部均可见散在分布微囊；2例伴脑积水；增强后3例病灶无强化，2例呈局灶性轻度强化、3例“花心样”明显强化。结论 室管膜下瘤MRI表现具有一定特异性，有助于诊断与鉴别诊断。     

皮下结节型脂膜炎MRI表现1例

患者男,37岁,主因“右上臂三角区肿块3个月,局部皮肤桔皮样改变1个月”就诊.查体:右上肢三角肌区见类圆形肿块,质硬,活动度差,表面皮肤桔皮样改变.血常规及肿瘤标记物正常.右上肢X线片:右侧肱骨骨质及周围软组织未见明显异常(图1).右上肢MR:右侧肱骨三角肌外侧缘皮下脂肪组织内见边界清楚的类圆形肿块,与表皮组织粘连明显,T1WI、T2WI于略低信号基础上见絮状稍高信号(图2),考虑为纤维瘤.行右上肢体表肿物切除术.术后病理诊断:脂膜炎.     

Diagnosis and treatment of eosinophilic fasciitis: Report of two cases

BACKGROUNDEosinophilic fasciitis (EF) is a rare disease characterized by inflammation of the fascia with immune system involvement. Failure to promptly diagnose and treat this disease can seriously affect the quality of life of patients. However, no clear and uniform criteria for diagnosis and treatment exist.CASE SUMMARYIn this paper, we report two cases of EF, both of which showed symmetrical limb swelling and rigidity, increased eosinophils in the peripheral blood and bone marrow, increased red blood cell sedimentation rate, increased antinuclear antibody titer, and pathological changes in the tissues such as eosinophil and lymphocyte infiltration. Both patients were treated with hormones and cyclosporine, and showed significant improvements in their conditions.CONCLUSIONEF is an autoimmune disease causing swelling and sclerosis of the fascia and eosinophilia. It is diagnosable by magnetic resonance imaging, positron emission tomography-computed tomography, blood routine tests, and bone marrow puncture. Glucocorticoids and immunosuppressants are effective treatments.     

眼眶原发淋巴瘤CT、MRI表现及文献复习(附7例报告)

目的:研究眼眶原发淋巴瘤CT、MRI表现,提高对该病的诊断能力。方法:7例经病理证实的眼眶原发淋巴瘤患者均经CT平扫增强和延迟扫描,其中3例行MRI平扫加增强扫描。回顾性分析CT及MR的影像学表现。结果:双侧眼眶原发淋巴瘤2例,分别位于双侧结膜和泪腺。单侧眼眶淋巴瘤5例。1例位于泪道;另4例跨越眶隔前后部呈不规则铸型累及泪腺及泪道,其中3例浸润肌锥内外间隙。所有病例均未见眼外肌推压移位、眼环增厚与变形。2例可见眶骨明显骨质破坏。所有病变CT平扫呈软组织肿块,密度类似于眼外肌,边缘清晰,增强后,4例呈中度强化,3例呈轻度强化,延迟期中度强化4例密度下降,轻度强化3例无明显变化。MRI上3例肿块在T1WI和T2WI上与眼外肌信号相比,呈等信号,增强后2例病变信号强度高于眼外肌。所有病变在CT、MRI上均呈匀质性。结论:眼眶原发淋巴瘤CT、MRI表现具有一定的特征性,能够高度提示该病的诊断。     

Clinical utility of sonography in diagnosing plantar fasciitis.

OBJECTIVE: The purpose of this study was to investigate the efficacy of sonography in the detection of plantar fasciitis (PF) compared with magnetic resonance imaging (MRI) findings in subjects with inferior heel pain. METHODS: Seventy-seven patients with unilateral (n = 9) and bilateral (n = 68) heel pain were studied. Seventy-seven age- and sex-matched asymptomatic subjects served as a control group. Magnetic resonance imaging was used to establish a diagnosis of PF with sagittal T1-weighted, T2-weighted, and short tau inversion recovery sequences. The sonographic appearances of PF were compared with MRI findings. Plantar fascia and heel pad thickness were also measured on both imaging modalities. RESULTS: Compared with MRI, sonography showed 80% sensitivity and 88.5% specificity in assessing PF. A strong correlation was found between plantar fascia and fat pad thickness measurements done by sonography (P < .001; r = 0.854) and MRI (P < .001; r = 0.798). Compared with the asymptomatic volunteers, patients with PF had significant increases in plantar fascia and heel pad thicknesses, weight, and body mass index (P = .0001). Heel pad thickness was also significantly increased with pain duration (P = .021). CONCLUSIONS: Although MRI is the modality of choice in the morphologic assessment of different plantar fascia lesions, sonography can also serve as an effective tool and may substitute MRI in the diagnosis of PF.