软组织肿瘤的MRI诊断

目的探讨MRI对软组织肿瘤的诊断价值。方法回顾性分析经病理证实的60例软组织肿瘤的MRI表现（大小、部位、边界、信号强度、瘤周水肿、液化坏死、囊壁特征及侵袭性特点）,总结其不同影像学征象并进行统计学分析。结果 T2WI信号的均匀性、瘤周水肿、囊壁特征及侵袭性在软组织良、恶性肿瘤中的差异均有统计学意义（均P﹤0.05）;肿瘤大小、肿瘤边界及液化坏死在两组肿瘤中的差异无统计学意义（均P﹥0.05）。脂肪源性肿瘤均含有脂肪成分;神经鞘瘤呈梭形,典型特征为靶征、神经出入征;血管瘤分为皮下和肌肉内,前者边界较清,后者通常累及多块肌肉,界限不清,最典型的特点是肿瘤内部或周边可见流空血管影。结论 MRI在软组织肿瘤中的表现具有一定的特征性,在区分软组织肿瘤良、恶性及其组织起源上具有重要的价值。     

软组织肿瘤的细胞学诊断

组织学和细胞学检查是软组织包块的唯一确诊手段。近年来,细针穿刺细胞学诊断愈来愈多地用于软组织肿瘤诊断。当肿瘤的局部或远处转移可能性极小时,细针穿刺活检与其它活检手段相比,易于操作,损伤性小。     

MRI在软组织肿瘤及肿瘤样病变中的应用进展

MRI是显示软组织病变最好的影像学检查技术,可以很好地显示病变及其范围,但对于病变的定性诊断特异性不高。采用系统化的诊断策略,通过几个关键性问题的分析,即以病变组织的MRI信号特征为基础,综合患者的临床资料及X线检查显示的病变内钙化和骨化情况,对有特征性表现者可以明确诊断,对不能明确诊断者可以缩小鉴别诊断的范围,而对于不能明确为良性病变者推荐通过组织学活检排除恶性病变。此影像诊断策略有助于临床对软组织病变治疗方案的制定。     

基于双序列MRI的计算机辅助诊断鉴别软组织肿瘤良恶性的研究

目的:研究使用计算机辅助分析方法针对软组织肿瘤MRI影像进行肿瘤良恶性鉴别的价值。方法:回顾性收集了在辽宁省肿瘤医院就诊的72例软组织肿瘤患者的CE-T1和T1WI双序列MRI影像数据(2017年1月至2018年1月)。通过提取和筛选MRI影像特征,建立支持向量机(SVM)、K-最邻近(KNN)和随机森林(RF)三种机器学习分类器模型对肿瘤病灶进行二分类鉴别;提出一种新型集成学习分类器模型用于将两个序列MRI信息进行融合。通过绘制受试者工作特征曲线(ROC)并计算ROC曲线下面积(AUC值)以评估模型的分类鉴别能力。结果:三种机器学习分类器均取得较好的良恶性鉴别效果;提出的集成学习分类器的分类效果最佳,AUC值达到0.922(敏感性=0.965,特异性=0.783)。结论:本研究提出的计算机辅助模型能够利用MRI影像对软组织肿瘤良恶性进行有效的辅助鉴别,具有一定的潜在应用价值。     

侧脑室肿瘤的MRI诊断及鉴别诊断

目的:分析侧脑室肿瘤的MRI影像特点,提高侧脑室肿瘤诊断的准确性。方法:回顾性分析28 例经手术病理证实的侧脑室占位性病变的MRI影像学表现。 结果:大多数侧脑室肿瘤具有年龄和性别特征。如脑膜瘤好发于30~50岁,女性多见;中枢神经细胞瘤发病年龄在20~40岁;转移瘤均大于40岁。不同的侧脑室肿瘤,其好发部位不同。室间孔区好发中枢神经细胞瘤,侧脑室体部好发星形细胞瘤,脑膜瘤和转移瘤好发于侧脑室三角区。不同侧脑室肿瘤的MRI表现有所不同,部分具有特征性表现。脑膜瘤增强后呈明显均匀强化。星形细胞瘤,邻近脑组织受侵伴水肿,增强扫描可见不均匀强化。中枢神经细胞瘤,围绕透明隔生长,周围可见多发囊变,增强可见不均匀强化。少突胶质细胞瘤内可见多发钙化灶。转移瘤,增强扫描大多数可见环形强化。室管膜瘤,增强扫描明显强化,容易侵犯邻近脑实质。结论:MRI影像学表现结合肿瘤的部位、发病年龄、强化程度和磁共振波谱(MRS)表现等可以提高侧脑室肿瘤的术前诊断准确率。     

软组织肿瘤

软组织肿瘤是一种常见疾病,可以发生在初生到老年的任何年龄。软组织肿瘤起源于粘液、纤维、脂肪、平滑肌、横纹肌、间皮、滑膜、血管、淋巴等间叶组织,并位于软组织部位(内脏器官除外)。临床上,软组织肿瘤还包括来自周围神经系统的肿瘤。尚有一些发生于软组织内,虽然细胞起源不明,但可能来源于间叶组织的,也包括在软组织肿瘤内。 由于间叶干细胞可向多种类型的组织分化,所以软组织肿瘤的类型也很多,表1各种类型中又可分为良性肿瘤、瘤样病变和恶性肿     

高频超声对手部软组织肿瘤诊断价值

目的 探讨高频彩色多普勒超声对手部软组织肿瘤的诊断价值.方法 2006年7月至2009年6月应用高频彩色多普勒超声检查21例手部肿物,观察肿物的位置、大小、形态、回声以及血流信号特征,结合临床表现和手术所见进行对比分析.结果 全部病例的超声诊断得到手术和病理证实,其中血管球瘤10例,腱鞘巨细胞瘤4例,血管瘤3例,腱鞘纤维瘤2例,神经纤维瘤1例,肉芽肿1例.声像图和肿瘤内部的血流信号存在差异.结论 超声影像学表现对手部软组织肿瘤具有重要的诊断价值.     

几种女性生殖道软组织肿瘤的病理诊断

介绍几种新近被认识的女性下生殖道软组织肿瘤(包括血管肌纤维母细胞瘤、浅表性宫颈阴道肌纤维母细胞瘤、浅表性血管黏液瘤、侵袭性血管黏液瘤、细胞性血管纤维瘤和颗粒细胞瘤)的病理诊断及其鉴别诊断方面的研究进展。     

咽旁间隙肿瘤的CT和MRI诊断价值

目的分析咽旁间隙肿瘤的CT及MRI表现,以提高该部位病变的诊断及鉴别诊断水平。方法回顾性分析54例经病理证实的咽旁间隙肿瘤的CT及MRI表现。结果神经鞘瘤形态较规则（85．7％）,涎腺肿瘤形态多不规则（63．2％）,二者边界多清楚。涎腺肿瘤位于茎突前方18例（94．7％）,神经鞘瘤位于颈鞘内26例（92．9％）。24例神经鞘瘤使咽旁间隙向两侧移位（85．7％）,涎腺肿瘤多向前、内侧移位。涎腺肿瘤中12例（63．2％）小部分伸人腮腺深叶。神经鞘瘤多位于二腹肌后腹的深面（96．4％）,涎腺肿瘤多位于二腹肌后腹的浅面（68．4％）。结论肿瘤与茎突、咽旁脂肪间隙、颈鞘、腮腺、二腹肌后腹的关系及肿瘤密度／信号及强化特点对咽旁间隙肿瘤的定位、定性诊断有重要的价值。     

实时超声显像对体表软组织肿瘤的诊断

本文分析我院1984年5月～1986年3月经手术和病理证实的43例体表软组织肿瘤声像图,并探讨其诊断价值。 资料与方法 本组年龄12～80岁,平均41.7岁。男21例,女22例。恶性肿瘤28例(65.1％),良性15例(41.7％)。计:来源于纤维组织4     

Cytodiagnosis of soft tissue tumors

The only acceptable definitive diagnosis of a soft tissue mass is histologic or cytologic examination. In recent years, fine-needle aspiration cytology is used in more and more centers for diagnosis of soft tissue masses. We studied 196 aspiration cytologies performed on soft tissue lesions. Out of these, in 48 cases a definitive surgical procedure or open biopsy for histology and further evaluation were performed. There were 25 sarcomas and 23 benign tumors. There was one false negative cytologic result in this group; no false positive cytologies were detected. It seems that cytodiagnosis of soft tissue masses performed by an experienced pathologist is the method of choice, permitting a good diagnostic evaluation, with almost none of the traumatic and oncologic disadvantages of the other methods of biopsy.     

Gadolinium-enhanced MRI of soft tissue masses

The efficacy of gadopentetate dimeglumine (Gd-DTPA) enhanced magnetic resonance (MR) imaging in the diagnosis and differentiation of soft-tissue, neoplastic and non-neoplastic lesion has not been well established. Thirty patients with soft tissue masses (18 neoplastic and 12 non-neoplastic) were studied, using MR imaging with and without administration of Gd-DTPA. Gd-DTPA proved helpful in characterisation of several entities, including differentiation of solid mass from proteinaceous cyst, demonstration of tumour nodules within haemor-rhagic or necrotic masses, and delineation of tumour adjacent to oedema. The use of Gd-DTPA may provide additional information for tissue specificity and, in complicated cases, Gd-DTPA may also provide essential information that cannot be obtained using other methods. We recommend the use of contrast enhanced MR as an adjunct to conventional MR imaging in the initial assessment of musculoskeletal soft tissue masses. However, T2-weighted images show better tissue contrast of the lesions, and are equal to contrast enhanced images in delineation of tumour margins. Non-contrast enhanced images are, therefore, probably adequate for the delineation of lesions for surgical planning when a diagnosis has already been made.     

Sonographic imaging of soft tissue tumors

In the course of this study 651 patients with morphologically confirmed soft tissue tumors of different localizations underwent gray-scale sonography, Doppler sonography and energetic Doppler carting. Hitachi HI Vision 900, Logiq-400, Aloka-650, Aloka-2000 scanners wih 5-13 MHz sensors were used. Lipomas, fibrolipomas, benign angioneoplasms and some of the desmoids were shown to have a characteristic sonographical picture. The potential sonographic symptom complexes were determined. Among the malignant tumors the distinct sonographic features were observed in liposarcoma and peripheral nerve sheath tumors. The other soft tissue sarcomas have no characteristic sonographic pattern. In this cases the differential diagnosis could be assisted by clinical signs and medical history analysis.     

DNA cytofluorometry of soft tissue tumors

We carried out DNA cytofluorometry with propidium iodide stain on the 17 cases of soft tissue tumors including giant cell tumor of the tendon sheath, pigmented villonodular synovitis, 2 hemangiomas, 3 lipomas, 5 schwannomas, 3 neurofibromas, liposarcoma and synovial sarcoma. The benign tumors were characterized by regular polyploidization with very few S-phase cells, indicating slow tumor growth. Most of the malignant soft tissue tumors were associated with remarkable polyploidization with an increase in S-phase cells. However, some malignant tumors did not show polyploidization. We concluded, therefore, that an increase in S-phase cells is an important, cytofluorometric criterion for malignancy of soft tissue tumors.     

MRI surveillance for local recurrence in extremity soft tissue sarcoma

IntroductionThe role of MRI in surveillance for local recurrence (LR) remains uncertain in extremity soft tissue sarcoma (STS). The aims of this study were 1) to examine the usefulness of MRI in detecting LR, 2) to identify the characteristics of LR detected by MRI, and 3) to examine whether MRI surveillance is associated with oncologic outcome.Materials and Methods477 patients who had regular surveillance for LR after surgery for extremity STS were reviewed. Surveillance was performed by routine MRI in 325 patients or other imaging modalities in 152 patients.ResultsThe rate of MRI-detected LR, defined as clinically undetectable LR identified on MRI, was 10.5% in the MRI surveillance cohort. The detection rates of MRI-detected LR were significantly higher in the patients with high risk of LR. MRI-detected LRs were more commonly located in the thigh or buttock (p = 0.005), were smaller (p = 0.001) and had LRs without mass formation (p = 0.007) than non-MRI-detected LRs. On Kaplan-Meier analysis, patients with MRI-detected LR tended to have better post-LR survival (p = 0.104).ConclusionRoutine MRI surveillance can detect a significant number of clinically undetectable LRs in extremity STS especially for LRs in the thigh or buttock, small LRs or LRs without mass formation.